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Optimal blood sugar before you get pregnant

At Women’s Health Practice we advocate a pregnancy planning visit, at which time women are screened for a variety of preventable problems in pregnancy including, for abnormal sugar tolerance as well as diabetes.

Once you conceive, prevention of diabetes is still a critical component of prenatal care. Part of prevention is early diagnosis of insulin resistance as fetal exposure to even small elevations in blood sugar is not thought to be healthy. ACOG (American College of Obstetricians and Gynecologists) and the ADA (American Diabetes Association) have been the two organizations weighing in on the standards that are used.

If you are high risk for diabetes, you can delay progression to diabetes by 70% if you take the proper health steps. This is true if you are pregnant or not.

To delay progression, you have to get that early diagnosis of predisposition. And that is done by sugar challenge testing. The standard plan after a woman is pregnant to then test women at risk early in pregnancy, and then all women at their 28 week visit. The guidelines have been tweaked with over time and there are still some that say to test earlier in pregnany. A newer guideline says doing testing mostly at 28 weeks misses as many as three quarters of all the gestational diabetes. A new guideline suggests that all pregnant women should be tested for diabetes at their first prenatal visit, unless they have already been diagnosed with the condition, according to a new clinical practice guideline from the Endocrine Society.

Women who test abnormal on screening tests have been asked to to do further testing, leading to a two step rather than a one step approach for making the diabetes diagnosis. The Endocrine Society suggested at one point 1-step approach for the testing of gestational diabetes, in line with the American Diabetes Association (ADA) but in contrast to the American College of Obstetricians and Gynecologists (ACOG) and the National Institutes of Health. This 1-step approach uses a lower level of blood glucose to diagnose gestational diabetes and is a subject of contention, with critics saying that it will increase the frequency of diagnosis of gestational diabetes 2- to 3-fold. Because of this we have moved to the ADA test from the ACOG approach, then back to the ACOG test based on best practice evidence. The new tests would use tests that could be drawn fasting or at any appointment, and not just tests done over several hours. Which would make it easier for young moms to comply with diabetes testing.

Overall nutritional assessment is best for a healthy pregnancy, not just diabetes tests, and it’s important to go over this at your prenatal visits. At Women's Health Practice we want you to optimize nutrition, how lean you are, and how healthy you are. Call for consultation 217-356-3736.

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