Early diabetes test
beneficial in pregnancies

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By Helen Altonn
haltonn@starbulletin.com

A study of 255 pregnant women in Honolulu shows testing for gestational diabetes at 16 weeks is more efficient than screening for the disease at 28 weeks, doctors involved say.

Gynecologistobstetrician Stephen Wilson conducted the study on his patients for about 1 1/2 years in a project with Dr. Gerard Nahum of Duke University Medical Center and Harold Stanislaw of California State University.

Wilson, on the University of Hawaii's clinical teaching staff, said pregnant women now undergo two blood tests, the primary one at 16 weeks and a second one to test for gestational diabetes at 28 weeks.

He said Nahum, associate clinical professor in Duke's obstetrics and gynecology department, raised the idea several years ago of doing the diabetes test at 16 weeks.

Wilson said he has many Asian patients who are at high risk for gestational diabetes, so he proposed a study to Nahum combining the blood tests at 16 weeks.

He said he felt this would be more efficient, reducing needle punctures for the women and costs to insurance companies, and allowing earlier treatment for women diagnosed with diabetes.

Earlier diagnosis allows time to gather resources and teach the patient about the need for diet and exercise and testing their blood sugar levels, he noted.

Findings of the study were published in this month's issue of the Journal of Reproductive Medicine.

Doctors generally have screened women in their third trimester for diabetes because they believed it would be more accurate later in pregnancy.

But Nahum said screening at 16 weeks "is more sensitive than screening later and allows us to focus earlier on women who are at greatest risk."

Gestational diabetes occurs in 2 percent to 7 percent of all pregnancies in the United States. But the rate is about 10 percent in Asian women, Wilson said. His patients in the study were mostly Chinese and Filipino. Many also were Vietnamese and Laotian, he said.

Six percent to 8 percent of diabetic pregnancies result in birth defects, Wilson said.

Complications include above-average weight gain for the baby that can injure nerves in the baby's neck from a difficult delivery, an increased risk of newborn fractures, higher possibility of fetal distress and possible hypoglycemia, jaundice or breathing problems in the baby.

It is hoped earlier intervention and treatment would reduce those defects, but more studies are needed to determine that outcome, Wilson said.

One of the advantages to early diagnosis, he said, is that patients can be referred to Kapiolani Medical Center for Women & Children or Queen's Medical Center.

They have programs and resources, such as nutritionists, to help pregnant women with diabetes and can monitor the women's blood sugars on a weekly basis, he said.

"If pregnancy diabetes gets out of control, then we can jump in earlier with insulin ... then we can start watching the baby through special ultrasound imaging," Wilson said.

But a much larger study would be needed to determine if earlier diagnosis and treatment of pregnant diabetic women has better outcomes, he said.

Diabetes that occurs during pregnancy usually disappears after the baby is born, but these women may be at greater risk for the disease years later, Wilson said.