New Recommendations For GDM Testing
Pregnancy has a tendency to generate some worries and questions for women. Will my baby be normal? Will I have a difficult delivery? What does that pain mean? Is it serious?
Once a woman becomes pregnant, her medical practitioner will do a battery of prenatal tests to ensure both mother and baby are doing the best they possibly can do. Overall, 95 percent of babies born are born healthy and normal. However, there are health situations that arise in pregnancy that can affect the health of the unborn baby.
Gestational Diabetes in Pregnancy
Gestational diabetes mellitus (GDM), otherwise known as glucose intolerance during pregnancy, affects more than 100,000 women per year. Unlike pregnancy in a diabetic woman, this type of glucose intolerance is first noted in pregnancy, in women who were not diabetic before they conceived. In cases of GDM, hormones secreted by the placenta change the way insulin is used in the body of a pregnant woman.
Things, They Are A-Changin'
Screening and opinions about testing have changed in medical circles when it comes to GDM. The American College of Obstetrics and Gynecologists (ACOG) recently said in a statement to the media that there is not one certain method of screening used to determine cases of GDM. They do not know which type of screening is best, or when it is best to do the testing.
Who Can Be Exempted From Testing?
It has also been determined that a woman may not need to be screened for gestational diabetes if she meets a specific criteria. If she is under 25 years of age and not a member of a racial or ethnic group which has a high prevalence of diabetes, if her body mass index (BMI) is 25 or less and she has no previous history of glucose intolerance, no incidence of diabetes in a close relative and no previous history of negative pregnancy outcomes due to GDM, then she probably can skip the screening.
Who Should Be Tested?
Women who are at higher risk for GDM are identified by their age, ethnicity, if they are obese and/or have a family history of diabetes, and if there is a past obstetric history of diabetes problems. These women should be screened and later tested for GDM.
One Size Does Not Fit All
Even though diet and exercise are key factors in treating gestational diabetes, there is no concrete evidence that one method is the best for all women. In the past, it was advised that women with GDM be placed on a calorie-restricted diet but now the ACOG suggests this may not be desirable. The current thought is that if a calorie restriction is undertaken, it should not exceed 33 percent of total calories. Proper diet and exercise are important. However, if there is no change in glucose levels with proper nutrition, then insulin should be considered. Another change is in the practice of early induction of labor. Now, the ACOS suggests that there are no data to support a policy of cesarean delivery solely based on GDM.
Testing for women who have a positive screening for GDM include fasting glucose, although, the ACOS indicates there is not one perfect time for testing for GDM and timing should be discussed between the practitioner and the woman. With the new screening methods in place, fewer women are tested unnecessarily for GDM.