Gestational Diabetes Screening
Gestational diabetes is a condition that can arise during pregnancy, and one that can put both mothers and babies at risk. Yet, screening for this condition is not yet routine in all places, with some locations only screening mothers who have risk factors for the condition. This approach needs to change, with screening for all mothers put in place to ensure that nobody is left without the care and treatment that they need.
How Does the Screening Currently Work?
The screening is currently inconsistent across areas, with some locations screening all women, and others screening those with risk factors. For gestational diabetes (GD), risk factors may include having had GD in your last pregnancy, being obese or overweight, having had a large baby (over 4.5kg) previously, or an Asian, African-Caribbean, or Middle Eastern ethnic background. Those with a history of type 1 or type 2 diabetes in their family are also more at risk.
The screening is performed by giving the patient a glucose drink, and administering a blood test before and after the drink is consumed, known as the Glucose Tolerance Test (GTT). This measures the base level of glucose for the patient, as well as the amount of glucose in her blood remaining several hours after drinking. The GTT can uncover patients who are not processing the glucose well: those with GD have impaired insulin function, and will have higher glucose levels in their blood after the test has been performed.
What Causes Gestational Diabetes?
GD is a type of diabetes that is only present during pregnancy, and once the baby has been born the diabetes goes away. It is caused by changes in insulin processing due to the placenta, which produces hormones that interrupt and inhibit the body’s normal insulin function. As the pregnancy goes on, the placenta produces an increasing amount of these hormones, and the likelihood of the mother developing GD increases. This altered, less-effective insulin function causes excess sugar to remain in the bloodstream, which gets passed along to the baby as well.
A representative from a firm that deals with numerous maternity care claims explained that in the UK, pregnant mothers may or may not be screened for GD during pregnancy, despite health professionals being aware of the risks. This inconsistency means that some mothers go undiagnosed, and it is important to raise awareness about this issue so that more mothers can be screened in future.
What Happens if GD is Not Caught?
Getting an early GD diagnosis is important for the health of the baby as well as the mother, as untreated GD can cause significant complications. Without screening, treatment (by way of dietary adjustment or medication), cannot be started, and blood sugar levels will stay high. As a result of this high blood sugar level, the baby can grow very large (macrosomia): the sugar in the baby’s blood is converted to fat, and the baby grows much bigger than what it should be for gestational age. If the baby is born at this large size, it may get stuck in the birth canal (shoulder dystocia), and the mother may end up giving birth by cesarean section.
When GD is diagnosed, the mother is provided with additional monitoring to check the size of the baby. If the baby continues to grow large despite treatment, the mother may be induced early. This can result in a large baby being born prematurely, and the complications that come alongside prematurity may also be present. Being aware of these potential issues early allows the mother and her treatment provider to create a plan in advance.
In addition to these complications, even if the baby is born an average size at 39-41 weeks, the baby can have problems with blood sugar after it is no longer attached to the placenta via the umbilical cord. If GD has been untreated, the baby will be used to having high levels of sugar in its blood, which prompts the baby’s system to produce excess insulin to cope with this sugar. When the baby is born and the umbilical cord is cut, the baby continues to produce this higher level of insulin, but with a sugar intake (from colostrum or formula) that is much lower. This causes the baby to process this sugar much too fast, causing hypoglycemia (low blood sugar). Serious hypoglycemia can cause seizures and other major issues, so monitoring at this stage is crucial. If GD has not been diagnosed, the health provider may not know to look out for blood sugar problems.
Routine Screening is Necessary
With the serious effects that can come about from GD, routine early screening for all mothers should be brought in throughout the UK so that mothers and babies can be protected. Those without risk factors may be missed by the current system, but all women deserve to have the best possible care throughout their pregnancies. Routine screening would stop rare cases from slipping through the cracks, and would ensure that health professionals and pregnant mothers can take steps to ensure that health and care levels remain optimum.