Gestational diabetes may be overdiagnosed

http://news.ninemsn.com.au/article.aspx?id=8518753

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Gestational diabetes may be overdiagnosed

00:02 AEST Mon Aug 20 2012

Pregnant women may be at risk of unnecessary medical interventions with predictions up to one in five could be diagnosed with gestational diabetes under proposed new guidelines.

Experts are concerned the new international criteria will lead to significant overdiagnosis of gestational diabetes and the further medicalisation of pregnancy.

The guidelines suggest universal screening using a lower diagnostic criterion and one blood test result, instead of two or more.

One critic of the proposed guidelines, University of Auckland diabetes specialist Professor Tim Cundy, said more women would ultimately be diagnosed if the criteria were lowered.

Another major concern was the high false-positive results associated with the oral blood glucose test, which is already used in diagnosis including in Australia.

He said with more women diagnosed, more pregnancies would be deemed higher risk which could lead to more interventions, including induced labours and caesarean sections.

"It will medicalise a lot of pregnancies that are probably pretty normal," he told AAP.

"The evidence that it will be of overall benefit is very thin.

"I think something of this magnitude will impact very much on the whole experience of pregnancy for a lot of women.

A study published in Diabetic Medicine this year by Prof Cundy concluded the main benefits of treating gestational diabetes were lower birth weight babies and fewer obstetric emergencies involving infants getting stuck in the birth canal.

He questioned whether those benefits justified the mass expansion of the number of women diagnosed with gestational diabetes.

Researcher Ray Moynihan, who addressed the issue in the Medical Journal of Australia on Monday, said labelling well people as sick was problematic.

"There is evidence suggesting that the act of labelling someone can bring harm," he told AAP.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists vice president, Professor Michael Permezel, agreed the blood glucose test could be improved.

He said between three and four per cent more women would be diagnosed with gestational diabetes under the new criteria but research showed those women had better outcomes when treated.

Prof Permezel said studies showed women treated for mild diabetes in pregnancy had less pre-eclampsia - high blood pressure - and fewer caesarean sections.

"It doesn't necessarily lead to more interventions, it can actually lead to fewer caesarean sections," he told AAP.

"Most people realise that including this group with milder diabetes seems to have more positives than negatives."

He said the international guidelines were currently being assessed for their suitability in Australia and New Zealand.

Australian women are already routinely screened for gestational diabetes at 26 to 28 weeks of gestation.

Women diagnosed with gestational diabetes must monitor their diet but only a small proportion require insulin

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Didn't have the test done with DD, won't be having it this time. I already monitor my diet and eat well during pregnancy anyway, if I did have GD and got to the point where I was one of the small amounts of people that needed insulin, one of my HCP's would pick up on those symptoms and we'd act accordingly. I really don't see the big deal in that :dunno:

I saw a similar piece in the Australian this morning. I'm off to test my 1 in 5 chances on Friday. I won't refuse the test because I'd rather enjoy smugly saying "told you so" to the folk who call me high risk.

The question, I think, is whether or not it is currently underdiagnosed? QLD Health seemed to think it was, and have changed their measures recently. At first thought, the article didnt bother me, but I had only thought of improved diet... Not the ensuing interventions. It's a tricky one.

After having my test I'm questioning the results. I scored an 8 which is positive GD.

However what I question is the rules I had to follow which seem unrealistic for a true result.

In 2007/8 I had the test, I could go for a walk and drink water during the test.

This time I was instructed not even a drop of water and they wanted me to lay on a patient bed for the 2 hours. However its unlikely i would take 75g of sugar then lay around for 2 hours. Had I walked for 5 minutes my glucose levels would have been lower and therefore I would have passed.

Until I get my monitor I can't see how correct the results were in diagnosing GD, but it will be interesting to see..... Especially seeing as I'm STARVING!!! All this carb control is hard lol


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Agreed with this for ages. It is totally over diagnosed and I have seen GD babies born beautifully to healthy mothers... babes without any health problems and of normal size. I didn't bother with the test.

