Early pregnancy diabetes detection

I recently introduced to my obstetric practice the new RANZCOG criteria for screening Early Diabetes Detection in Pregnancyfor diabetes in pregnancy. There is information about this in the Questions & Answers section of my website under the topic ‘Diabetes screening in pregnancy.

Recently a 32-year-old lady booked with me for management of her first pregnancy. I saw her for her first antenatal visit when she was eight weeks’ and five days’ pregnant.

She advised me that her father was a diabetic. This was a sufficient criterion for me to arrange for her to have 75 g Oral Glucose Tolerance Test (OGTT) when she had her routine pregnancy blood tests.

The result was abnormal.

Time                            Plasma Glucose

Fasting                             4.2     mmol/L (abnormal if ≥ 5.1 mmol/l)

1 Hour                              10.3    mmol/L (abnormal if 1 hr ≥ 10.0 mmol/l)

2 Hours                             9.0     mmol/L (abnormal if ≥ 8.5 mmol/l)

Two of her three results were abnormal.

Appropriate diabetes care has been commenced. I anticipate a good pregnancy outcome.

Without the new criteria, there would have been delayed diagnosis. Unless she had significant glycosuria, she would have had a glucose challenge test at about 26 weeks. The result would most likely have been abnormal. She would then have had a 75 g OGTT at about 28 weeks, which would have diagnosed diabetes.

With the new criteria, we have become aware of the diabetes problem about 20 weeks earlier would have been the case!

Posted by Dr Gary Sykes on - Tests in pregnancy

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