Gestational diabetes develops is 7% of the 4 million women who give birth in the United States each year. These 280,000 women are at risk for complications of pregnancy that can cause severe injury to both mother and baby, including death. The American College of Obstetrics and Gynecology (ACOG) has noted that this condition is increasing as obesity and older age at pregnancy become more frequent. Mothers with gestational diabetes are at higher risk for hypertension, preeclampsia, cesarean section and a 7 time increase risk of developing diabetes later in life. Their babies are at increased risk for macrosomia, hypoglycemia, hyperbilirubinemia, birth trauma, shoulder dystocia and Erb's Palsy. ACOG Practice Bulletin No. 137 conclude that the 2 Stage test should be used rather than the shorter 1 Stage test.
The 2 Step diabetes screening procedure entails first administering 50 grams of oral glucose followed by a 1-hour venous blood glucose test. Women who meet or exceed the testing threshold then undergo a 100 gram, 3 hour diagnostic oral glucose tolerance test (OGTT) typically between 24 and 28 weeks gestation. "ACOG supports this recommendation [to keep a 2-step approach] and recommends that before the testing approach and diagnostic criteria for gestational diabetes are changed, implications of such changes should be studied," the new bulletin notes.
Initial management starts with nutritional counseling and exercise. If blood sugar is not controlled with that, pharmacologic treatment with insulin and oral medications is indicated. Careful monitoring with a high risk obstetrician improves the outcomes for both mothers and babies. By minimizing elevated maternal blood glucose during the pregnancy, problems at birth such as shoulder dystocia, Erb's palsy and neurological brain injury can be minimized or avoided altogether. Obstetricians who follow this ACOG guideline optimize the care for their patients.