Experts Recommend Diabetes Testing at First Prenatal Visit

The Endocrine Society has issued a clinical practice guideline to help health care professionals provide the best care to pregnant women who have diabetes. The guideline appeared in the November 2013 issue of the Journal of Clinical Endocrinology & Metabolism.

Experts acknowledge that cases of diabetes in pregnant women are being missed by traditional screening methods, according to Ian Blumer, MD, of the Charles H. Best Diabetes Centre in Whitby, Ontario, Canada, and chair of the task force that authored the guideline. The guideline recommends that all pregnant women who haven’t been previously diagnosed with diabetes be tested for the condition at their first prenatal visit. The test should be done before 13 weeks’ gestation or as soon as possible thereafter. “Many women have type 2 diabetes but may not know it,” Blumer says. “Because untreated diabetes can harm both the pregnant woman and the fetus, it’s 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 fetus healthy.”

As many as one in five women may develop gestational diabetes. Traditional testing strategies identify only about one-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.

“To address this problem, the [guideline] advocates for using lower blood glucose levels to diagnose gestational diabetes,” Blumer says. “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.

“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 adds. “The guideline synthesizes evidence-based strategies to support women who have diabetes during pregnancy.”

Other recommendations from the guideline include the following:

• All pregnant women who haven’t 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 before pregnancy for women with diabetes who are overweight or obese.

• Initial treatment of gestational diabetes should be medical nutrition therapy and daily moderate exercise lasting at least 30 minutes.

• If lifestyle therapy isn’t sufficient to control gestational diabetes, blood glucose–lowering medication should be added.

• Women with gestational diabetes should have an oral glucose tolerance test six to 12 weeks after delivery to rule out prediabetes or diabetes.

• Women who have had gestational diabetes with a previous pregnancy need to be tested for diabetes regularly, especially before any future pregnancies.

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

Source: Endocrine Society