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July 12, 2002

Gestational Diabetes

Question from Cumberland, Rhode Island, USA:

I do not have type�2 diabetes as far as any one can tell, but with my third and fourth babies, my fasting and postprandial blood sugars (which I monitor rather faithfully) both jumped up. I wasn't ill, injured, tired, stressed, etc., so I did a pregnancy test which was positive. What does it mean that someone who doesn't have type 2 diabetes develops gestational diabetes the instant a pregnancy can be confirmed? What hormones are at interplay here? Certainly it wasn't because the baby was drawing great nutritional demands at only days past conception! My pre-pregnancy A1c was 4.6%, my pre-pregnancy fasting post-prandial blood sugars were normal.

Answer:

It is unusual for gestational diabetes to be detected so early. This leads me to believe that you have mild glucose intolerance. When you are not pregnant everything is fine, but the least bit of stress (such as pregnancy) may be enough to cause some elevations in your blood glucose values. However, before the diagnosis of gestational diabetes is confirmed, I would suggest that you take the glucose tolerance test. If if is normal now, then it should be repeated at 24 weeks.

OWJ

[Editor’s comment: Please remember that home glucose monitoring should not be used for the diagnosis of diabetes. Testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal. See Classification and Diagnosis of Diabetes for further information.

Occasionally, lab blood sugar testing might be normal in an early case of diabetes (or in a pregnant woman who is developing gestational diabetes), repeat blood sugar testing at the same or a different time, or performing a glucose tolerance test, would be appropriate if there is a high suspicion of diabetes despite normal initial testing. Home glucose testing, if done, might be positive, as it apparently was in your case, which would make the situation more urgent to get lab testing done to confirm the abnormal results.

WWQ]