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Diabetes and Pregnancy Testing at First Visit

New recommendations for testing and diagnosing diabetes among pregnant women….

Currently, recommendations for testing and diagnosing diabetes in women who are pregnant are based on their risk for having the disease. Women who are considered high risk should be tested at the first prenatal visit and if negative, tested again at 24-28 weeks; average risk women should be tested at 24-28 weeks; and low risk women do not require any testing as long as they meet certain characteristics. Based on these recommendations, some believe that cases of diabetes are being missed among pregnant women. This can pose harm to both the mother and the fetus.

To assist healthcare professionals with providing the best possible care, The Endocrine Society published a Clinical Practice Guideline (CPG) entitled "Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline" in the Journal of Clinical Endocrinology and Metabolism. Diabetes specialists and obstetricians contributed to the CPG providing best practices based on evidence-based strategies. The following are recommendations contained in the CPG.

  • All pregnant women who have not been previously diagnosed with diabetes should be tested at their first prenatal visit. The test should be done before 13 weeks’ gestation or as soon as possible thereafter.
  • All pregnant women who have not previously been diagnosed with diabetes should be tested for gestational diabetes by having an oral glucose tolerance test performed at 24-28 weeks’ gestation;
  • Weight loss is recommended prior to pregnancy for women with diabetes who are overweight or obese;
  • Initial treatment of gestational diabetes should be medical nutrition therapy and daily moderate exercise lasting at least 30 minutes;
  • If lifestyle therapy is not sufficient to control gestational diabetes, blood glucose-lowering medication should be added;
  • Women with gestational diabetes should have an oral glucose tolerance test six to 12 weeks after delivery to rule out prediabetes or diabetes;
  • Women who have had gestational diabetes with a previous pregnancy need to be tested for diabetes regularly, especially before any future pregnancies; and
  • Women who have type 1 or type 2 diabetes should undergo a detailed eye exam to check for diabetic retinopathy, and, if damage to the retina is found, have treatment before conceiving.

Practice Pearls:

  • The CPG are evidence-based recommendations from specialists in order to provide best practices for healthcare providers
  • Untreated diabetes can cause harm to both the mother and fetus and should be evaluated early on
  • To reduce the number of missed cases of diabetes in pregnancy, all women should be tested at their first prenatal visit

Journal of Clinical Endocrinology and Metabolism, November 2013