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Friday, January 23, 2015

Diabetes in Pregnancy: One Test,Two Tests or Multiple Tests? Or Just Check The Baby?

Everyone in pregnancy will be tested for diabetes through your pregnancy as normalizing blood sugar prevents multiple pregnancy complications. Every time you come in for a check up they dip your urine to see if you are spilling sugar, it is a diabetes test. At other times there are blood tests of sugar, blood tests of your sugar levels that you have had for over three months, and sugar tests that are stress tests for your pancreas by giving you sugar to drink.The World Health Organization began looking at diabetes in pregnancy in a new way. They checked the babies after birth for the amount of sugar they were exposed to. They checked the babies for large birthweight (macrosomia) and for cord blood levels of C-peptide (think of this as a marker for insulin levels). They found that these problems in the babies were associated with single abnormal results on a 2 hour 75 g glucola test. So no more two step testing in pregnancy. In the past we would do a 1 hour test, randomly, and bring people back who didn't pass, for three hour test after fasting. Now we will have to have our patients fast, and come in between 24 and 28 weeks and be tested in a 2 hour test for diabetes in pregnancy. More women will get the diagnosis of diabetes, we are fairly sure of this. And what is important is that effects on mom and baby just from abnormal sugar are virtually eliminated by a tight blood sugar control. And control doesn't necessarily mean medicines, it may mean a change in diet and more exercise if that is possible.

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