Change To Diagnosis Of Gestational Diabetes Helped Women
A new clinical trial suggests women may benefit from a lower threshold for diagnosing pregnancy-related diabetes – but on average, it doesn’t reduce the risk of having a large baby.
Pregnant women with gestational diabetes have abnormally high blood sugar levels. One of the main consequences of the condition is fetal overgrowth, which can cause severe problems for moms and babies. An extensive baby results in a difficult delivery, injuring the baby or mother and increasing the risk of a C-section. A few infants also suffer from breathing problems or low blood sugar.
Additionally, gestational diabetes can increase the risk of preeclampsia, a potentially dangerous condition characterized by increased blood pressure and urinary protein.
Even though gestational diabetes is a commonly diagnosed condition, experts are still debating its precise definition, according to Harvard Medical School professor Michael Greene.
A new study in the New England Journal of Medicine, published Aug. 18, requires evidence on how to draw the line, says Greene, who wrote an editorial accompanying it.
Diabetes and Pregnancy Study Groups (IADPSG) and the American Diabetes Association lowered blood sugar thresholds for gestational diabetes diagnosis in 2010.
A large international study found that blood sugar levels were linked to a continuous increase in the risk of negative pregnancy outcomes. Greene explained that gestational diabetes can’t be diagnosed at a specific “inflection point.”
The expert consensus was to lower the blood sugar threshold for diagnosis to prevent more complications during pregnancy.
New Zealand researchers compared the impacts of lower thresholds with higher thresholds currently used in their country in the new trial.
In general, women diagnosed with gestational diabetes according to the lower threshold had no less chance of having a large newborn than those diagnosed with the higher threshold.
Using the lower cutoff point, the researchers could have prevented gestational diabetes diagnosis in women whose blood sugar levels fell between the higher and lower thresholds.
There was a reduced risk of having a large newborn and preeclampsia among those women who received treatment for gestational diabetes.
According to lead researcher Dr. Caroline Crowther of the University of Auckland, the health differences we observed were primarily caused by the 9% of women with ‘milder’ gestational diabetes who had blood sugar results that fell between the upper and lower thresholds.
According to her, the findings support the lower cutoff – though more women will be treated for diabetes. It typically involves changing diet, exercising regularly, and checking blood sugar levels regularly. Some women need to take insulin or the oral medication metformin.
According to Crowther, using the lower [blood sugar threshold] will increase women’s chances of being diagnosed with gestational diabetes, leading to increased health care utilization. “However, the study suggests significant health benefits for women with milder gestational diabetes.”
Approximately 4,000 pregnant women with gestational diabetes were evaluated in this study. According to New Zealand guidelines, half of the participants were assigned to a higher-threshold group. Another half of the patients were divided into a lower-threshold group, according to IADPSG recommendations.
Women diagnosed with gestational diabetes at lower cutoffs are expected to be more likely to develop it: 15% versus 6%. The proportion of large newborns in both groups was just under 9% – exceeding the 90th percentile for newborns born at that point in pregnancy.
As a result, the researchers focused on women with mild gestational diabetes who were between the two thresholds. A large newborn was diagnosed and treated among 6% of the lower-threshold group. A higher-threshold group went untreated at 18%, while a lower-threshold group did not receive treatment.
Preeclampsia was also less prevalent among treated women, 0.5% compared to over 5% in the higher-threshold group.
According to Crowther, lower thresholds might need to be considered in places where they are not currently used, such as New Zealand.
As for the optimal cutoff for blood sugars, Greene does not have an answer. Blood-sugar management is intended to identify the greatest number of pregnant women who can benefit from it without being so restrictive that healthy women are diagnosed with medical problems.
Greene pointed out that gestational diabetes can be found and treated effectively.
Preventing it in the first place can be done by maintaining a healthy weight during pregnancy.