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Should all pregnant women be screened for diabetes?

January 20, 2014
The Preventive Services Task Force had lagged behind other US organisations such as the American Association of Clinical Endocrinologists in backing screening for diabetes in pregnancy – termed gestational diabetes. Screening is routine in the USA but the latest guidelines from the UK National Screening Committee do not recommend that university screening should be done. Dr Mark Vanderpump, Consultant Endocrinologist at The Physician's Clinic explains more about gestational diabetes and provides some information about private screening for diabetes in pregnancy. “Pregnant women need to produce a threefold rise in insulin to keep their blood sugar levels controlled within normal limits, so being pregnant is a significant physiological challenge,” explains Dr Vanderpump. Women who develop diabetes in pregnancy usually return to normal once their baby is born but data suggest that two-thirds of women with gestational diabetes may develop type 2 diabetes within 15 years.

How is gestational diabetes defined?

It does not matter whether the signs of diabetes end with delivery, or whether the woman developed diabetes earlier and it remained undiagnosed. Any woman who first shows any degree of glucose intolerance during pregnancy is diagnosed as having gestational diabetes mellitus (GDM).

Is diabetes in pregnancy a problem?

“It can be,” explains Dr Vanderpump. “Women who have diabetes in pregnancy are more at risk of having a baby with a large birthweight, so are more likely to have a complicated labour and delivery and to need a C-section.” “Although any woman who has diabetes when pregnant is more likely to go on to develop type 2 diabetes, not every woman faces the same level of risk. Older women and Asian women diagnosed with gestational diabetes are particularly prone to developing type 2 diabetes subsequently. A woman who has severe diabetes and who therefore needs insulin treatment during pregnancy is also at greater risk,” he adds.

How common is diabetes in pregnancy?

Many studies have been performed to answer this question but they have studied different populations of women (different ages, different ethnic backgrounds) and they have used varying diagnostic tests to detect the problem. The conclusion is that, on average, 7 in every 100 pregnant women will develop diabetes while they are pregnant. Not surprisingly, the range is wide – between 1% and 14%, “This proportion may seem quite low but because diabetes in pregnancy creates the risk of complications for mother and baby, there is a case to be made for screening.” “Various approaches can be used to screen for diabetes in pregnancy. In the UK, most centres would perform an oral glucose tolerance test following an overnight fast of at least 8 hours. If a woman has a fasting glucose of greater than 5.5mmol/l or a two hour glucose greater than 8.1mmol/l, she is diagnosed with gestational diabetes.”

Screening for gestational diabetes at The Physicians' Clinic

“At the Physicians Clinic we work closely with our local obstetric colleagues based at the Portland and Lister hospitals helping to interpret glucose tolerance test results in pregnant women. We can also advise on how women found to have GDM in the pregnancy can be cared for both during the rest of their pregnancy and in the long-term to reduce their future risk of type 2 diabetes.”    
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