Why pregnant women need to get tested for gestational diabetes by 14 weeks: New Lancet study has answers
Gestational diabetes affects 15-20 per cent of all pregnancies in India, says Dr Yashdeep Gupta, Additional Professor, Department of Endocrinology, AIIMS
During pregnancy, a woman’s hormones can interfere with the functioning of insulin, which means it may not regulate your blood sugar levels like it’s supposed to. When expecting mother Aditi Sharma, 32, told her gynaecologist in Pune that she had a family history of diabetes, the latter tested her blood sugar levels immediately. The results showed higher blood glucose levels, indicating the beginning of her gestational diabetes (pregnancy-induced blood sugar). She was put on a strict diet and exercise regime, didn’t need medication, was able to stabilise her sugar levels and deliver a healthy baby. Early testing within 14 weeks saved her and her child from complications, something which a Lancet study now wants as a global protocol.
“Given the huge burden of diabetes in India and comorbidities like hypertension and fatty liver, universal testing for glucose has already been recommended at the very first ante-natal visit — this is usually in the first trimester,” says Dr Yashdeep Gupta, Additional Professor, Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, and one of the Lancet series authors. He and the others have now challenged the current approach on testing for gestational diabetes at 24 weeks and moving it to an earlier window of 14 weeks.
“Get your first antenatal visit as soon as possible after conception, and accomplish testing for glucose and other conditions. Promote healthy diet during pregnancy so that women have appropriate gestational weight gain, ensure regular antenatal check-ups and screen again at 24- 28 weeks of pregnancy,” advises Dr Gupta.
What causes gestational diabetes?
During pregnancy, a woman’s hormones can interfere with the functioning of insulin, which means it may not regulate your blood sugar levels like it’s supposed to. This can lead to gestational diabetes. Other triggers like genetic history and obesity (a body mass index or BMI greater than 25) can cause sugar spikes too.
What are risks to mother and baby?
For mothers, there is a risk of high blood pressure, bleeding, a C-section delivery and diabetes in the future. Their babies could be born pre-term, overweight, have low blood sugar and have respiratory difficulties. “If during the first ante-natal visit, the doctor finds clear-cut diabetes or blood sugar levels in the intermediate range, we can prevent gestational diabetes in women who are at high risk. If the first test is negative, the second glucose screening test should be done between 24 and 28 weeks of pregnancy. Post delivery, another glucose screening test is done between six and 12 weeks. This is then followed by an annual glucose screening test, so that we can detect cases of diabetes and prediabetes as early as possible,” says Dr Gupta.
Why is gestational diabetes on the rise?
While gestational diabetes affects one in seven pregnancies (or 14 per cent), in India, Dr Gupta says, it affects 15-20 per cent of all pregnancies. He makes a strong case for raising awareness about a healthy lifestyle in children, adolescents and the young population in the reproductive age group to reduce the risk of obesity, diabetes, hypertension and fatty liver. “With increasing urbanisation and lifestyle choices, we have moved more towards a sedentary lifestyle, a high-carbohydrate/high-fat diet, which have resulted in increased the risk of gestational diabetes. Late pregnancies and a higher bodyweight at conception increase the chances of gestational diabetes and pregnancy complications,” adds Dr Gupta.
While gestational diabetes affects one in seven pregnancies (or 14 per cent) globally, in India, Dr Gupta says, it affects 15-20 per cent of all pregnancies. “With increasing urbanisation and lifestyle choices, we have moved towards a sedentary lifestyle, a high-carbohydrate/high-fat diet, which have resulted in an increased risk of gestational diabetes. Late pregnancies and a higher bodyweight at conception increase the chances of gestational diabetes and pregnancy complications,” he adds.
Between 30 per cent and 70 per cent of women experience high blood glucose (hyperglycemia) from early pregnancy (20 weeks gestation or sooner). These women have worse pregnancy outcomes compared to women whose gestational diabetes does not show up until later in pregnancy (24-28 weeks). Even later in pregnancy, in studies where gestational diabetes was not managed adequately (e.g., where insulin was needed but not used), women were associated with increased risks of caesarean delivery (16 per cent), pre-term delivery (51 per cent) and large for gestational age babies (57 per cent). Other studies that looked at women requiring insulin therapy found it was associated with a more than two-fold increased risk of neonatal intensive care unit admission.
Share
