Screening And Diagnosis Of Gdm
Early screening. Screening for diabetes in the first trimester should be considered for diagnosing overt diabetes in women who are at risk , including those with a history of previous GDM. The ability to predict abnormal results on glucose screening tests at 24 to 28 weeks and risk of continued dysglycemia postpartum are other, but less compelling, reasons cited to screen in the first trimester.
The test of choice for early screening should be based primarily on the ability to predict poor obstetrical outcomes, which may be modifiable by lifestyle or pharmacological intervention. There are 2 strategies for testing glucose levels in early pregnancyusing the nonpregnancy-recommended screening tests or using the typical 24- to 28-week gestational diabetes screening criteria . To apply nonpregnant FPG or A1C criteria in early pregnancy does not take into account that both decrease early in pregnancy and may lead to underdiagnosis in women with pre-existing diabetes. On the other hand, there has been no rigorous validation that criteria accepted for the diagnosis of GDM in the second or third trimester are appropriate for use in the first trimester.
What Is A Pregnancy Glucose Test
Before we cover what to eat before a glucose test, lets dive into some specifics about whats measured in the test and why.
A pregnancy glucose test sometimes referred to as a gestational diabetes test, measures a pregnant womans blood glucose levelsbetween 24-28 weeksof pregnancy.
If these levels are high, it may mean the body isnt producing enough insulin to manage the excess glucose from pregnancy.
This condition is known as gestational diabetes.
If youre diagnosed with gestational diabetes, your doctor will help you with a special care plan to ensure you have a healthy pregnancy.
Is There An Alternative Way To Test For Gestational Diabetes
Yes. If you do not want to drink the glucose solution for one reason or another, there is another way we can test you for gestational diabetes.
It would involve you actually checking your blood glucose through finger sticks four times a day for an entire week. This will give us a good idea of how your body processes the foods you eat.
Again, dont try to manipulate this test in any way. For example, dont try to eat really healthy for that week, then go back to eating your normal diet the subsequent week.
Just to be safe, your health care provider may have you check your finger sticks for 2 or more additional weeks just in case.
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Management: Healthy Behaviour Interventions
Weight gain. The 2009 IOM guidelines for weight gain during pregnancy were developed for a healthy population and little is known regarding optimal weight gain in women with GDM. Retrospective cohort studies of GDM pregnancies show that only 31.7% to 42% had GWG within IOM guidelines. Those gaining more than the IOM recommendations had an increased risk of preeclampsia , caesarean deliveries , macrosomia , LGA and GDM requiring pharmacological agents . Modification of IOM criteria, including more restrictive targets of weight gain, did not improve perinatal outcomes of interest . A large population-based study including women with GDM, concluded that while pre-pregnancy BMI, GDM and excessive GWG are all associated with LGA, preventing excessive GWG has the greatest potential of reducing LGA risk . These researchers suggest that, in contrast to obesity and GDM prevention, preventing excessive GWG may be a more viable option as women are closely followed in pregnancy.
Further studies are needed to develop weight gain guidelines for GDM patients and to determine whether weight gain less than the IOM guidelines or weight loss in pregnancy is safe. Until this data are available, women with GDM should be encouraged to gain weight as per the IOM guidelines for the BMI category to reduce adverse maternal and neonatal outcomes and postpartum weight retention.
Glucose Challenge Test Results
What many medical experts consider a normal result for a glucose challenge test is a blood sugar level equal to or less than 140 mg/dL . The mg/dL means milligrams per deciliter and the mmol/L means millimoles per liter. This is how the glucose is measured in your blood sample. A normal result means you do not have gestational diabetes.If your level is higher than 140 mg/dL , your healthcare provider may recommend you do the glucose tolerance test, which can help better determine if you have gestational diabetes or not.
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Random Blood Sugar Test
A physician takes a blood sample at any time, and not necessarily when fasting. People who have serious diabetes symptoms may have this test. If blood glucose levels are 200 mg/dL at any time, this indicates that diabetes is present.
People with diabetes should monitor their blood glucose levels regularly, using a home testing kit or continuous glucose monitor.
How Can You Prepare For A Glucose Screening Test
Before your one-hour glucose test, it’s recommended to follow a diet that’s high in carbohydrates for three days so your pancreas gets accustomed to processing simple sugars. Your health care provider can give you more information on what to eat prior to testing.
