Early diagnosis of gestational diabetes in high risk women reduces complications

20 November 2017 | Pregnancy | Research and clinical trials

Screening women at high risk of gestational diabetes early in their pregnancy reduces the overall risk of complications for their baby, including preterm birth and stillbirth, new research from the Royal Women’s Hospital has found.

The research is being presented at the Women’s Research Week which begins today.

A study of 769 patients at the Women’s found that women at high risk of developing gestational diabetes who were tested and diagnosed early in their pregnancy were less likely to have babies who experienced complications, compared to low risk women diagnosed with routine screening later in their pregnancy. The benefits were a reduced risk overall of newborn complications including preterm birth, stillbirth, hypoglycaemia, admissions to neonatal intensive and injury during birth.*

Accessing early treatment also resulted in the high risk group having no increased risk of having big babies, pre-eclampsia or caesarean section which are common complications for women with gestational diabetes, compared to lower risk women diagnosed later in the pregnancy.

Women who had experienced previous gestational diabetes, were overweight, women of some ethnic backgrounds**, were older mothers, or had a family history of diabetes were considered high risk and were offered early testing. Thirty-percent of women were diagnosed in early pregnancy.

The study’s lead researcher, Erin Clarke, said once diagnosed with gestational diabetes, patients were provided support, treatment and advice to manage their diabetes primarily through diet and exercise.

“All pregnant women are screened from 24 weeks’ gestation for gestational diabetes, but women identified as high risk receive screening in the first trimester as early as 8 weeks’ gestation,” Ms Clarke said. “This research shows there is a significant benefit to high risk women receiving an early diagnosis, with the pregnancy having the same or better outcomes compared to lower risk women diagnosed later in the pregnancy.

“It is important that we understand the best diagnosis and treatment options for these high risk women, as there are growing numbers of women falling into this group as more women choose to delay motherhood and more women are overweight.”

High risk women often develop gestational diabetes earlier in pregnancy before routine screening occurs. Identification of these high risk women allows for earlier treatment.

Women who have undiagnosed and unmanaged gestational diabetes are at increased risk of having a large baby, pre-eclampsia, birth trauma to mum and baby, stillbirth, haemorrhaging, hypoglycaemia in the baby and their babies being admitted to neonatal intensive care.

“Recent research from the Women’s Diabetes in Pregnancy Clinic has shown the most problematic complications, such as having a large baby, are avoided by effectively managing the gestational diabetes, particularly through diet and exercise,” Ms Clarke said. “Large babies are responsible for many of the other complications associated with gestational diabetes and it is reassuring for mothers to know they can do something to help their baby if they are diagnosed with gestational diabetes.”

Background

*Composite outcomes are the collective group outcomes of preterm birth, stillbirth, hypoglycaemia, admissions to neonatal intensive and injury during birth. Due to sample size conclusions cannot be drawn for individual morbidity.

*Women of some ethnic non-Caucasian backgrounds, particularly of South Asian or South-East Asian backgrounds, are at higher risk of developing gestational diabetes.

Of the 769 women involved in the study, 133 women were diagnosed with gestational diabetes before 24 weeks’ gestation. The remainder were diagnosed during routine screening at 24-28 weeks into their pregnancy.