The pregnancy period is a very delicate one for an expectant mother and the fetus inside her. It is therefore, advisable that total necessary care be given to her and the child inside her and the best way she can be cared for, by health care professionals, is for her to harness the opportunity Antenatal period avails her.

In ensuring that adequate Antenatal Care is given to the expectant mother, health care practitioners outlined some particular tests necessarily important for a pregnant woman to do while in her carrying the pregnancy. These routine tests may include:

  • Pelvic Ultrasound Scan
  • Oral Glucose Tolerance test
  • Urinalysis
  • Urine culture and sensitivity test
  • Protein test
  • Hepatitis B and C
  • Weight
  • Fundal height
  • Fetal examination

This article shall be spot-lighting the importance of Oral Glucose Tolerance test, the average value for a pregnant woman, an overview of gestational diabetes and ways to prevent its development.

Oral Glucose Tolerance test is the measurement of body’s response to glucose or sugar, which is the major source of energy for the body.  This test is particularly to determine gestational diabetes while fasting blood sugar test is used to diagnose type 1 and type 2diabetes, and pre-diabetes. A glucose tolerance test can also be used.

Gestational diabetes occurs when a pregnant woman who doesn’t have diabetes before pregnancy has high blood sugar levels as a result of the influence of the hormones, produced by the placenta, on the pancreas during pregnancy. Gestational diabetes can affect the health of both mother and child if not taken care of timely. It usually resolves itself after delivery, returning to normal value. It is, however, important to note that not all expectant mothers develop this condition; therefore, if a pregnant woman had developed it before, she stands the risk of developing it in subsequent pregnancy and type 2diabetes, and should take every necessary medical step to keep it under constant check.

CAUSES OF GESTATIONAL DIABETES

GD usually occurs around the middle of the pregnancy cycle. This is because the main organ implicated, the placenta, does not become actively functional until towards the middle phase of pregnancy there by producing hormones that interferes with the function of the pancreas to produce insulin. Insulin is the hormone that helps to transport glucose into muscle cells. In gestational diabetes, the placental hormones provoke a rise in blood sugar to a level that can affect the growth and welfare of your baby.

RISK FACTORS ASSOCIATED WITH DEVELOPING GD

Gestational diabetes can develop in any pregnant woman, the risk of developing it, however, varies among the women.

Generally, the risk factors may include:

  • Late 20’s: Women in their late 20s are more likely to develop gestational diabetes than those in their early 20s.

 

  • Health history: The risk of developing gestational diabetes increases if a woman has developed pre-diabetes or if a close family member, such as a parent or sibling, has type 2diabetes. There is also every possibility she might develop it if she had had it during a previous pregnancy, if she was delivered of a baby who weighed more than 4.1 kilograms or if she had an unexplained stillbirth.
  • Excess weight: A woman with a body mass index of 30 and above is more likely to develop it, hence the need to constantly check the weight during each ANC visit.
  • Race: Black, Hispanic, American Indian and Asian women are more prone to develop the condition than white women, though the reason is unclear.
  • Having a medical condition associated with the development of diabetes, such as metabolic syndrome or polycystic ovary syndrome

IMPORTANCE OF ORAL GLUCOSE TOLERANCE TEST

This test is important for all pregnant women as it helps to detect the possibility of developing any abnormality during pregnancy such as:

  • Detecting the possibility of developing pre-diabetes and diabetes,
  • The like hood of giving birth to a baby weighing more than 4.1kg, and if she has had such baby before.
  • The occurrence of pre-eclampsia.

It’s important to eat and drink normally in the days leading up to the glucose tolerance test. The woman should let the health care provider know her health status and if she is on any medication as these factors can affect the result of the test.

For eight hours before the test, she is not expected to eat or drink anything. It is sometimes encouraged to fast overnight and schedule the test for early the following morning.

 

The glucose tolerance test is done in several steps. To carry out the test, blood sample will be obtained from the woman. This blood sample will be used to determine her fasting blood glucose level. After which, a syrup glucose will be given to her to drink. The American Congress of Obstetricians and Gynaecologists recommends performing a one-hour blood glucose challenge test to screen for gestational diabetes in low-risk pregnant women between 24 and 28 weeks of pregnancy.

If the doctor determines the woman to be at risk or discovers a suspicious value on the one-hour test, she may be advised to take a three-hour glucose tolerance test.

For the three-hour test:

  • She will be asked to perform a fasting, when she must not have eaten or drank anything for the previous 8 hours. A fasting blood sugar will be obtained.
  • Then she will drink about 237 milliliters (8 ounces) of a glucose solution containing 100 grams (3.5 ounces) of sugar.
  • Her blood glucose level will be tested again hourly for the next three hours after she must have drank the solution.

She will then be required to wait for her result before returning to her normal activities.

EXPECTED NORMAL VALUE

For the three-hour test:

  • A normal fasting blood glucose level is lower than 95 mg/dL (5.3 mmol/L).
  • One hour after drinking the glucose solution, a normal blood glucose level is lower than 180 mg/dL (10 mmol/L).
  • Two hours after drinking the glucose solution, a normal blood glucose level is lower than 155 mg/dL (8.6 mmol/L).
  • Three hours after drinking the glucose solution, a normal blood glucose level is lower than 140 mg/dL (7.8 mmol/L).

If one of the tests is higher than normal, she will likely need to test again in four weeks. If two or more of the tests are higher than normal, then she will be diagnosed with gestational diabetes.

If she is diagnosed with gestational diabetes, complications can be prevented by carefully managing the blood glucose level throughout the rest of the pregnancy period.

PREVENTION

Healthy lifestyle is the key to preventing gestational diabetes. If an expectant mother has had gestational diabetes, these healthy choices may also reduce her risk of developing it in future pregnancies or developing type 2diabetes:

  • Healthy eating: Choose foods that are rich in fiber and low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety in order to achieve the desired goals without compromising taste or nutrition. Avoiding the need to just satisfy the hunger pang or crave.
  • Exercise: Working out before and during pregnancy can help protect a pregnant woman from developing gestational diabetes. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk and running some errands can assist a great deal in achieving the desired goal.
  • Shedding weight: Losing some weight especially before conception is a good way to prevent the development of gestational diabetes.

Focus on permanent changes to your eating habits. Motivate yourself by remembering the long-term benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

REFERENCES

–               American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2015;38(suppl):S8.

–              Diagnosing diabetes and learning about prediabetes. American Diabetes Association. http://www.diabetes.org/diabetes-basics/diagnosis. Accessed Jan. 27, 2015.

–              American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletin – Obstetrics. ACOG Practice Bulletin No. 137. Gestational diabetes mellitus. Obstetrics and Gynecology. 2013;122:406.

–              Coustan DR, et al. Diabetes mellitus in pregnancy: Screening and diagnosis. http://www.uptodate.com/home. Accessed Jan. 27, 2015.

 

–              Diagnosing diabetes and learning about prediabetes. (2015, June 9).

http://www.diabetes.org/diabetes-basics/diagnosis/

 

–              Gestational diabetes. (2015, August).

Gestational Diabetes

 

–              Glucose tests. (2014, December 19).

–              https://labtestsonline.org/understanding/analytes/glucose/tab/test/