Gestational diabetes cases are soaring, and you (as well as your baby) might be at risk without even knowing it.
This process will change significantly if the international panel’s recommendations, under consideration by the American Diabetes Association and The American College of Obstetricians and Gynecologists, are adopted in the U.S., as they have been in Japan. The doctor’s office screening will be dropped, and all pregnant women will undergo a two- hour, three-blood-draw version of the OGTT, including the overnight fast but requiring a smaller amount of glucose-sweetened beverage. If the results of just one of the three blood draws exceed a threshold that is slightly lower than the current numbers, GDM will be diagnosed.
Why the proposed change? Because new studies show that blood sugar levels previously considered healthy actually are associated with higher rates of pregnancy complications. Women considered to have GDM under the proposed lower cutoff— many of whom are not included with the current guidelines—have double the risk of delivering an overweight baby and developing preeclampsia and a 45 percent greater chance of delivering early or having a C-section. “These are really substantial differences,” says Boyd E. Metzger, M.D., chairman of the panel and an endocrinology professor at Northwestern University Feinberg School of Medicine in Chicago.
Out with the old
Metzger and his panel believe that it’s time to replace the current guidelines, since they were adopted 40 years ago, when the primary consequence of GDM was thought to be a risk to the mother of developing type II diabetes later in life. “It wasn’t known that gestational diabetes carries risk to the pregnancy,” Metzger notes.
Here’s the good news: Though some women require insulin injections, most GDM cases can be treated through regular exercise and dietary changes, such as eating fewer sweets and smaller, more frequent meals. “It’s very likely that treatment will be effective,” Metzger says.
If you’re diagnosed with gestational diabetes, under the current guidelines or the proposed new ones, know that the lifestyle changes you will be asked to make during pregnancy and postpartum and thereafter will help keep you healthy for years to come. “For many women,” says Downs, “a diagnosis could be the best thing that ever happens to them.”
Who's most at risk?
Some of the latest research findings about gestational diabetes:
>>Women who gain excess weight in the first trimester are at higher risk, according to a 2010 study published in Obstetrics and Gynecology. The association was even stronger among women who started their pregnancies overweight, a study at Kaiser Permanente Medical Group in Oakland, Calif., found.
>>Korean-American and Filipino-American women have twice the risk of GDM compared with Caucasian and African-American women, another recent Kaiser Permanente study found.
>>Women who drink five or more sugar-sweetened sodas a week before conceiving have a higher GDM risk, according to a study conducted by Harvard University and Louisiana State University.
>>Women with gum disease have higher odds of developing GDM than women with healthy gums, a New York University study found.
>>Frequent snorers have a 14.3 percent chance of developing GDM, compared with a 3.3 percent chance for women who don’t snore, according to a Northwestern University study.