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 delivery.
"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 pregnancy."
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.