Why Early Screening for Gestational Diabetes Matters

If you have been pregnant before or have talked to any of your pregnant girlfriends, chances are, they have talked to you about their experience with their oral glucose tolerance test. You know, that super sweet, sugary mixture you have to drink in a certain amount of time prior to getting your blood drawn. This test is specifically designed to evaluate and diagnose gestational diabetes. The test, which is typically performed during your second trimester-between 24-28 weeks of pregnancy- is often a ride of passage for all expecting mothers.

In the United States alone, it is estimated that between 6-9% of all pregnant women will be diagnosed with gestational diabetes. Some of the complications associated with gestational diabetes including factors that can impact both mom and baby, including: 

• Macrosomia (large for gestational age babies) 
• Preeclampsia and gestational hypertension 
• Preterm labor 
• Increase risk of cesareans 
• Labor and delivery complications, including shoulder dystocia 
• Polyhydramnios- excessive accumulation of amniotic fluid 
• Type II Diabetes development in mom 
• Type I diabetes development in baby
• Neonatal morbidity and stillbirths 

As you can see, gestational diabetes is a serious complication of pregnancy and something that requires immediate attention. Unfortunately, with how the current guidelines are written, most women don’t find out they have gestational diabetes until later in their second to early third trimester. They often are given weeks (sometimes just two weeks) to reverse or manage a disease process that has been happening for months. This can be extremely frustrating and stressful for expecting mothers. The other problem with testing this late in pregnancy is that, unfortunately, when treatment is provided late in pregnancy, it may not have a significant impact on late-stage pregnancy outcomes associated with gestational diabetes.

Although we may not be able to predict every woman who will experience gestational diabetes, there are a few critical risk factors we should be looking for, even prior to pregnancy, that we should consider as “red flags” when evaluating your risk. These patients should not only be evaluated sooner in pregnancy but , they should be treated for their condition way before 28 weeks.

The Importance of History Taking 

During your first prenatal doctor’s visit, chances are, your doctor will be reviewing your personal and family history. They will be asking you questions about your overall health and any factors that may influence your pregnancy. Sometimes, these appointments are long, while other times, they may be more brief. This is where advocating for your health and providing your doctor with as much information about your health as possible can help you receive the care you deserve.

Some of the most important risk factors associated with gestational diabetes that should be mentioned include: 

• History of PCOS 
• Family History of Gestational Diabetes or Type II Diabetes 
• Previous Pregnancy with Gestational Diabetes or Preeclampsia 
• History of Multiple Miscarriages 
• Obesity 
• History of Stillbirth, Macrosomia or Abortion (Lee 2018) 
• Hypothyroidism (Giannakou 2019) 

If you experience any of the above risk factors, we should consider early oral glucose tolerance testing in your first trimester rather than waiting until your second trimester. In fact, although many women assume that gestational diabetes only happens to women with PCOS or other insulin related conditions, gestational diabetes can occur in a variety of other women who may not appear to be at risk, including women with hypothyroidism.

In fact, according to a meta-analysis (Giannakou) released in 2019, researchers found a variety of factors that independently increased the risk of gestational diabetes including: 

• BMI 
• Dietary Iron Intake 
• Snoring 
• Sleep Disordered Breathing 
• Hypothyroidism 
• PCOS 
• Family History of Diabetes 

This helps us understand that not only women with a personal or family history of diabetes should be screened early for gestational diabetes. Another meta-analysis (Li) released in 2020 found that 24 different studies confirmed that there was an increased risk of gestational diabetes associated with advanced maternal age. So again, early testing should be offered to all women of advanced maternal age.

Why Does Gestational Diabetes Happen? 

During a normal pregnancy, every woman will experience fluctuations in their body’s sensitivity to insulin. This occurs naturally due to a fluctuation of hormones released by the placenta that now will favor hormone production for the baby vs. you. This hormone fluctuation towards the baby is absolutely critical to the development of your baby and a normal and important process that happens to all pregnant women. We also will see an increase in all lipids and cholesterol molecules including LDL, HDL and triglycerides, which again, is important to help our body support the development of your baby.

Unfortunately, this natural increase in metabolic pathways, can also lead to an increase in the concentration of circulating proinflammatory molecules (cytokines) which, in turn, can lead to over expression of inflammation mediated pathways. This increase in inflammation can inhibit or alter the normal insulin signaling pathway and lead to an inappropriate insulin response by the body. In other words, pregnancy naturally causes women to become more insulin resistant.

Risk Factor in Preconception That Are Associated with The Development of Gestational Diabetes 

Preconception evaluations are becoming more common practice as more women advocate for hormone and pre-screening testing prior to conception. But did you know, your lab results prior to pregnancy may be an indicator that you should be considered for early testing for gestational diabetes? In fact, here are a few important preconception “red flags” we should be considering when evaluating you during your first trimester.

If, prior to pregnancy, you experienced: 

• Elevated Fasting Glucose 
• Elevated Androgen Levels 
• Low Sex Hormone Binding Globulin (Veltman-Verhulst et al. 2010)
• Elevated Triglycerides 
• Elevated HOMA-IR 

We should be suspicious of the possibility you will develop gestational diabetes during your upcoming pregnancy and should consider performing an early oral glucose tolerance test in the first rather than second trimester.

Why Early Trimester Testing Matters

Although, you likely might not enjoy completing your oral glucose test, especially during your first trimester, when you might be experiencing strong aversions to foods, nausea and vomiting, early testing could significantly reduce your risk of late-term pregnancy complications. Again, the earlier we test, the sooner we can implement effective treatment options that can help women manage and control their gestational diabetes and, most importantly, reduce their risk of experiencing late-term pregnancy complications. Treatment can likely include nutrition and exercise support and guidance, as well as, the use of both medications and supplement support. Advocating for early testing if you are more predisposed to developing gestational diabetes could help optimize both the health of your baby and you!

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About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...