The International Association of Diabetes in Pregnancy Study Group has has made new recommendations for the diagnosis and classification of hyperglycemia is pregnancy. Rather than the current 2 stage screening and diagnostic tests used now, the Association suggests that women undergo one test for gestational diabetes, a 75 gram 2hour oral tolerance test. Also, the condition of a large for gestational age infant would now be factored into the diagnosis.
The suggested change is partly based upon evidence from two well done medical studies that indicate diagnosis and treatment of even mild gestational diabetes is associated with improved pregnancy outcome.
For years we have seen women who we believed were gestational diabetics but failed the very rigid test now given. Often these women were carrying babies that were large for gestational age and based upon that and being diabetic would have had reason for a cesearian section. In many cases a trial of labor was allowed because gestational diabetes was not diagnosed. In many cases as a result of the serious risk factor of gestational diabetes and a big baby there was a shoulder dystocia ending in permanent brachial plexus injury that could have been avoided with a cesearian section.
The new guidelines have not been adopted yet and are not wanted by the obstetricians. The major reason why is that the diagnosis of gestational diabetes would move from the current level of 5% to 18%. The obstetricians are concerned that it would lead to more cesearian section deliveries.
On the other hand, how many deliveries would be spared shoulder dystocia and how many brachial plexus injuries could be avoided. with the more broad diagnostic criteria.
For women that are pregnant it may be worth discussing this with your obstetrician.
Ken Levine
617-566-2700
Klevine@Klevinelaw.com
http://www.Klevinelaw.com