Gestational diabetes–the kind that first shows itself during pregnancy–is a growing problem. More women are getting gestational diabetes as they wait until their thirties or later to have a baby, and as they increasingly begin their pregnancies already overweight.
A new test has the potential to diagnose even more women with gestational diabetes and prevent serious complications. The implementation of this test could nearly triple the number of women diagnosed with diabetes during pregnancy and ensure that these at-risk populations are adequately cared for.
The Dangers Of Untreated Diabetes
Gestational diabetes is one of the most common complications of pregnancy, and almost every pregnant woman gets checked for it. That’s because if a pregnant woman’s high blood sugar isn’t controlled, the mother could get dangerously high blood pressure and/or her fetus can grow too large, leading to C-sections and early deliveries.
Complications of gestational diabetes include the following:
- Newborn jaundice
- Premature birth
- Being large for gestational age (macrosomia). This occurs because of the increased blood glucose and insulin levels, which stimulate fetal growth. This may increase the likelihood of a C-section or vacuum extractor or forceps birth. It also may result in shoulder dystocia and Erb’s palsy (the baby’s shoulders ‘getting stuck’) or cephalopelvic disproportion (the baby’s head being too large to fit through the mother’s pelvis). These delivery problems may lead to brain bleeds and hemorrhaging and problems with oxygenation, such as hypoxic ischemic encephalopathy (birth asphyxia).
- Reduced uteroplacental perfusion (RUPP). RUPP is a serious condition that affects blood flow between the mother and fetus, and it can cause harm to the health of both.
- Low blood sugar (hypoglycemia)
While gestational diabetes usually disappears once the baby is born, the mother is left with another risk. Months or years later, half of the women who had it wind up developing full-fledged Type 2 diabetes.
Physicians diagnose gestational diabetes in about 5-6 % of U.S. pregnancies, or about 240,000 a year, according to an expert panel that met this week at the National Institutes of Health (NIH).
Testing For Gestational Diabetes
Most U.S. physicians use a two-step testing method. But now there’s a push for physicians to switch to a simpler one-step test that is used in other parts of the world. The one-step approach, backed by the American Diabetes Association and World Health Organization, isn’t significant just for the convenience of getting diagnosed in one or two physician visits. It also would lower the blood sugar threshold for diagnosing the condition. “The implications of this are very, very large, and there are so many unanswered questions,” said Dr. Catherine Spong of the National Institute of Child Health and Human Development.
An NIH-appointed panel agreed, and said many more pregnant women would be classified with gestational diabetes, 15-20 %, if physicians widely adopt the one-step approach.
The more aggressive approach treats milder cases with diet and exercise, not medication. This would increase medical care for many women. There would be an increase in nutritionist visits and physician visits for blood sugar and fetal growth checks. This could add up to hundreds of millions of dollars in health costs annually.
But there has been no study of whether treating cases milder than are diagnosed today makes any difference to the health of mother and baby, the experts concluded. “If we can extend benefits to mothers, their unborn children… and impact their future health care, everybody would want to get on board even if it were more expensive,” said Dr. Peter VanDorsten of the Medical University of South Carolina. He chaired the NIH panel. Physicians aren’t required to follow its advice. He called for quick research to settle the debate, saying, “We absolutely left the door ajar for reconsideration.”
Under the two-step method, nearly every woman drinks a very sweet liquid, and has a blood test an hour later to see how the body processes the sugar. Those who fail repeat the test with a larger drink and three hours of blood tests. With the one-step method, everyone would get a single, two-hour test.
Why A More Sensitive Test Is Needed
The push to switch came after 25,000 pregnant women in nine countries were studied. The study found that various health risks for the mother and baby gradually grew as the mother’s blood sugar rose above normal levels, even if she wasn’t officially diabetic.
Some physicians already are trying the simpler approach. The Oregon Health & Science University began using it last summer, and gestational diabetes cases doubled, obstetrics chairman Dr. Aaron Caughey told the NIH panel. But his medical center decided it’s worth trying because even women with mild diabetes could benefit from nutritional counseling that insurance doesn’t always cover unless they’re diagnosed, Caughey said.
Wednesday’s report urged physicians also to consider the anxiety that a diagnosis of even mild gestational diabetes can bring. In Birmingham, Ala., attorney Kira Fonteneau was diagnosed with gestational diabetes after traditional two-step testing. She cried at the news even though physicians made clear she had a very mild case. She wasn’t overweight, but diabetes runs in her family.
Armed with a nutritionist’s advice and regular blood-sugar checks, Fonteneau quickly changed how she ate, cutting back on carbohydrates. She got better. “Knowledge is power,” she said. “You want to have a healthy baby.”
Medical Negligence And Gestational Diabetes
Gestational diabetes can cause an array of complications, especially if a physician fails to diagnose the condition or treat it properly. These failures can constitute negligence, and if this negligence causes injury to the mother or baby, it is medical malpractice.
Reiter and Walsh ABC Law Centers have been helping families with birth injuries for many years. Call our highly skilled attorneys for a free case review, 888-419-2229.