Both times I did the test I wasn't allowed to eat, drink or move around. The moving would burn the sugar off.... anyway tested positive first time & negative this time. I just checked my ante-natal card for this time & it says 7.5.... I think my weight loss prior to falling pg had a huge impact on my test being negative this time around - JMO

Interesting article. I'm in my third GD pregnancy (second time on insulin) and have now already had to bump my insulin up from 4 to 9 units in the space of a week because no matter what I was eating for breakkie (even the recommended food) was slowly going from 6's up to 9's. I really tried everything this time, dieting and cutting out carbs and sugars but it left me starving and I actually lost nearly 3 kilos and looked so gaunt in the face. I tried drinking 2 litres of water a day or more and exercising to bring my levels down but in the end the diabetes nurses and endocrinologist at the hospital said that my body is very touchy with food so for bubs I needed to go on insulin, which I agreed straight away as I was so hungry and weak trying to manage a diet of basically vegies and crackers. Since being on it though I have now gone back up to the weight I was and my new diet is keeping me full with all the new foods and extra carbs I can eat now that I have insulin to help me. I have a friend who has been diagnosed with GD with her first pregnancy and she has been managing fine with diet and exercise, her levels are only just above what they allow for pregnancy and I'm sure the recommended levels have changed since I had diabetes last time. I'm sure you were allowed up to 5.5 as your morning level but now it's under 5 this time. The OGTT the last two pregnancies I was not allowed to leave the premises or drink anything, but this time I was allowed to drink small amounts of water but still had to stay in the building. My 2 hour post sugary drink level was 9.8 this pregnancy, last time it was 8. something. This is my last pregnancy too, due to the diabetes and bedroom arrangments in the house lol

I'd also like to to add that both my diabetes babies were small! My son was 3.2kgs at 3 days over due, and my daughter was 3.04kgs at 2 weeks early

Hi y'all :)

I had GD with B1 so with this pregnancy the Ob (public system, different state to where B1 was bord) wanted to test me early so 'we can treat it early as you will definitely ahve it'. When it came back negative I was surprised as I am overweight and have had it before figured I was high risk. Needless to say I was thrilled. The doc howeve just frowned and said 'Oh, we'll test again in a few weeks because you'll definitely have it'. I'm frankly really pi**ed off as I know its not standard procedure to test women endlessly until a postive comes back. I don't want to test again, partly because its difficult to take such a huge chunk out of my work day, but I don't feel like I have a choice.

Anyone else had this experience?

Absolutely you have a choice. You just have to say that you are content with the results of the first test, and won't have another one.

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Absolutely you have a choice. You just have to say that you are content with the results of the first test, and won't have another one.

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Yeah this. You don't have to do any test you don't want to.

Well, I ended up doing the GTT again and lucky I did because my levels came back quite high - 10.9. I already consume little to no sugar, and few carbs outside of fruit and veg so I probably will end up needing insulin again. Buggar.

Oh that sucks blondedoctor :( Fingers crossed it gets better than worse.

Would it be unwise for me to decline this test? What kind of symptoms should I look out for indicating diabetes? I had none last time and my level was 8. something. I was diet controlled only.

Seriously, what are the ramifications if I did have GD and was undiagnosed? I'm afraid of the interventions I might face... don't want to give them reason to call me high risk and start to intervene (interfere). But of course I want baby to be well. :(

I think the main thing that the docs are worried about is a 'larger than normal' baby which nowadays seems to be anything above 9 pounds! There is also considered to be an incresed risk of morbidity for the child, as well as a high risk of the mother developing diabetes beyond the pregnancy. This is what http://www.wdxcyber.com/gestational_diabetes.html says:

How Can Gestational Diabetes Affect My Baby?

Left untreated, gestational diabetes can cause a number of problems at birth. Low or high blood sugar levels as well as jaundice are all possible side effects of babies born from mothers with gestational diabetes.

Furthermore, the American Diabetes Association warns that gestational diabetes also causes extra blood glucose to be circulated through the placenta. As a result, the baby’s pancreas will be forced to work overtime, producing extra insulin to get rid of the excess. This causes what’s leftover to be stored as fat, leading to higher than normal birth weight. For the mother, this will likely mean a more painful birth with a greater chance of cesarean section.

What’s worse is that overweight babies are more likely to be obese in childhood, putting them at greater risk for developing type 2 diabetes. Indeed, contrary to the popular belief that children are primarily at risk for type 1 diabetes (previously referred to as juvenile diabetes), poor lifestyle choices including minimal exercise and poor nutrition has caused more and more to be diagnosed with type 2 diabetes.


I felt the same way and didn't really want to be tested this time, but since my result came back reasonably high I am glad I did. The main intervention I wanted to avoid was being induced as to from my experience that is a gateway to a lengthy mild labour, countless minor interventions and then emergency ceasarean. Luckily when I voiced that to my doc he said to em there is no way they would induce someone who has already had a c-section as it increases the risk of uterine rupture. My doc said either vbac or scheduled c.

