WHO’s non-fasting plasma glucose testing recommendation makes testing easy and patient-friendly for pregnant women.
About 2% to 5% of all pregnant women will develop gestational diabetes, a type of diabetes that usually occurs only during pregnancy. As with other types of diabetes, the body is unable to properly use glucose, a simple sugar that the body converts to energy.
Gestational diabetes usually starts halfway through the pregnancy. Expect to be screened for the disorder between the 24th and 28th week.
The 1999 WHO guidelines required a pregnant woman to come fasting for testing. The plasma glucose level was tested two hours after 75 mg of glucose was given to a woman. If the value was between 140 mg/dl and 199 mg/dl, the pregnant woman was diagnosed as having gestational diabetes.
The 2013 WHO guidelines address the concerns faced by pregnant women with gestational diabetes in developing countries with a non-Caucasian population.
With this revision, diagnosing gestational diabetes mellitus (GDM) in pregnant women in low- and middle-income countries with high diabetes burden, like India, has become easy. The revised guidelines address the concerns faced by pregnant women with gestational diabetes in developing countries with a non-Caucasian population.
What Difference does the Revision Make?
The 1999 WHO guidelines required a pregnant woman to come fasting for testing. The plasma glucose level was tested two hours after 75 mg of glucose was given to a woman. If the value was between 140 mg/dl and 199 mg/dl, the pregnant woman was diagnosed as having gestational diabetes. “The revised WHO guidelines retain the same value but the biggest difference is [that] women need not come fasting for testing,” underlined Dr. V. Seshiah, Chairman of the Diabetes in Pregnancy Study Group India (DIPSI) and WHO expert committee member on GDM. “A pregnant woman can come for testing irrespective of her last meal timing.”
The rest of the procedure remains the same. The non-fasting plasma glucose level is tested two hours after 75 gm of glucose is given to the woman. “If the two-hour plasma glucose measurement is between 140 [mg/dl] and 199 [mg/dl], she is diagnosed as GDM,” he said. “The 140-199 range for diagnosing GDM in pregnant women is the same as the one used for diagnosing impaired glucose tolerance (IGT) in non-pregnant adults.”
WHO’s non-fasting plasma glucose testing recommendation makes testing easy for pregnant women. The non-fasting test is patient-friendly and causes the least inconvenience to pregnant woman. The single-step procedure is easy to follow, economical, simple and evidence-based. “Women develop nausea or tend to vomit if they are given 75 gm glucose in a fasting stage,” Dr. Seshiah said.
How does it Help?
Though GDM most often resolves after delivery, the effects of elevated glucose levels in a pregnant woman tend to affect the foetus. Foetuses exposed to elevated maternal glucose tend to become big babies before birth (macrosomia). Such babies are at higher risk of becoming diabetic later in life much like the women who had GDM.
A simple solution to prevent this is to go in for universal screening of pregnant women for gestational diabetes and to keep the glucose level within desired levels — fasting plasma glucose 90 mg/dl and two hours after meal — 120 mg/dl. “But it was difficult to follow the 1999 WHO guidelines to diagnose GDM,” said Dr. V. Seshiah.
Who is at the Risk of Developing Gestational Diabetes?
You are at a greater risk for gestational diabetes than others if you:
- Are older than 25.
- Were overweight before the pregnancy.
- Have a family history of diabetes.
- Had gestational diabetes with another pregnancy.
- Gave birth to a baby who was very large, had a birth defect, or was stillborn.
- Have too much amniotic fluid.
- Have hypertension.
- Have glucosuria (glucose in your urine).
When to Get Tested?
Risk assessment for GDM should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. If they are found not to have GDM at that initial screening, they should be retested between 24 and 28 weeks of gestation. Women of average risk should have testing undertaken at 24–28 weeks of gestation.
Dangers of Having Gestational Diabetes
Left unchecked, gestational diabetes can harm both the mother and the fetus. Gestational diabetes can increase the risk of:
- Having a very large baby, 10 pounds or more. This condition, called macrosomia, occurs when the fetus is exposed to high blood glucose levels and stores the extra glucose as fat.
- Maternal and/or fetal trauma at birth due to the large size of the baby.
- Hypoglycemia (low blood sugar) in the newborn.
- Jaundice in the newborn. Characterized by a yellowish skin tone, jaundice is associated with a buildup of bile pigment (bilirubin) in the bloodstream.
- Pregnancy-related high blood pressure.
- Premature delivery.
- Birth defects (rare).
- Stillbirth (rare).
Source: University of Maryland Medical Center, The Hindu
Image Source: Getty Images
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