Gestational diabetes (also known as gestational diabetes mellitus) is one of the most common medical complications of pregnancy
How Australian pregnant women are
tested for gestational diabetes is set to change, with new national guidelines
released today.
Changes are expected to lead to fewer
diagnoses in women at lower risk, reducing the burden of extra monitoring and
intervention. Meanwhile the changes focus care and support towards women and
babies who will benefit most.
These latest recommendations form the first update in
screening for gestational diabetes in more than a decade, and potentially
affect more than 280,000 pregnant women a year across Australia.
The new
guidelines, which we have been involved in writing, are released today by the
Australasian Diabetes in Pregnancy Society and published in the Medical Journal
of Australia.
What is gestational diabetes? Why do
we test for it?
Gestational
diabetes (also known as gestational diabetes mellitus) is one of the most common
medical complications of pregnancy.
It is defined by abnormally high levels of glucose (sugar) in
the blood that are first picked up during pregnancy.
Most of the time gestational diabetes goes away after the
birth. But women with gestational diabetes are at least seven times more likely
to develop type 2 diabetes later in life.
In Australia, routine screening for gestational diabetes is
recommended for all pregnant women. This will continue.
That's because treatment reduces the risk of poorer pregnancy
outcomes. This includes babies being born very large – a condition called
macrosomia – which can lead to difficult births, and a caesarean. Treatment
also reduces the risk of pre-eclampsia, when women have high blood pressure and
protein in their urine, and other serious pregnancy complications.
Screening for gestational diabetes is also an opportunity to
identify women who may benefit from diabetes prevention programs and ways to
support their long-term health, including support with nutrition and physical activity.
Why is testing changing?
Most women benefit from detection and treatment. However, for
some women, a diagnosis can have negative impacts. This often relates to how
care is delivered.
Women have described feeling shame and stigma after the
diagnosis. Others report challenges accessing the care and support they need
during pregnancy.
This may include access to specialist doctors, allied health
professionals and clinics. Some women have restricted their diet in an
unhealthy way, without appropriate supervision by a health professional. Some
have had to change their preferred maternity care provider or location of birth
because their pregnancy is now considered higher risk.
So we must diagnose the condition in women when the benefits
outweigh the potential costs.
When are blood sugar levels too high?
Diagnosing gestational diabetes is based on having blood
glucose levels above a certain threshold.
However, there is no clear level above which the risk of
complications starts to increase. And determining the best thresholds to
identify who does, and who does not, have gestational diabetes has been subject
to much research and debate.
Globally, screening approaches and diagnostic criteria vary
substantially. There are differences in who is recommended to be screened, when
in pregnancy screening should occur, which tests should be used, and what the
diagnostic glucose levels should be.
So, what changes?
The new recommendations are the result of reviewing
up-to-date evidence with input from a wide range of professional and consumer
groups.
Screening will continue
All pregnant women who don't already have a diagnosis of
pre-pregnancy diabetes, or gestational diabetes, will still be recommended
screening at between 24 and 28 weeks' gestation.
They'll still have an oral glucose tolerance test, a measure
of how the body processes sugar. The test involves fasting overnight, and
having a blood test in the morning before drinking a sugary drink. Then there
are two more blood tests over two hours. However, fewer women will have this
test twice in their pregnancy.
Changes mean more targeted care
The following changes mean health services should be able to
reorient resources to ensure women have access to the care they need to support
healthier pregnancies, including early support for women who need it most:
1. Women with risk factors of existing,
undiagnosed diabetes (such as a higher body-mass index or BMI, or a previous
large baby) will be screened in the first trimester, with a single, non-fasting
blood test (known as HbA1c)
2. Fewer women will have an oral glucose
tolerance test early in the pregnancy, ideally between ten and 14 weeks
gestation. This early testing will be reserved for women with specific risk
factors, such as gestational diabetes in a previous pregnancy, or a high level
on the HbA1c test
3. Women will only be diagnosed if their
blood glucose level is above new, higher cut-off points for the oral glucose
tolerance test, for tests conducted early or later in the pregnancy.
These changes will be implemented over coming months. So
women are encouraged to speak to their maternity care provider about how the
changes apply to them. (The Conversation)
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