WebMD Health News
Louise Chang, MD
Feb. 26, 2010 -- In response to research confirming that even small
elevations in blood sugar during pregnancy can lead to sick
babies, an international panel of experts is recommending sweeping changes in
how gestational diabetes is diagnosed.
If adopted, the changes would mean that in the future two or three times as
many pregnant women would be diagnosed and treated for gestational
About 5% of pregnant women in the United States receive a diagnosis of
But Northwestern University Feinberg School of Medicine Professor of
Metabolism and Nutrition Boyd Metzger, MD, says closer to 15% of pregnant women
and their babies would benefit from treatment.
“Current recommendations for the diagnosis of gestational diabetes are
designed to identify women at risk for developing diabetes after pregnancy,”
Metzger tells WebMD. “But we now know that many low-risk women with blood sugar
levels considered normal in the past are at risk for having overweight babies.”
High-birth-weight babies have an increased risk for obesity and diabetes
later in life, and women carrying large babies are at increased risk for
premature delivery and C-section delivery.
Findings from a seven-year, international study led by Metzger showed that
even modest increases in blood sugar during pregnancy raise the risk for
complications to mothers and their babies.
More than 23,000 women who took part in the trial were followed for nearly a
decade. The study was published in May 2008.
Several months later, diabetes experts from across the globe met to consider
the clinical implications of the findings and this meeting led to the new
Under the proposed guidelines, a fasting blood sugar of 92 or
higher, a one-hour glucose tolerance test reading of 180 or higher, or a
two-hour glucose tolerance test of 153 or higher would meet the criteria for
“Any one of these would be enough to make the diagnosis,” Metzger says.
He says that at these levels, the risk of having an overweight baby
or developing pregnancy-related high blood
pressure doubles and the risk for early delivery increases by 40%.
The consensus panel recommendations appear in the March issue of the
American Diabetes Association (ADA) journal Diabetes Care.
But it is not clear if the ADA or the American College of Obstetricians and
Gynecologists (ACOG) will endorse the proposed guidelines.
An ACOG spokesperson tells WebMD the group does not comment on
recommendations by other organizations.
Carol J. Homko, PhD, of the ADA, says the recommendations may overwhelm
already struggling obstetrics practices.
Homko is an associate professor of medicine with a joint appointment in
obstetrics and gynecology at Temple University in Philadelphia. She also served
on the ADA’s Gestational Diabetes Mellitus workgroup.
“I worry that these practices may not have the resources to suddenly double
or triple their gestational diabetes caseload,” she says.
Metzger says most women with mild gestational diabetes can be successfully
treated with dietary and other lifestyle changes and will not need drugs or insulin.
But Homko points out that even lifestyle modification usually requires close
medical supervision to be successful. She says there is also little consensus
on the type of diet
women with gestational diabetes should follow.
Metzger recommends a diet that balances protein, carbohydrates, and fats and is very low in
Lois Jovanovic, MD, counsels her gestational diabetes patients to eat a very
Jovanovic, who is CEO and chief scientific officer of the Sansum Diabetes
Research Institute in Los Angeles, supports the new recommendations.
“If we don’t do something, more and more women are going to have big, sick
babies and these babies will be the next generation of the type 2
diabetes epidemic,” she tells WebMD.
SOURCES:Metzger, B.E. Diabetes Care, March 2010; vol 33: pp 676-682.Boyd E. Metzger, MD, Tom D. Spies Professor of Metabolism and Nutrition,
Northwestern University Feinberg School of Medicine, Chicago.Carol J. Homko, PhD, American Diabetes Association Gestational Diabetes
Mellitus Workgroup; associate professor of medicine, Temple University School
of Medicine, Philadelphia.Lois Jovanovic, MD, FACE, CEO and Chief Scientific officer, Sansum Diabetes
Research Institute; clinical professor of medicine, University of Southern
California-Los Angeles Medical Center.News release, Northwestern University News.ACOG Practice Bulletin, Gestational Diabetes.
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