Your pregnancy: That glucose test


Tuesday, March 28, 2017

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RESEARCH shows that between two and five per cent of expectant mothers develop gestational diabetes, which makes it one of the most common ailments in pregnancy. Cognisant of this, and particularly since the condition rarely presents any symptoms, consultant obstetrician and gynaecologist at ICON Medical Centre, Dr Keisha Buchanan, recommends that all mothers-to-be should take a glucose test.

"One of the most common complications that affect pregnancy in Jamaican women is diabetes, commonly called "sugar", and so blood glucose or blood sugar testing is essential to detect this complication," Dr Buchanan said.

She explained that while development of the condition during pregnancy is more common, diabetes may be present in women before pregnancy (pre-gestational). In both instances, however, and particularly if developed during the first trimester, the condition has the potential to wreak havoc on the foetus. It can lead to the following: spinal cord defects that can cause paralysis; facial and lip defects such as cleft palate; shortened limbs; heart malformations, and defects of the penis (hypospadias).

"On the other hand, diabetes that develops later in pregnancy can lead, if uncontrolled, to large babies, traumatic birth to the baby, tears to the mother’s vaginal passage, heavy bleeding, higher risk of Caesarean section, and higher risk of sudden unexplained stillbirths. Also, in general, children of diabetic mothers have a higher risk of diabetes and obesity," Dr Buchanan explained.

She advised that either O’Sullivan’s Test or a Fasting Oral Glucose Tolerance Test (OGTT) can be administered, generally between the 24th and 28th weeks of pregnancy. The results will provide valuable information that can guide mothers-to-be and their doctors how to protect their foetuses against complications.

"The O’Sullivan’s Test involves the patient drinking a glass of glucose (50mg) diluted in water, and the blood test is done one hour later. A glucose of 7.8 mmol/L or higher will require further testing such as the OGTT. By far, most women will test negative for the O’ Sullivan’s and will require no further testing. If the woman is diagnosed with diabetes after the OGTT, hospital admission may be required, and following this, regular testing [must be] done to ensure optimal health of the mom and her foetus," Dr Buchanan explained.

She pointed out that the best way to prevent abnormalities is to have the blood sugar under control, especially in the first six weeks of pregnancy when the organs of the foetus are developing.

"A blood sugar of four to seven millimoles per litre is ideal to prevent malformations, and in some cases hospitalisation may be necessary to keep this in check. Also, these moms-to-be will be encouraged to embrace a different lifestyle, and in particular a different diet. Some ladies may need to be placed on insulin to help get the blood sugar levels normal to assist with achieving this," Dr Buchanan advised.

She noted that for women who get diabetes later in pregnancy, blood sugar levels usually return to normal about 48 hours after giving birth. However, there are some exceptions.

"If the glucose remains high after one week post-delivery, those women may have developed permanent diabetes, and these patients will need long-term management of their diabetes by their physicians. However, regardless of the result of the first test, the glucose is tested again six weeks post-delivery, and annually onwards," Dr. Buchanan advised.

She recommended that women who are considering getting pregnant should have their blood glucose controlled. She also recommended frequent screening for women who are at high risk for diabetes – such as obese patients, those who have siblings or parents who are diabetic, as well as pregnant women who show the following symptoms: excessive thirst, frequent urination, excessive hunger, severe vomiting in pregnancy, and recurrent bladder infections.

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