The Importance of Gestational Diabetes Screening for Pregnant Mothers
For most women, gestational diabetes screening is a routine part of pregnancy and prenatal care, designed to flag women whose insulin function is no longer working efficiently. It can have complications for both mother and baby, so accurate and early screening is crucial for preventing later problems.
What is Gestational Diabetes?
Unlike type 1 and type 2 diabetes, gestational diabetes (GD) is not a permanent change - rather, it only occurs during pregnancy, and disappears once the pregnancy is over. Women who have GD during pregnancy do have a higher likelihood of developing type 2 diabetes later in life, but for most women once the baby is born their diabetes goes away.
Gestational diabetes is caused by your body becoming insulin resistant, due to the hormones produced by the placenta interfering with insulin's normal function. As the pregnancy progresses, the placenta produces more and more insulin-affecting hormones, which increases the likelihood of developing GD as the pregnancy goes on. When insulin isn't functioning effectively, sugars from the food the mother eats end up staying in her bloodstream. This high level of sugar ends up in the baby's bloodstream as well, which can affect the growth and health of the baby.
A representative from a law firm dealing with frequent maternity care claims explained that in the UK, despite knowing the potential risks from untreated gestational diabetes, future mothers may or may not be screened for it during pregnancy. This lack of consistent screening can mean that some mothers go undiagnosed. As a result, it is important to raise awareness about this issue, especially because GD often comes with no symptoms.
How Does the Screening Work?
In the UK, some areas have a policy of screening all pregnant women for GD. In other areas, only those with risk factors are screened. Risk factors could be things like being overweight (BMI over 30), having previously had a large baby (over 4.5kg), having GD in a previous pregnancy, your ethnicity (Asian, African-Caribbean and Middle Eastern populations are more at risk), and those with a history of diabetes in their family.
The screening works by giving the patient a blood test to establish the base level of glucose in their blood, and the patient drinking a sugary drink soon after. Two hours later, the patient's blood is tested again to see how much of the glucose from the drink remains in her blood. This test is called the Glucose Tolerance Test (GTT).
This screening is intended to flag anyone whose insulin is not functioning correctly, as those with GD will have high levels of glucose remaining in their blood after the 2 hours have passed.
Why is it Important That GD is Caught?
Catching GD early is crucial for preserving the health of both the pregnant mother and her baby. There are a number of potential complications that can arise if GD goes untreated, and if a mother is not screened, her doctor may not be aware that she needs treatment.
One major complication that comes alongside GD is macrosomia (a very large baby). If the baby grows very large (as a result of being flooded with sugar, which is converted to fat), this can cause problems with the mother giving birth to the baby, and the baby may become stuck in the birth canal. The mother may then be required to have a cesarean section.
For this reason, if a mother is diagnosed with GD, she is usually advised to modify her diet to reduce carbohydrate and sugar intake to keep her blood sugar lower. If the GD isn't able to be controlled by diet, she may be required to take medication.
In the event that the baby is still growing very large (determined by regular ultrasound scans), the mother may be induced early. This can then cause further issues, as if the baby is very large it may need to be induced several weeks early. As a result, the baby may be large, but premature. Prematurity comes with its own complications, so treating GD early can avoid not just a large baby, but the accompanying flow-on effects as well.
Furthermore, even if the baby is born at a size within normal range, and at full term, it may still have problems with blood sugar and breathing. If GD is not detected and goes uncontrolled, the baby's blood sugar will have been high throughout the pregnancy. This not only causes the baby to grow larger, but also causes the baby to produce excess insulin to deal with the extra sugar. After the birth, when the baby is no longer connected to the mother, the baby is still producing this excess insulin. This can then cause the baby's blood sugar to drop extremely fast, as the excess insulin will then process the now-lowered blood sugar in the baby's blood too quickly (hypoglycemia). In some cases, severe hypoglycemia can cause the baby to have a seizure. As a result, babies of mothers who have GD often spend some time in the neonatal unit.
Early Detection is Crucial
It's clear that GD can have major effects on both the mother and her baby, and early screening and detection is vital for protecting their health. Screening should not just be for those with risk factors, but instead should be for all women during their pregnancies. While women with risk factors are more likely to develop GD, there are still plenty of women who develop it even with no risk factors whatsoever. Catching these cases can save mothers from unnecessary surgery, and babies from complications after the birth.
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