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NICE targeted screening to identify gestational diabetes: who are we missing?

NICE targeted screening to identify gestational diabetes: who are we missing?

Click here to read our paper published in the British Journal of Diabetes. We explore whether we should screen all pregnant women or only at-risk women for gestational diabetes.

Delighted to see this Brighton and Sussex Medical School and ERimNN student research project in print. Congratulations Dr Canel Kucuk and many thanks to Dr Ali Chakera for vital support and to the fab diabetes antenatal team at Brighton and Sussex University Hospitals Trust🤓
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Gestational diabetes causes elevated blood glucose. This can occur in pregnancy due to increasing demands for insulin and insulin resistance due to increased hormones from the placenta
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Women are screened at 24 – 28 weeks. Current UK guidelines recommend only women at risk are screened for GDM(family history T2DM, ethnic origin at higher risk of DM, BMI over 30, persistent glucose in urine or previous large baby). However, other international guidelines advise screening all pregnant women
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It is important to diagnose GDM early so women are supported to keep blood glucose levels in target. They are taught how to monitor blood and advised on reducing total carbohydrates and improving diet quality. Some women need medication in addition
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For baby, this reduces the risk of being born too big, which reduces the risk for pregnancy and birth complications.

For pregnant women GDM increases risks for Type 2 diabetes later in life. This offers an opportunity for preventative intervention advising on healthy foods, increasing activity and to promote breastfeeding if this is what women want to do. Women are then advised to have yearly diabetes screening for life
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For this study, we screened all pregnant women. We found that a third of women who were diagnosed with GDM would not have been screened following UK NICE guidelines, which means they may have not been diagnosed or their diagnosis may be delayed.
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Within this group of women who wouldn’t have been screened following UK NICE guidelines some still required medication in addition to dietary interventions and also had equivalent mild adverse outcomes such as baby hypoglycemia (This happens if mums blood glucose is too high at the birth). Although there is a risk of more serious complications if GDM is undetected as unknowingly the women will continue to have high blood glucose through pregnancy.

Larger, multicenter studies are warranted to investigate further.

Elaine Macaninch

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