U.S. Panel Urges Diabetes Screening for All Pregnant Women
MONDAY, Jan. 13, 2014 -- The U.S. Preventive Services Task Force has released new recommendations that call for universal screening of expectant mothers for gestational diabetes once they are 24 weeks into their pregnancy.
"The number of women who have gestational diabetes is rising, and gestational diabetes has effects not only on the mother, but also on the baby," said task force chairwoman Dr. Virginia Moyer, vice president for maintenance of certification and quality at the American Board of Pediatrics. "We want to prevent adverse outcomes for both of them."
Depending on the area of the country, the rate of gestational diabetes ranges from 1 percent to 25 percent, according to background information in the new recommendations.
Gestational diabetes can increase the risk of pregnancy complications, such as preeclampsia, according to the task force. It can also increase the risk of labor complications, because the baby grows to be larger than normal. After birth, the baby is at risk of developing low blood sugar levels because the baby's body is used to responding to high levels of blood sugar in the mother.
Moyer said there's also some evidence that babies born to mothers who have gestational diabetes might be more likely to become obese later in life.
Women who have had gestational diabetes also have an increased risk of developing type 2 diabetes later in life.
Early treatment -- with lifestyle changes, blood sugar monitoring and insulin, if needed -- can help reduce the risks during pregnancy and delivery for the mother, as well as the risks to the baby, according to the recommendations. The test to screen for gestational diabetes is simple and cost-effective, Moyer said.
In 2008, the task force found the evidence inconclusive for recommending universal screening for gestational diabetes either before or after 24 weeks.
In the latest recommendations, however, the task force found sufficient evidence to say all pregnant women should be screened for gestational diabetes after 24 weeks of pregnancy. Moyer said most obstetricians already screen for gestational diabetes.
One expert said the new task force guidelines line up with guidelines already issued by the American College of Obstetricians and Gynecologists and other organizations.
"These guidelines ... are based on a large literary review that showed that if you screen women and control their symptoms -- whether it's diet, exercise or even insulin treatment -- there was an association with reduced preeclampsia and shoulder [dislocation]," said Dr. Roxana Mehran, director of interventional cardiovascular research and clinical trials at the Icahn School of Medicine at Mount Sinai Medical Center in New York City. "These are really important complications that can be prevented if screened correctly and screened well."
"All women, whether symptomatic or not, should be screened," Mehran said. "[If diagnosed with gestational diabetes], it is important to follow these women for cardiovascular health. [This is] a great time to educate them about heart disease in women."
The task force wasn't able to make a recommendation one way or the other for universal screening before 24 weeks.
"We don't know if earlier screening is harmful, and we don't know if it's helpful," Moyer said. "We need more information."
Moyer said one concern is that a woman who gets screened before 24 weeks and has a negative result might not be screened again after 24 weeks. It's then possible that gestational diabetes could be missed.
Dr. Ryan Walter, an obstetrician at Scott & White Healthcare in College Station, Texas, said he thinks most obstetricians are screening for gestational diabetes between 24 and 28 weeks.
Walter said he occasionally screens an expectant mother before 24 weeks of pregnancy.
"I might screen earlier if I'm concerned because of a woman's symptoms, or if she has significant risk factors for diabetes," he said. "Then I'll screen again after 24 weeks."
Moyer said the best thing to do is try to prevent gestational diabetes. "There are many risk factors, but the only one you can fix is your pre-pregnancy weight," she said. "Maintain a healthy weight before pregnancy."
The new recommendations were published online Jan. 13 in the Annals of Internal Medicine.
Learn more about gestational diabetes from the American Diabetes Association.
Posted: January 2014
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