An Israeli research team has come up with what it says are simpler and more accurate ways to screen pregnant women for gestational diabetes, a condition with profound implications for the health of both mothers and their unborn and newborn infants.
The researchers, led by Prof. Moshe Hod of Petah Tikva’s Rabin Medical Center, proposed simple alternatives to the standard oral glucose tolerance test, which is usually administered between the 24th and 28th week of pregnancy and which involves drinking one or measured doses of glucose and then testing blood sugar levels over a period of hours.
They said using either a simple blood-glucose test, without prior oral glucose ingestion, or measuring the size and weight of the fetus, could increase by up to 50 percent the number of cases of gestational diabetes that are diagnosed in the course of pregnancy.
Gestational diabetes often causes complications such as pregnancy-induced hypertension or an exceptionally big fetus, which increases the chances of child obesity. Every year 10,000 Israeli women – accounting for six percent of all pregnancies – are diagnosed with the disease. That rate is low for Western countries.
“Israeli pregnant women are younger and thinner,” said Dr. Ofra Kalter-Leibovici, director of the Unit of Cardiovascular Epidemiology at Gertner Institute for Epidemiology & Health Policy and a member of the research team. “Therefore they are less prone to suffer from gestational diabetes.”
The team’s recommendations differ from those of a landmark study that was published in 2008 in the New England Journal of Medicine. The study, carried out by the International Association of the Diabetes and Pregnancy Study Groups, found that the current glucose tolerance tests fall far short of reflecting the real number of women suffering from diabetes during pregnancy.
It recommended using a single-dose, two-hour glucose tolerance test instead of the variant that can include successive ingestion of glucose and multiple blood tests. This recommendation was adopted by the American Diabetes Association.
Recent studies have shown that mild gestational diabetes can be treated through diet and exercise, with only 10 percent of cases requiring medical intervention.
“General practitioners can diagnose gestational diabetes in most cases,” Kalter-Leibovici said. “These cases should not be treated by obstetricians specializing in high-risk pregnancies, who are unable to see all of these patients.”
The findings of the study led by Hod were recently presented at a conference of the Israel National Institute for Health Policy Research.
“We are not adopting the recommendations automatically,” Hod said. “We examine them according to the findings of Israeli and international studies, and measure potential financial costs. In any event, the findings prove that the modes of diagnosis of gestational diabetes need to change.”
A panel will be set up to devise concrete recommendations that will in turn be submitted to respective panels of gynecologists and diabetes specialists for approval. At a later stage they will require the stamp of the the Health Ministry and the country’s health maintenance organizations.
Another team, this one composed of both Israeli and American physicians, is in the process of developing a mathematical model that would assess the overall cost of the suggested alternatives to glucose tolerance tests.