What is gestational diabetes?
Gestational diabetes are women who have high blood sugar levels during pregnancy. This can be quite common, almost 10% of pregnant women are diagnosed with gestational diabetes. In the human body, your pancreas plays a very important role in regulating glucose (sugar) levels in your blood, by excreting insulin when the levels are high. Later on in the pregnancy glucose levels tend to rise due to hormones that are released from the placenta. Often times, the mother’s pancreas can’t secrete enough insulin to deal with this increase, and she has trouble regulating the sugar levels. This can cause the fetus’ pancreas to work overtime as well, excreting large amounts of insulin. This causes the baby to absorb large amounts of glucose which can be dangerous for 2 reasons: The first being damage to the baby’s shoulders at birth. The second can be dangerously low glucose levels at birth. This is because there are large amounts of insulin, but the baby loses the source for this excess sugar. A basic level of glucose is needed in the blood in order for the brain to receive the appropriate amounts of energy.
When should screening take place?
All pregnant women should be screened for gestational diabetes sometime after their 24th week of pregnancy. It is preferable to be checked between weeks 24-28, however if you missed this window you should be checked afterwards anyway. There are very small differences between the recommendations of different organizations, but most of the difference relate to the amount of glucose that the patient needs to drink during the text, or the threshold of the results. The evidence does not support being screened before the 24th week of pregnancy.
Does screening work?
Here’s the part where we should skeptical of the results. Despite the recommendations, not everything is backed up by solid evidence. According to a compilation of a number of studies, there is no significant difference between neonatal admissions, no significant difference in infants born with low birth weight, and no significant differences in neonatal hypoglycemia (low sugar levels). However there is conflicting evidence about the hypoglycemia, possibly due to different definitions of what the cutoff threshold is. An international study including over 25,000 women however does show strong continuous correlation between high glucose levels in the mother, and fetal outcomes like increased birth weight, neonatal hypoglycemia, and primary cesarean delivery. The study however was unable to define a specific threshold at which the mothers and babies outcomes were at higher risk for these complications.
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Knowledge is power. It’s very important for each of us to understand what our options are, and what evidence supports each option. Preventing diseases before they start is often the most efficient way to be healthy, and this starts by screening for the diseases that are appropriate for us depending on age, gender, and other factors. Download our app to go through a short list of questions, and receive a personalized list of the appropriate screening recommendations for you. More information about each of these tests is provided through the app, so that you can stay informed and educated.
Here are a few studies which give insight into the efficacy of screening and early treatment for gestational diabetes. Feel free to contact us for more information about the matter, we would be happy to provide more information.
International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al.. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–82.
Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systemic review and meta-analysis. Lancet 2009;373:1773–9.
Pettitt DJ, Knowler WC, Baird HR, Bennett PH. Gestational diabetes: infant and maternal complications of pregnancy in relation to third-trimester glucose tolerance in the Pima Indians. Diabetes Care 1980;3:458–64.