All pregnant women should be
screened for diabetes at their first prenatal check up, according to new
recommendations from an international group of endocrinology experts.
The test should be done before women
are 13 weeks pregnant or as soon as possible after that milestone is reached,
according to new clinical practice guidelines released by the Endocrine Society
to help doctors improve the level of care for pregnant women with diabetes.
Up to one in five women may develop
gestational diabetes a form of diabetes that begins during pregnancy.
Traditional testing methods, however, only detect about 25% of these cases.
As a result, the experts caution that many
pregnant women with gestational diabetes are going undiagnosed, which could
increase their risk of having an overly large baby and complications during
"Many women have type 2 diabetes
but may not know it," Dr Ian Blumer, chair of the guidelines task force,
said in a society news release. "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 immediately be taken to keep both the woman and her foetus healthy."
The guidelines also recommend using
lower blood sugar levels to diagnose gestational diabetes, which will allow
doctors to detect more cases.
"Once the diagnosis is made,
treatment can be given to help the foetus grow normally," said Blumer,
from the Charles H. Best Diabetes Centre in Whitby, Ontario.
"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," Blumer added. "The guideline synthesizes
evidence-based strategies to support women who have diabetes during
Other recommendations from the
Endocrine Society task force include the following:
- Women who have never been
diagnosed with diabetes should undergo an oral glucose tolerance test to
screen for gestational diabetes between 24 and 28 weeks of pregnancy.
- Women who are overweight or
obese are advised to lose weight before becoming pregnant.
- Initially, women with
gestational diabetes should be treated with medical nutrition therapy and
30 minutes of daily moderate exercise.
If lifestyle therapy doesn't
effectively control gestational diabetes, medication to lower blood sugar
levels should also be used. Women with gestational diabetes
should have a repeat oral glucose tolerance test six to 12 weeks after
delivery to ensure they do not have pre-diabetes or diabetes.
Women who have ever been
diagnosed with gestational diabetes need to be tested for diabetes
regularly, particularly before becoming pregnant again.
Women with either type 1 or
type 2 diabetes should undergo a thorough eye exam to make sure they do not
have diabetic retinopathy. Any damage to the retina should be treated
before women become pregnant.
The new guidelines were published in
the November issue of the Journal of Clinical Endocrinology and Metabolism.
The American Diabetes Association
has more about gestational diabetes.
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