Note that some people find the syrupy glucose solution unpleasant or even nausea-inducing. You can increase your odds of successfully completing the test by drinking it cold, sipping slowly over five minutes, or using an anti-nausea medication beforehand. If you still have trouble tolerating it, your OB-GYN can discuss alternatives, such as checking blood sugars for a week using a glucometer.
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Final Thoughts On Glucose Screening
The glucose test in pregnancy is an easy way to check your bodys ability to tolerate sugar.
Theres no way to cheat this test, and you should prepare for it by eating a well-balanced diet as soon as you find out youre pregnant.
If you fail the test, make sure that you follow up very closely with your doctor to try and prevent the development of type 2 diabetes mellitus.
Now I want to hear from you.
Did you fail your glucose test?
What did you do to prepare for it?
How To Lower Your Blood Glucose Levels
Even if you have a normal glucose screening and never test positive for glucose in your urine, its still important to follow a healthy diet during pregnancy, which can help stabilize your blood sugar levels.
Here are some tips on what to eat to keep blood sugar spikes at bay, plus other smart strategies:
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Are There Any Side Effects Associated With The Glucose Tests
Most pregnant women donât have any side effects during or after either glucose test. It’s possible that you may feel nauseous, lightheaded, or even sweaty after drinking the glucose solution. It tastes like a very sweet soda, which can be easier to stomach for some women than for others.Youâll need to have your blood drawn, so you might feel dizzy, and you may have slight bruising around the blood withdrawal spot, but otherwise the risks associated with these tests are minimal.
How To Pass The Gestational Diabetes Test
People sometimes ask how to pass the glucose tolerance test. But heres the truth: theres no passing or failing. If youre diabetic, the results will reflect thatand truly, thats important for you and your baby, so you can get the treatment you need to prevent problems. And if youre not, youre not. So no trying to cheat the system here.
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Group B Streptococcus Test
GBS is a healthy vaginal bacterium however, not all women will test positive. GBS does not usually pass to the baby, but if it does, it can cause serious illness. A vaginal-rectal swab will be done around 35-37 weeks to identify whether you have this bacteria present. If our laboratory identifies that the bacteria is present, you will be treated with antibiotics while in labour.
What Not To Eat The Night Before A Glucose Test
Here is a list of foods not to eat before your glucose test.
If your glucose challenge test is tomorrow, it is a good idea to avoid high glycemic foods for at least 8 hours before the glucose test.
These foods include
- Breakfast cereal
All of these will spike your glucose levels high.
Instead, go for whole grains that contain complex carbohydrates, such as steel-cut oats, brown rice, sweet potatoes, and leafy green vegetables.
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How To Prepare 3 Hour Test
If your doctor would like to see additional testing, based on your results from the 1 hour test, you may be asked to have a 3 hour OGTT. It is important to follow all of the instructions very carefully, as it will affect the results of the test.
When you arrive at the office a sample or baseline glucose test will be run and used for comparing other glucose values. You will be asked to drink a sweet liquid containing a measured amount of glucose, it is best to drink it quickly. Then blood samples will be collected at timed intervals of 1,2, and 3 hours after you drink the glucose.
Here is the best method of preparation:
Alternatives To The Glucose Test During Pregnancy
Glucose tests are considered the gold standard for diagnosing gestational diabetes, and doctors strongly recommend that all women get the initial screening. However, we recognize that in some circumstances, including women whove had bariatric surgery, performing these tests may not be possible, says Greves.
Klein acknowledges that people may have trouble tolerating the highly concentrated drink. She says that, instead, they may be able to use a glucometer at home to regularly self-monitor their levels and assess if theres any blood glucose dysregulation. She adds that some doctors will allow alternatives to the Glucola beverage if its something equivalent to 50 or 100 grams of glucose. Another form of simple sugar, such as jelly beans or fruit juice may be acceptable, she says. Of course, protocols vary by practice, and Klein and Greves stress that youll want to discuss options with your doctor. They may want you to stick with the tried-and-true oral glucose tolerance test.
The initial glucose test during pregnancy is par for the course for moms-to-be. And those that need to carve out the time for the three-hour glucose tolerance test will come to realize that some minor unpleasantness is no big thing if it means keeping you and your little one on the path to a healthy delivery. Well drink to that.
About the experts:
Stephanie Klein, RD, LDN, CDCES, is a registered dietitian and the clinical director of diabetes prevention and reversal at Simplex Health.
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Education About Insulin Commencement
It is very important that you get information and support from your diabetes educator or doctor on how insulin works, how to give insulin and how to store it.
Insulin sometimes causes blood glucose levels to go too low , so it is very important that you learn the signs and symptoms of this and how to prevent and treat it .
