When Should Pregnant Women Test for Gestational Diabetes?

According to the American Diabetes Association, approximately 10% of pregnant women experience pregnancy-related diabetes. Given the somewhat common nature of this condition, standard procedure calls for mothers to get screened during the second trimester of pregnancy. At this prenatal visit, expectant mothers are given an oral glucose-tolerance test (OGTT) to make sure their bodies are processing sugar. Abnormal results could signify the mothers are experiencing gestational diabetes, which can cause complications for both mother and baby if not treated properly.

Recently, there has been renewed discussion about the most effective time to conduct the screenings. Crystal Phend reports in MedPage today, “the confluence of rising maternal age and overweight and obesity among women — the two strongest factors for gestational diabetes — has led professional societies to call for screening high risk women for hyperglycemia early in pregnancy.” In fact, as early as 2013, the American College of Obstetricians and Gynecologists suggested that screening should occur earlier in pregnancy.

Two trials have sought to determine whether this change of protocol improves the health of women or their newborns.

First, Jauk et al. conducted a trial to see what kind of impact early screenings would have. Their findings, reported in the American Journal of Obstetrics and Gynecology in 2020, revealed that earlier screenings did not affect the outcome for the baby or the mother. Unfortunately, this trial included too few participants and therefore does not carry enough statistical weight to draw definitive conclusions or to create new protocols.

Second, Simmons and colleagues conducted a randomized trial that included 802 women in Australia, Austria, India, and Sweden. While their findings suggest earlier screenings may have some benefits, particularly to the newborn child, these benefits are not considered significant enough to merit changing protocol.

Simmons’ research found some evidence that women who are tested for, diagnosed with, and treated for gestational diabetes in the first trimester improve the health of their newborns. “Immediate treatment significantly reduced the composite incidence of adverse neonatal outcomes­—preterm birth, birth trauma, high birth weight, respiratory distress, phototherapy, stillbirth or neonatal death, or shoulder dystocia—to a rate of 24.9% compared with 30.5% among those whose treatment depended on confirmation as usual after repeat OGTT at 24 to 28 weeks’ gestation.” The early intervention did not, however, improve maternal outcomes.

It is entirely possible that women with specific risk factors may be better served by testing for gestational diabetes earlier in their pregnancies than what is now recommended. These studies offer important information and underscore the need for further investigations to make an informed decision that puts the health and well-being of mothers and their newborns at the forefront.

We’re keeping an eye on these developments, so that we can provide the most up-to-date information and support to our clients. If you’ve got questions, don't hesitate to contact our experienced lawyers, and schedule a free consultation. Call 216-687-0900 or contact us online today.