Glucose May Affect More Pregnancies

Jun 23, 09:03 AM

Current Headlines: By Robert Mitchum, Chicago Tribune

Jun. 23--Expectant mothers are warned frequently of the dangers of gestational diabetes. Now, doctors say a wider range of pregnant women may need to be concerned about high blood-sugar levels.

Researchers at the annual meeting of the American Diabetes Association in Chicago on Friday presented data showing that even a moderately elevated glucose level during pregnancy was associated with more cesarean sections and heavier babies, among other complications.

Although most expectant mothers in the United States are tested for glucose levels, only women with blood sugar above a certain point and with no history of diabetes are officially diagnosed with the gestational diabetes. The condition affects about 4 percent of pregnant women.

If gestational diabetes is not treated through diet or insulin, large amounts of glucose can be transmitted to the fetus via the placenta.

In addition to higher birth weight and increased risk of birth complications, high fetal glucose also can trigger increased production of insulin in the fetus, which scientists link with obesity and diabetes as the baby grows up.

The new study sought to establish the effect of less severe levels of blood sugar during pregnancy.

"One of the issues is where on the spectrum of normal to abnormal does glucose in pregnancy begin to have a clinically significant effect on the outcome of the pregnancy," said Boyd Metzger, principal investigator of the study and professor of medicine at Northwestern University. "That's the big unanswered question."

To help answer it, researchers measured glucose levels and pregnancy outcome in nearly 25,000 women from nine countries, including the United States.

They found that women with the highest measured blood glucose were six times more likely to have an overweight baby and 10 times more likely to have a newborn with elevated blood insulin than women with the lowest levels of glucose.

However, women in a range just below established criteria for gestational diabetes were still two to four times more likely to deliver a baby with high birth weight or elevated insulin levels.

"This study will finally give us the chance to reach a consensus in all countries on how to diagnose diabetes in pregnancy," said one of the authors, Dr. Moshe Hod, a professor of obstetrics and gynecology at Tel Aviv University.

Metzger said more discussion will be necessary before any changes are made to guidelines for diagnosis of gestational diabetes and treatment of high glucose levels.

"You can't point to [a] number and say this is obviously the point" of diagnosis, he said.

rmitchum@tribune.com

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