The glucose tolerance test (blood sugar test) in pregnant women
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Gestational diabetes (diabetes gravidarum) occurs in one in twenty pregnancies. It is a form of diabetes that usually develops after the twentieth week of pregnancy and in most cases disappears after the pregnancy has ended. Gestational diabetes can, among other things, cause the baby to become too big and overweight, which can cause complications during delivery. It is important to detect gestational diabetes as soon as possible so that the necessary measures can be taken to reduce the risk of complications. This determination is made by means of a glucose tolerance test. This is a measurement of the blood sugar in the pregnant woman's blood before and after taking a glucose drink. When the blood sugar level is too high, the glucose is processed too slowly by the body and there is gestational diabetes.
What is gestational diabetes?
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Gestational diabetes is a form of diabetes that occurs in about one in twenty pregnancies. This temporary form of diabetes often develops after the twentieth week of pregnancy and usually ends after the pregnancy has ended. The hormones that the body produces during pregnancy inhibit the action of the hormone insulin. Insulin is produced in the pancreas to convert the glucose present in the body as a building material for body cells. In a normal pregnancy, the pregnant body makes extra insulin to keep the blood sugar stable. In a woman with pregnancy sugar this does not happen, because of this the amount of glucose in the blood remains too high after eating. The baby also receives this too high concentration of sugar via the placenta. This causes the baby to grow faster than normal and can lead to complications. Delivery may be more difficult and may require a Caesarean section. Also, due to the strong fluctuations in the blood, the maturation of the baby's lungs can be slower. If the insulin output is still high in the last phase of pregnancy, this can lead to low blood sugar in the baby after delivery. It may be necessary to provide the baby with extra nutrition or, if necessary, with extra insulin. It is important for both the mother and the baby to detect pregnancy sugar as early as possible so that necessary measures can be taken to keep glucose levels as stable as possible to avoid complications.
When to be referred for a glucose tolerance test?
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When an obstetrician or gynecologist thinks that there may be an abnormality in the sugar metabolism of the pregnant woman, she is referred for a glucose tolerance test. Risk factors and suspicions of getting gestational diabetes are when:
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How does this glucose tolerance test work?
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A laboratory test is required for the diagnosis of gestational diabetes. This takes place in the hospital at the outpatient clinic for blood collection. The test usually takes place between the 24th and 28th week of pregnancy. If there was gestational diabetes in previous pregnancies, the test can take place as early as week sixteen or eighteen. If it appears that later in the pregnancy the baby is growing too fast or there is too much amniotic fluid in the womb, the test can also take place after the 28th week. At the agreed time, the woman reports sober to the outpatient clinic for the blood collection. The lab technician will draw blood through the arm. After this, the woman will receive a sugar drink with 75 grams of glucose, which must be drunk within a few minutes. This amount of glucose in the drink is determined by the World Health Organization. After taking the sugar water, the woman has to wait in the waiting room for two hours. She should not exert too much effort and no smoking, eating or drinking is allowed. Another blood sample will be taken two hours after consuming the sugar drink. Immediately after taking this sugar drink, the glucose level in the blood will be high, but after 2 hours the blood sugar level should drop to a certain value. If this value has not decreased sufficiently, the glucose is processed by the body too slowly and we speak of gestational diabetes.
The result and the continuation of the glucose tolerance test
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The blood sugar value is measured in mmnol per liter and indicates the number of millimoles of glucose per liter, the amount of sugar in the blood. The result of the test is positive when two hours after the glucose challenge, the blood sugar value is above 7.8 mmnol / l. This means that when the glucose value is <7.8 mmnol / l, the blood sugar value is normal and there is no pregnancy sugar. When the result shows that the woman has pregnancy sugar, the follow-up program is started.
Diabetes nurse
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After the diagnosis of gestational diabetes, there will be a referral to the diabetes nurse. This will give the woman nutritional advice with regard to an even distribution of the glucose load of the different meals. The aim will be a fasting value of <5.9 mmnol / l and a value of <7.8 mmnol / l, one and a half to two hours after a meal. After an explanation of the blood glucose meter, the woman is given it to take home, with the advice to make a day curve of the blood glucose values that are measured with the blood glucose meter via blood from the finger at different times during the day. A new appointment will take place after approximately 2 weeks. When the values are found to be normalized, the woman can continue to be treated by the diabetes nurse and the midwife.
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Gynecologist and internist
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If it appears that the values are still too high, a referral is made to the internist and it may be examined whether it is necessary to use medication. This medication will consist of injecting insulin. The injection of insulin is an indication for the check-ups and delivery to take place in hospital, under the supervision of a gynecologist. He will regularly make a growth ultrasound to check the birth weight of the baby, in order to reduce the risk of complications as much as possible. Early detection and proper medical supervision will ensure that most babies born to a woman with gestational diabetes will be born healthy. Once after delivery, the blood sugar level will usually be stable again within 24 hours.