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Gestational diabetes screening 'too late'

Friday April 8th, 2016

Obese women at risk of gestational diabetes may need to be screened earlier, researchers say today.

A UK-based study found that excessive foetal growth begins weeks before women are tested for the condition.

A study led by the University of Cambridge, found that obese women who develop gestational diabetes are five times as likely to have very large foetuses by six months of pregnancy.

However, the findings could have implications for when screening programmes are carried out after the researchers warned they may take place too late during pregnancy to prevent lasting health impacts on the baby.

Although women can have a blood glucose test between eight to 12 weeks of pregnancy, mothers-to-be at the greatest risk are offered a full test at between 24 and 28 weeks of pregnancy.

However, the study by a team in the university’s Department of Obstetrics and Gynaecology, published in Diabetes Care, believe earlier testing would be beneficial after analysing data from the Pregnancy Outcome Prediction study, which used ultrasound scans to assess the growth of more than 4,000 foetuses of first-time mothers.

The babies' abdominal and head circumference were measured and comparisons were made between women who developed gestational diabetes and those who did not.

Of the 4,069 women studied, 171 (4.2%) were diagnosed with gestational diabetes at or beyond 28 weeks.

Although there was no association between the size of the foetus at 20 weeks and the mother subsequently developing gestational diabetes, the foetuses of women who subsequently developed gestational diabetes grew excessively before the women were diagnosed.

The researchers also studied women who were obese, finding that even if no diabetes develops, their babies were also twice as likely to be big at 28 weeks.

The combination of obesity and gestational diabetes was linked to an almost five-fold risk of excessive foetal growth by the 28-week scan.

"Our study suggests that the babies of women subsequently diagnosed with gestational diabetes are already abnormally large by the time their mothers are tested for the disease," says first author Dr Ulla Sovio from the Department of Obstetrics and Gynaecology.

"Given the risk of complications for both mother and child from gestational diabetes, our findings suggest that screening women earlier on in pregnancy may help improve the short and long term outcomes for these women.

"Early screening may be particularly beneficial for obese women, as foetal growth is already abnormal by 20 weeks among these women. Any intervention aimed at reducing the risk of abnormal birthweight in the infants of obese women may need to be implemented even earlier."

Senior author Professor Gordon Smith, also from the University of Cambridge, adds: "The evidence from our study indicates that there is an urgent need for trials to assess the effect of earlier screening, both on the outcome of the pregnancy and the long term health for the offspring."

Janet Scott, research and prevention lead for the stillbirth charity Sands said: "We know from recent enquiries that failure to screen for gestational diabetes currently plays a part in a significant number of potentially avoidable stillbirths at term.

“Good risk assessment is crucial to avoiding harm to mothers and babies and we welcome these important findings which have real potential to inform better antenatal care for these high risk pregnancies. We are delighted to have supported this research, funded with donations from bereaved families."

Sovio, U et al. Accelerated fetal growth prior to diagnosis of gestational diabetes mellitus: a prospective cohort study of nulliparous women. Diabetes Care 8 April 2016. doi 10.2337/dc16-0160

Tags: Childbirth and Pregnancy | Diabetes | UK News | Women's Health & Gynaecology

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