Gestational Diabetes and pregnancy outcomes

I got my results from the 3 hour glucose tolerance test last week. I don’t have gestational diabetes. Phew!

But 2 of my 4 blood glucose measurements were pretty close to the cut off, and it only takes 2 of the 4 to be above the cut off to diagnose gestational diabetes. So really, with a slightly different evaluation, I might have gotten a positive result. While my result means I don’t need to start taking my blood sugar or go to a nutritionist and other extra doctor visits, I don’t really think it means I’m free and clear.

Being so close to the cut off made me think, how do they pick that cut off anyhow? Is there a gestational pre-diabetes similar to the adult categorization for people who have high blood sugar but not enough to be called diabetic?

So I did a little research. And what I found was not surprising – the risks for pregnancy outcomes associated with gestational diabetes actually increase along the continuous scale of blood glucose levels.

But this wasn’t always known. Just 2 years ago, a large, multicenter study known as HAPO demonstrated that having high results that aren’t quite enough to qualify as diabetic still results in increased amounts of higher birth weights, c-section births, newborns with high insulin at birth, and hypoglycemic newborns, and other issues. The study, Hyperglycemia and Adverse Pregnancy Outcomes, is available online. 

What’s a bit scary about this is that while the American Diabetic Association (ADA) has updated their guidelines based on the results of the HAPO study, the American College of Obstetricians and Gynecologists (ACOG) hasn’t yet adjusted any of their recommendations. So depending on your doctor, he or she might not tell you if your levels were high but not high enough to diagnose as gestational diabetes.

I always ask for copies of all of my lab results, and they usually come with the reference numbers. That’s how I know that if 2 of my readings had been just 5 points (3-5%) higher, I would have had a different outcome.

Gestational diabetes is usually a very manageable condition, so it’s not that I’m super worried about this. But I like to know the facts, and by my reading, the facts are that I am at a somewhat increased risk of having a large birthweight baby, a c-section, or a newborn with high insulin or hypoglycemia, which puts them at risk for weight difficulties later in life.

It seems the prudent thing to do is to pay more attention to my diet and exercise going forward. I’ve been doing prenatal yoga weekly and walking about 4 miles on weekdays, so I just need to step it up a little bit, and lay off the sweets a bit more. I can do this for me and my baby!


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