New guidelines suggest pregnant women be tested for diabetes earlier

by Barbara Hewitt on November 7, 2013

New guidelines for clinicians advise that pregnant women should be screened for diabetes before 13 weeks gestation if possible.

Experts acknowledge that cases of diabetes in pregnant women are being missed by traditional screening methods and the Endocrine Society has issued a Clinical Practice Guideline (CPG) stating that all pregnant women who have not been previously diagnosed with diabetes be tested for the condition at their first prenatal visit.


As many as one in five women may develop gestational diabetes, a form of diabetes that has its onset during pregnancy

As many as one in five women may develop gestational diabetes, a form of diabetes that has its onset during pregnancy. Traditional testing strategies only identify about a quarter of these cases. This means that many women go undiagnosed and are at increased risk of having an overly large baby, which can complicate delivery.

Many women have type 2 diabetes but may not know it, according to Dr Ian Blumer of the Charles H. Best Diabetes Centre in Whitby, Ontario, Canada, and chair of the task force that drew up the guidelines.

‘Because untreated diabetes can harm both the pregnant woman and the foetus, it is important that testing for diabetes be done early on in pregnancy so that if diabetes is found appropriate steps can be immediately undertaken to keep both the woman and her foetus healthy,’ he said.

‘To address this problem, the CPG advocates for using lower blood glucose levels to diagnose gestational diabetes. Using these lower levels will allow for the detection of gestational diabetes in many women when it would otherwise go undetected using the older diagnostic thresholds. Once the diagnosis is made, treatment can be given to help the foetus grow normally,’ explained Blumer.

Other recommendations from the CPG say that all pregnant women who have not previously been diagnosed with diabetes should be tested for gestational diabetes by having an oral glucose tolerance test performed at 24 to 28 weeks’ gestation.

Weight loss is recommended prior to pregnancy for women with diabetes who are overweight or obese and initial treatment of gestational diabetes should be medical nutrition therapy and daily moderate exercise lasting at least 30 minutes.

The guidelines say that if lifestyle therapy is not sufficient to control gestational diabetes, blood glucose lowering medication should be offered.

‘Thanks to important new studies of the interplay between diabetes and pregnancy, diabetes specialists and obstetricians have identified best practices for caring for pregnant women with this condition. The guideline synthesizes evidence based strategies to support women who have diabetes during pregnancy,’ said Blumer.

Women with gestational diabetes should have an oral glucose tolerance test six to 12 weeks after delivery to rule out prediabetes or diabetes and women who have had gestational diabetes with a previous pregnancy need to be tested for diabetes regularly, especially before any future pregnancies.

Also women who have type 1 or type 2 diabetes should undergo a detailed eye examination to check for diabetic retinopathy, and, if damage to the retina is found, have treatment before conceiving.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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