The World Health Organization defines Gestational Diabetes as “carbohydrate intolerance resulting in high blood glucose levels of varying severity with onset or first recognition during pregnancy“. This includes women with undiagnosed pre-existing diabetes as well as those who have their first episode of high blood sugar during pregnancy. The International Association of Diabetes and Pregnancy Study Groups (IADPSG), as well as the American Diabetes Association and the National Institute for Health and Care Excellence in the United Kingdom recommend assessing high-risk populations to identify previously undiagnosed diabetes in pregnant women. This article focuses on the ideal time and tests to screen and monitor gestational diabetes and the population that is more likely to develop the condition.
Who is more likely to develop gestational diabetes?
Women with a previous history of gestational diabetes, family history, Asian or Caribbean ethnicity and obesity are at a higher risk. However, some women without these risk factors may also develop gestational diabetes and the condition may go unattended. Thus, all pregnant women should be screened for high blood glucose levels.
What is the most accurate method of diagnosing gestational diabetes?
The WHO recommends oral glucose challenge tolerance test (OGTT).
This is because it has a high sensitivity and follows the same diagnostic criteria as nonpregnant adults. Nevertheless, the OGTT’s key drawbacks are that it is expensive and inconvenient for some women. A random plasma glucose test, a glycated hemoglobin test, and a glucosuria examination are some other tests. However, these are not preferred because they overlook a large proportion of women with gestational diabetes.
When should blood sugar levels be monitored in gestational diabetes?
There is disagreement about the best time to test women for gestational diabetes. The timing is critical because due to the burden on pregnant women and the limited resources of healthcare services, the screening test should ideally be performed only once during pregnancy. Simultaneously, earlier diagnosis and treatment of any woman with the condition could assist in avoiding adverse perinatal outcomes.
Women with previously undiagnosed diabetes can be identified when the screening test for gestational diabetes is administered during the first three months. This test can also identify early-onset as well as newly occurring diabetes. Women at high risk, such as those who had gestational diabetes in a previous pregnancy, are frequently offered OGTT during the first three months. However, the majority of physiological pregnancy-related changes in insulin sensitivity occur during the second trimester. Therefore, testing in the first trimester may miss a large proportion of women who might develop the condition. As a result, high-risk women who have a normal first-trimester test should take a second test later in pregnancy. Most women are offered a single test in the late second trimester to avoid the need for repeated testing. This timing is to strike a balance between testing too soon and testing too late.
If gestational diabetes is confirmed, the doctor will advise you to get frequent checkups, particularly in the last three months of pregnancy. During these check-ups, your doctor will frequently monitor the blood sugar levels. They may instruct a blood sugar check as part of the treatment plan. You should monitor blood sugar levels even after the birth of the baby.
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