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What’s worse is that overweight babies are more likely to be obese in childhood, putting them at greater risk for developing type 2 diabetes. Indeed, contrary to the popular belief that children are primarily at risk for type 1 diabetes (previously referred to as juvenile diabetes), poor lifestyle choices including minimal exercise and poor nutrition has caused more and more to be diagnosed with type 2 diabetes.
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Let's break this down abit. What is their definition of an overweight baby - what weight, and are they talking about birth weight or later weights?

What charts are they using (breastfed only charts or other)? Have they accounted for how the baby is fed?

If it is poor lifestyle choices etc, then obese children could have nothing to do with a mother having 'gestational diabetes'.

actually it is so confsuing, it is hard to make anything concrete out

But studies have shown that inducing GD mums for suspected macrosomia doesnt improve outcomes or reduce incidence of things like shoulder dystocia, only increase the rate of caesarean section.

My grandmother had five children. 10, 10, 11, 12 and 13 pounds. Never had a stitch. Last labour 40 mins. Never had GD either.

Big babies does not equal painful labour or c/s. Leave the women alone and our bodies work just fine thank you.

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But studies have shown that inducing GD mums for suspected macrosomia doesnt improve outcomes or reduce incidence of things like shoulder dystocia, only increase the rate of caesarean section.

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Exactly right - and thats part of the reason why my doc said that doesn't like inducing GD (or other) mums. Plus ultrasounds showing mocrosomia are notoriously wrong!

HotI - they refer to babies over 9 pounds as overweight. Funny because my generation (1970's kids) were often born at 10 pounds plus and don't believe there were any inherrent problems with that. We really have no idea whether GD played a part in that because they didn't fully test for it then; there was a 'sugar' test which sounds like a dipstick in urine type test, nowhere near as precise as the GTT used today, and obviously GD is very fashionable nowadays with the markers for it getting lower and lower, ostensibly to 'catch' more GD cases.

I am really in two minds about the whole thing. With DS1 I took it all as a bit of a joke, but I am taking it more seriously this time. I figure if I am already eating a no sugar, minimal bread, primarily vegan diet with no sweets except fruit, and I still get high BSL's...... then surely my pancreas isn't working like it needs to at this time. I am well aware of the commercialisation of the condition and that really bothers me as I then perversely tend to disregard a lot of the message. I just try and be objective, read a balance of various journal articles, and try not stress too much.

The thought of a scheduled c/s because my baby 'might' be bigger than normal makes me so angry. I will be declining that! To me, that is not a medical indication for intervention. It's a 'just in case' slice n dice. No thanks.

I'm still in two minds about having the test or not. I find a lot of that information quoted very confusing.

I thought macrosomic was over 4.5kg, so 10lb-ish.

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Hi y'all :)

I had GD with B1 so with this pregnancy the Ob (public system, different state to where B1 was bord) wanted to test me early so 'we can treat it early as you will definitely ahve it'. When it came back negative I was surprised as I am overweight and have had it before figured I was high risk. Needless to say I was thrilled. The doc howeve just frowned and said 'Oh, we'll test again in a few weeks because you'll definitely have it'. I'm frankly really pi**ed off as I know its not standard procedure to test women endlessly until a postive comes back. I don't want to test again, partly because its difficult to take such a huge chunk out of my work day, but I don't feel like I have a choice.

Anyone else had this experience?

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I had GD with DS... A lovely score of 9.5 made me the highest out of the 4 people in my "lets learn how to use insulin class" lol
They did tell me that I would be tested with any future pregnancies at 16 weeks, 28 weeks and again at 30 something weeks (if previous are negative) AND I should test every 2 years for the rest of my life!
I was very surprised I had GD as I did not come under any of the high risk factors.
Funny enough I gained 18kg in the first 6 months and once I started insulin only gained another 2kg! DS was a healthy 3kg 2 weeks early.

I am refusing all GTT testing. I have sugar aversion as it is- there is no way in hell I'm drinking 75g of sugar! I doubt I consume that is 2days, let alone 30 minutes. I have offered my GP to take random blood sugar levels only. Both times I had a good breakfast and a piece of fruit before the test (which is as bad as my body ever really sees) and both results were 4.3. The agreance is that if I return a random result over 6.5, we will review GTT testing. I looked at this test as something inherently wrong- my body is never exposed to these conditions and how could I expect it to "perform" when it is not the normal, and when I'm pregnant to boot.