Pregnant patients may start getting screened for gestational diabetes at or after six months gestation, in order for it to be treated, if discovered, to reduce health risks for mothers and their babies. The U.S. Preventive Services Task Force posted a draft recommendation on February 16 regarding screening for gestational diabetes, recommending providers screen their pregnant patients for gestational diabetes at or after 24 weeks of pregnancy.
This draft recommendation applies to pregnant people who have not been previously diagnosed with type 1 or type 2 diabetes and who do not have signs or symptoms of gestational diabetes.
Endocrinologist Dr. Cynthia Herrick, of Barnes-Jewish Hospital in St. Louis and assistant professor of medicine at Washington University School of Medicine, said in a 2019 interview with St. Louis Public Radio’s Shahla Farzan, that gestational diabetes “can lead to babies that are large for gestational age, babies that are born early, and low blood sugar for babies at delivery.”
For the mother, gestational diabetes increases her risk of high blood pressure, and preeclampsia, which is a serious complication that causes high blood pressure and can threaten the lives of both the mother and her baby.
The Mayo Clinic lists risk factors for gestational diabetes is being overweight or obese; low physical activity; previous gestational diabetes or prediabetes; polycystic ovary syndrome; diabetes in an immediate family member; and previously delivering a baby weighing more than 9 pounds. Additionally, it says women who are Black, Hispanic, American Indian and Asian American have a higher risk of developing gestational diabetes.
What can happen during pregnancy is that certain hormones can block insulin, which is the hormone that helps the body use sugar to become energy. This can lead to high blood sugar and, in some cases, the development of gestational diabetes. The way health care providers screen for gestational diabetes includes drinking a sugary solution and having blood draws to measure how well the body processes sugar. Screening can be done during a regular prenatal visit.
“Gestational diabetes can cause serious health problems for pregnant people and their babies,” stated Task Force member Dr. Chien-Wen Tseng, who is the Hawaii Medical Service Association endowed chair in health services and quality research, a professor, and the research director in the Department of Family Medicine and Community Health at the University of Hawaii John A. Burns School of Medicine. “Fortunately, screening for gestational diabetes at or after 24 weeks is simple, safe, and effective, and can help to keep pregnant people and their babies healthy.”
The USPSTF says screening is important so that those found to have gestational diabetes can be treated through lifestyle changes or medicine. Treatment can reduce the risk of babies born with a high birth weight, C-sections, birth injuries, and admission to the intensive care unit. However, more research is needed on the benefits and harms of screening and treatment before 24 weeks of pregnancy. “Gestational diabetes is increasing as obesity, older age during pregnancy, and other risk factors become more common among pregnant people,” Task Force member Michael Cabana M.D. stated. “More research is needed on the accuracy and effectiveness of screening for gestational diabetes before 24 weeks and whether earlier screening could be beneficial for some pregnant people with risk factors.” Cabana is a professor of pediatrics and the chair of the Department of Pediatrics at the Albert Einstein College of Medicine. He is also physician-in-chief at the Children’s Hospital at Montefiore.
The Task Force states providers should use their clinical judgment to determine what is appropriate for individual patients, given their health needs.
The Task Force’s draft recommendation statement and draft evidence review have been posted for public comment on the Task Force website at www.uspreventiveservicestaskforce.org. Comments can be submitted from February 16, 2021, to March 15, 2021, at www.uspreventiveservicestaskforce.org/tfcomment.htm.