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October 22, 2007

Diagnosis and Symptoms, Gestational Diabetes

Question from Roanoke, Virginia, USA:

I am expecting a baby girl so my ob/gyn ordered a one hour glucose test around week 28. My result came back at 166 mg/dl [9.2 mmol/L] so I was asked to do the three hour test. Here are my results: fasting - 100 mg/dl [5.6 mmol/L]; one hour - 179 mg/dl [9.9 mmol/L]; two hours - 142 mg/dl [7.9 mmol/L]; and three hours - 105 mg/dl [5.8 mmol/L]. The nurse who called me said I passed the test with one value over normal. By curiosity, I asked her for all the results and later looked online to see how far off I was. I am concerned because the second value is so close to the abnormal reading of 180 mg/dl [10.0 mmol/L] or higher after one hour. Shouldn't I have been told that I was borderline? Doesn't this make me positive for gestational diabetes? After all, it is not just one result close to the abnormal, but the combination of two results (one almost abnormal). Additional information that may be helpful: I am considered a bit overweight. Before my pregnancy, I was 5 feet, 10 inches, 190 pounds.

Answer:

Technically, your doctor is correct in stating that you do not have gestational diabetes. However, your concern is legitimate regarding the borderline test results. One option would be to retest you at 32 weeks since about 30% of women with borderline results will develop overt gestational diabetes later in the pregnancy. The other option would be to go ahead with some dietary adjustment, which is the first step in managing gestational diabetes. For this, I suggest that you ask your physician for a referral to a nutritionist for specifics. Essentially, the “diet” is one of low fats and more protein and complex carbohydrates, not necessarily reduced calories. Then, a follow-up fasting and post meal glucose testing may show normal values.

OWJ