Scientists have warned in a recent study that tests for diabetes in pregnancy are taking place too late. If left untreated, gestational diabetes can increase the risk of stillbirth and other complications.
Gestational diabetes is common. It affects up to 18 in every 100 pregnancies. Most babies are born normally and healthy but the condition increases the likelihood of a large baby, due to the extra sugar in the bloodstream which acts as ‘baby fuel’ leading to rapid growth inside the womb. This can create difficulties in delivery and cause babies to suffer bone fractures. They can also be at a higher risk of obesity and diabetes in later life.
Screening usually takes place at 28 weeks but the University of Cambridge study recommends that it should be brought forward to 24 weeks, which would still be consistent with the existing guidelines.
The study, of 4,069 women, revealed excessive foetal growth had already started by 28 weeks. Women testing positive for gestational diabetes at the 28-week stage were twice as likely as other mothers to have an abnormally large foetus. Mothers who were obese as well as having gestational diabetes had five times the risk of a large foetus.
In addition to bringing forward the screening to 24 weeks, there are suggestions of carrying out a second, earlier, screening test for early onset of diabetes, but that needs further research. There were no signs of large babies at 20 weeks.
Dr Daghni Rajasingam, from the Royal College of Obstetricians and Gynaecologists, said: "This study emphasises the importance of early detection and diagnosis. There is growing awareness for the need to screen earlier, but further research should assess the ideal timing of screening and the impact this has on the child's health. It is important to emphasise that immediate changes to lifestyle, including a healthy diet and moderate levels of exercise, can have significantly positive effects on a woman and her baby's health.”
Janet Scott, from the stillbirth charity Sands, commented: "We know from recent enquiries that failure to screen for gestational diabetes currently plays a part in a significant number of potentially avoidable stillbirths at term. Good risk assessment is crucial to avoid harm to mothers and babies and we welcome these important findings which have real potential to inform better antenatal care for these high-risk pregnancies."
Rebecca Morgan, an associate in the clinical negligence team at Penningtons Manches LLP, added: “We see a number of clinical negligence claims each year arising from complications relating to diabetes in pregnancy. It is important to raise awareness of the potential dangers of diabetes and that care continues to be prioritised as the implications of poorly managed diabetes can be very serious.”