Universal diabetes testing at first prenatal visit recommended

The USPSTF recommendations released Monday called for pregnant women to be tested for gestational diabetes after 24 weeks gestation.

The Society agrees that pregnant women who have not previously been diagnosed with overt or gestational diabetes should be tested at this stage of pregnancy. However, the Society also recommends universal diabetes testing for women at the first prenatal visit in its Diabetes and Pregnancy Clinical Practice Guideline published in the November 2013 issue of the Society's Journal of Clinical Endocrinology and Metabolism. The test should be done before 13 weeks' gestation or as soon as possible thereafter.

"Given that many cases of type 2 diabetes are undiagnosed, it's important to ascertain early in pregnancy whether women have this condition," said Ian Blumer, MD, of the Charles H. Best Diabetes Centre in Whitby, Ontario, Canada, and chair of the task force that authored the guideline. "Untreated diabetes poses serious risks to the mother and the fetus, so it is important to reduce the chance of complications through early diagnosis and treatment."

As many as one in five women may develop gestational diabetes -- a form of diabetes that has its onset during pregnancy. However, traditional testing strategies only identify about 25 percent of the cases. Women who go undiagnosed are at an increased risk of having an overly large baby, which can complicate delivery.

When pregnant women are screened for gestational diabetes at 24 to 28 weeks gestation, the Endocrine Society recommends using a one-step testing approach in line with the consensus panel of the International Association of the Diabetes and Pregnancy Study Groups' protocol. This involves pregnant women taking a 75-g oral glucose tolerance test, which is more sensitive and can help physicians diagnose more cases. This differs from the 50-g oral glucose challenge test, which is commonly used in the United States. As the USPSTF noted in its statement, many pregnant women receive this test and are only given the oral glucose tolerance test if the first test yields abnormal results.

"The Society's task force felt the overriding concern of pregnant women was to avoid complications that can harm the fetus," Blumer said. "Using the more sensitive, one-step test supports the goal of early diagnosis and treatment."