All pregnant women should be screened for gestational diabetes but not until the pregnancy has passed the 24th week, according to a new recommendation from the US Preventive Services Task Force (USPSTF) published today in the Annals of Internal Medicine. In 2008, the task force had found insufficient evidence to support routine screening for gestational diabetes in women.
About 6% of pregnant women in the United States develop symptoms of diabetes during pregnancy. In certain populations, particularly minority populations, the rate can be as high as 25%. If left untreated, gestational diabetes increases the risk of poor outcomes for mother and child. Women with gestational diabetes may develop life-threatening preeclampsia, and the fetus may grow unusually large, leading to a complicated delivery and possible injury to the newborn. To avert these problems, nearly all (96%) US pregnant women are currently screened for this condition so that their blood sugar levels may be managed, if needed.
Women who are identified as having gestational diabetes may be advised to increase physical activity, make dietary changes, and monitor their glucose levels. If those steps don’t improve the condition, medications may be prescribed. The USPSTF in 2008 found inadequate evidence to support screening for gestational diabetes before or after 24 weeks, despite the widespread adoption of screening. Other prominent groups such as the American Academy of Family Physicians, the American Diabetes Association, and the Endocrine Society recommend screening after 24 weeks.
But the USPSTF’s new review of the evidence found enough evidence to support the benefits of screening for gestational diabetes after 24 weeks, and the task force has updated its recommendation accordingly. The review did not find sufficient evidence to support screening before 24 weeks, but the report notes that there may be specific circumstances in which a physician may choose to do so. For example, if a woman has risk factors that place her at greater risk, such as obesity or a family history of gestational diabetes, her physician may want to consider earlier screening.