The American College of Obstetrics and Gynecologists (ACOG) said in a recent statement to the media that there is not one certain method to be used to effectively screen the pregnant population for gestational diabetes. They do not, however, know what screening is best or agree on when the screening should take place.
One of the most intriguing recommendations is that a woman may not need laboratory testing to screen for GDM if she meets all of the following criteria:
- less than 25 years old
- not a member of a racial or ethnic group with a high prevalence of diabetes (eg, Hispanic, African, Native American, South or East Asian, or Pacific Islands ancestry)
- a body mass index (BMI) 25
- no history of abnormal glucose tolerance
- no previous history of adverse pregnancy outcomes usually associated with GDM
- no known diabetes in first-degree relative
- family history of diabetes
- past obstetric history
Other things that were long held in popular belief for women with GDM includes routine early induction simply because they had GDM. "When glucose levels are under control, and no other complications arise, there is no strong evidence to support routine delivery before 40 weeks of gestation," says the report issued on August 31, 2001. They gone on to report, "Although cesarean delivery rates are higher in women with GDM, ACOG notes that there are no data to support a policy of cesarean delivery purely on the basis of GDM."
Testing for those women who have a positive screen for GDM can take many forms. The most common is a fasting glucose after a woman has been given a drink called glucola (concentrated sugar) and had her blood drawn. About four years ago some studies were done showing that ingesting 18 Brach's® jelly beans worked just as well as the glucola. The jelly bean test is a bit more pleasant and has few stomach side effects than the glucola for most women. It is also important to note that there is not one perfect time for testing for GDM and that this should be decided between the practitioner and the woman.
The risks of GDM are real for both the woman and her baby, including problems for the mother like ecclampsia, blood pressure, urinary tract infections and an increased risk of Type II Diabetes later in life and problems of the heart, kidney and respiratory distress syndrome in the newborn. However, many women are tested unnecessarily and the new screening methods should help to lower the number of women tested and therefore reduce the number of false positives. This will also hopefully decrease the amount of worrying that goes along with pregnancy in general. If you have any questions about GDM, your health history and whether or not you should be screened or tested do not hesitate to talk to your doctor or midwife about the new recommendations.