Medical experts haven't agreed on a single set of screening guidelines for gestational diabetes. Some question whether gestational diabetes screening is needed if you're younger than 25 and have no risk factors. Others say that screening all pregnant women is the best way to identify all cases of gestational diabetes.
When to screen
Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy.
If you're at high risk of gestational diabetes — for example, your body mass index (BMI) before pregnancy was 30 or higher or you have a mother, father, sibling or child with diabetes — your doctor may test for diabetes at your first prenatal visit.
If you're at average risk of gestational diabetes, you'll likely have a screening test during your second trimester — between 24 and 28 weeks of pregnancy.
Routine screening for gestational diabetes
Initial glucose challenge test. You'll drink a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 130 to 140 milligrams per deciliter (mg/dL), or 7.2 to 7.8 millimoles per liter (mmol/L), is usually considered normal on a glucose challenge test, although this may vary by clinic or lab.
If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. You'll need a glucose tolerance test to determine if you have the condition.
- Follow-up glucose tolerance testing. You'll fast overnight, then have your blood sugar level measured. Then you'll drink another sweet solution — this one containing a higher concentration of glucose — and your blood sugar level will be checked every hour for three hours. If at least two of the blood sugar readings are higher than normal, you'll be diagnosed with gestational diabetes.
If you're diagnosed with gestational diabetes
Your doctor will likely recommend frequent checkups, especially during your last three months of pregnancy. During these exams, your doctor will monitor your blood sugar. Your doctor may also ask you to monitor your own blood sugar daily as part of your treatment plan.
If you're having trouble controlling your blood sugar, you may need to take insulin. If you have other pregnancy complications, you may need additional tests to evaluate your baby's health. These tests assess the function of the placenta, the organ that delivers oxygen and nutrients to your baby by connecting the baby's blood supply to yours.
If your gestational diabetes is difficult to control, it may affect the placenta and endanger the delivery of oxygen and nutrients to the baby.
Your doctor will also conduct tests to monitor your baby's well-being during your pregnancy.
Blood sugar testing after you give birth
Your doctor will check your blood sugar after delivery and again in six to 12 weeks to make sure that your level has returned to normal. If your tests are normal — and most are — you'll need to have your diabetes risk assessed at least every three years.
If future tests indicate diabetes or prediabetes — a condition in which your blood sugar is higher than normal, but not high enough to be considered diabetes — talk with your doctor about increasing your prevention efforts or starting a diabetes management plan.
April 25, 2014
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- Gestational diabetes. American Diabetes Association. http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html. Accessed Dec. 10, 2013.
- Coustan DR, et al. Medical management and follow-up of gestational diabetes mellitus. http://www.uptodate.com/home. Accessed Dec. 10, 2013.
- Gestational diabetes: A guide for pregnant women. Agency for Healthcare Research and Quality. http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=162&pageaction=displayproduct. Accessed Dec. 10, 2013.
- Greuter MJE, et al. Quality of guidelines in the management of diabetes in pregnancy: A systematic review. BioMed Central Pregnancy and Childbirth. 2012;12:58.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 137. Gestational diabetes mellitus. Obstetrics and gynecology. 2013;122:406.
- Blumer I, et al. Diabetes and pregnancy: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism. 2013;98:4227.
- Coustan DR, et al. Screening and diagnosis of diabetes mellitus during pregnancy. http://www.uptodate.com/home. Accessed Dec. 10, 2013.
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