What Abnormal Results Mean
Abnormal blood values for a 3-hour 100-gram oral glucose tolerance test are:
- Fasting: greater than 95 mg/dL
- 1 hour: greater than 180 mg/dL
- 2 hour: greater than 155 mg/dL
- 3 hour: greater than 140 mg/dL
ONE-STEP TESTING
Abnormal blood values for a 2-hour 75-gram oral glucose tolerance test are:
- Fasting: greater than 92 mg/dL
- 1 hour: greater than 180 mg/dL
- 2 hour: greater than 153 mg/dL
If only one of your blood glucose results in the oral glucose tolerance test is higher than normal, your provider may simply suggest you change some of the foods you eat. Then, your provider may test you again after you have changed your diet.
If more than one of your blood glucose results is higher than normal, you have gestational diabetes.
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What Are The Complications Of Untreated Gestational Diabetes
- shoulder dystocia, which occurs when the babys shoulders to get stuck in the birth canal during delivery
- slightly higher rates of fetal and neonatal death
Untreated gestational diabetes can also result in the baby having a high birth weight. This is called macrosomia. Macrosomia may result in shoulder damage during birth and can require a cesarean delivery. Babies with macrosomia have a higher likelihood of childhood obesity and type 2 diabetes.
What Else Should I Do To Manage Glucose Tolerance In Pregnancy
If youre diagnosed with gestational diabetes youll be given a self-testing kit to monitor your blood sugar levels at home.
The glucose test involves a small prick to your finger before and after meals. It helps you and your care team make adjustments to your diet to keep your glucose levels stable.
Youll also be offered regular ultrasound scans to assess your babys growth and placenta function.
If you cant stabilise your blood glucose levels, youll be encouraged to consider medication, to help your body use insulin more effectively. If diet and other medication arent helping, your care team can discuss injectable insulin.
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What Should I Do Before Coming For The Gtt
As your midwife has identified a risk factor for gestational diabetes you will have been given an appointment for an oral Glucose Tolerance Test, usually at around 26/28 weeks of pregnancy.
You will need to have two blood tests taken. The second blood test will be taken two hours after the first. You will need to remain within the clinic until the test is completed. If you walk around or go home the test will become invalid as you will be burning off the sugar you have been given.
What Is Gestational Diabetes Mellitus
Gestational diabetes mellitus, commonly referred to as GDM, occurs only during pregnancy when hormones prevent your pancreas from releasing sufficient insulin.
Insulin is a hormone that allows the cells to convert sugar in the blood into energy. Insulin resistance causes high levels of sugar to remain in the blood.
Usually women with GDM have healthy pregnancies and babies. But GDM increases the risk of:
- Macrosomia: a baby grows larger than usual, causing problems during birth and increasing the chance of induction and c-section
- Polyhydramnios: too much amniotic fluid, causing premature labour
- Premature birth
- Pre-eclampsia: high blood pressure during pregnancy, which can lead to pregnancy complications if not treated
- A baby developing low blood sugar or jaundice after birth
- Stillbirth, although this is rare.
Because of these factors, a glucose test is a standard pregnancy check up, to make sure all is well with you and your baby.
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How To Prepare 1 Hour Test
How Do I Prepare For My 1 Hour Glucose Test
You shouldnt make any drastic changes to prepare for the 1 hour glucose test.
In fact, its best that you follow your normal diet because its important to get an accurate representation of how your body handles sugar on a day to day basis.
Otherwise, try and get a good nights sleep the week before the test.
Sleep deprivation can increase cortisol levels, which can also affect your blood sugar levels.
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What To Eat Before Your Pregnancy Glucose Test
– Last updated: July 26, 2022
Heres what to eat before a pregnancy glucose test, which foods to avoid, and what happens if you dont pass!
If youre a first time mom you might be nervous to take your first glucose test which happens around 24 weeks of pregnancy.
But, dont fret!
This post will help relieve any fears and help you understand how to prepare and what to expect.
So, heres what to eat before a glucose test, foods to avoid, and what happens if you dont pass!
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Pregnancy Glucose Tolerance Test Results
As the normal range of glucose tolerance test results may vary depending on the lab or clinic, your doctor is the best resource for information and advice on your specific results and recommended next steps. However, these general guidelines may apply:
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If any one of the test results are higher than normal, a new test may be recommended for about four weeks later.
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If two or more of the results are higher than normal, your doctor may diagnose you with gestational diabetes.
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