Gestational Diabetes Testing
Gestational Diabetes, It Happens To Some
Nearly 100,000 women in the US are affected every year with Gestational Diabetes Millitus (GDM), otherwise known as glucose intolerance in pregnancy. Different from a pregnant woman who has diabetes, GDM shows up during the pregnancy when there was no pre-existing condition. In GDM, the hormones that are secreted by the placenta change the use of insulin in a pregnant woman.
The American College of Obstetrics and Gynecologists (ACOG) stated recently that there is no one specific screening method sufficient for the pregnant population. They do not know which type of screening is best, or when the screening should be performed. However, there are now new criteria established which means that women meeting the criteria may not need the lab testing done to screen for GDM.
Identifying The Need For Testing
Women who meet the following criteria may not need laboratory testing for GDM: If they are younger than 25 years-of-age and not a member of a racial or ethnic group with high incidence of diabetes (such as Hispanic, South or East Asian, African, Native American, or Pacific Islands), they may be exempt. A body mass index of less than 25 with no former history of glucose intolerance or abnormal tolerance, or no known diabetes in a first-degree family member, are other factors that are considered. If there has been no former history of GDM with adverse outcomes, then a woman will not have to be tested for GDM.
One of the following factors earmarks high-risk situations: A woman's age and ethnicity as well as weight (obesity) are risk factors for GDM. Along with these, a family history of diabetes or any past obstetric GDM occurrences also raise a flag for testing.
Changes Afoot In Treatment Of GDM
It seems that many of the "old standby" mainstays are also being challenged in terms of diet and exercise. In times past, a strict diet focusing primarily on calorie intake was recommended and now the ACOG suggest that may not be the best tact. True, the focus should be on healthy eating habits and good nutrition, however, caloric intake should not be reduced by more than 33 percent. Women are instead advised to eat a low carb, no sugar diet to help control their diabetes. If diet does not make a change in the glucose levels, then insulin should be considered.
Another factor that has changed in the testing and treatment of GDM is early induction and cesarean delivery. Even though incidence of cesarean delivery is higher in women with GDM, the ACOG states that, "there is no data to support a policy of cesarean delivery purely on the basis of GDM." Women who screen positive for GDM may be tested using the most common method-fasting glucose test or sugar loading test. After a period of fasting, they are given a sugar drink, called glucola, and then blood is drawn. The time for testing should be determined between the doctor and the woman.
The risks are real for both a woman with GDM and her baby. However, many women endure unnecessary screening and it is hoped that with the new screening methods, women will have one less concern over the possibility of a false positive on a test she may not even need.