Pregnant women should be tested for diabetes far earlier, study suggests

Pregnant women should be tested for diabetes much earlier than the current practice of doing so between 24 and 28 weeks, according to research.

Gestational diabetes, a form of the condition that only develops in pregnancy, affects thousands of women in the UK and one in seven pregnancies worldwide. It is the most common medical pregnancy complication and occurs when a hormone made by the placenta stops the body from using insulin effectively, leading to elevated blood glucose levels.

Without treatment, gestational diabetes can lead to high blood pressure, increased risk of caesarean sections, mental health conditions and complications for the baby at delivery, alongside health complications for the mother later in life such as type 2 diabetes and cardiovascular disease.

In England, like many countries, women at risk of gestational diabetes are generally tested between 24 and 28 weeks of pregnancy.

Twenty-eight academics from 13 countries have called for testing and treatment before 14 weeks of pregnancy rather than in the third trimester to prevent complications during and after pregnancy.

Writing in three linked papers in the Lancet, the authors say they conducted a literature review of the evidence and observed that a significant proportion of women had high blood glucose in the first 20 weeks of pregnancy. They had worse pregnancy outcomes compared with women whose gestational diabetes was not present until later in pregnancy. Earlier treatment helped reduce those risks.

Prof David Simmons, of Western Sydney University, the lead author of the series, said there was an “urgent need for a major shift” in the diagnosis and management of gestational diabetes, not only during pregnancy but throughout the lifetime of mothers and their babies.

This would include new systematic approaches to prevention, early treatment and more research to better understand how gestational diabetes affects women and their children during pregnancy and throughout their lives, he added.

Dr Lucy Chambers, the head of research communications at Diabetes UK, said: “Gestational diabetes touches the lives of thousands of women in the UK each year, increasing the risk of poor health for them and their baby, not only during pregnancy but over their lifetimes too.

“This review, showing that detection and treatment in the first trimester reduces some of these risks, stresses the need for better understanding of how this evidence may impact on current antenatal care practices in the UK, where the standard is usually to test for gestational diabetes during the later stages of pregnancy.

“Investing into research to enable improved treatment and support for women with a gestational diabetes diagnosis is a priority, too.”

Amina Hatia, midwifery manager for Tommy’s, the pregnancy research and baby loss charity, said: “Any shift towards early testing is welcome if it means there is better support and the risk and symptoms of gestational diabetes can be better controlled with personalised and specialist care when needed.”