Bittersweet warning for women with gestational diabetes

A common test to diagnose gestational diabetes – a temporary condition which can harm both mother and child if left untreated – also has predictive power for type 2 adult-onset diabetes, a new Tel Aviv University study finds.

Dr Gabriel Chodick of Tel Aviv University's Department of Epidemiology and Preventive Medicine at the Sackler Faculty of Medicine has proven that women who "fail" the glucose challenge test, a series of four blood tests conducted over a single four-hour period, have a higher chance of developing adult onset diabetes later in life. In his latest research, reported in the journal Diabetic Medicine, Dr Chodick found that nearly half the women who fail all four of the four-part tests, demonstrating an elevated blood sugar level, developed type 2 diabetes within ten years.

Dr Chodick's study statistically proves what has been anecdotally believed by healthcare practitioners in the past. "While doctors take this into consideration, there usually isn't close follow-up in the clinical setting," says Dr Chodick. He says that women in the highest risk group (those who fail all four of the tests) should be given special counselling and intervention to prevent the onset of diabetes, which can greatly diminish quality of life and lead to adverse effects including heart disease, blindness and liver cancer.

An effective warning sign

In the retrospective study, Dr Chodick, Dr Varda Shalev and their colleagues collected data on more than 185,000 women in Israel who took the glucose challenge test, then acquired information from the health registry as to what percentage of these women contracted diabetes later in life.

Dr Chodick and his colleagues ascertained that women who failed all four glucose challenge blood tests had a nearly 50% chance of developing type 2 diabetes within the ten years following the test. Those who failed three of the four tests had a 20% overall chance of developing the disease within the same period.

"This is the first-ever study to show the long-term health of those who failed the glucose challenge test," says Dr Chodick.

Stopping the diabetes clock

While doctors commonly advise that women with gestational diabetes exercise and supplement their diet with fibre and fruit (and, in the most extreme circumstances, take insulin injections), women who take the advice usually have the health of their child in mind, not themselves. After giving birth, they resume adverse eating and lifestyle habits.

Dr Chodick, whose life's work is focused on preventative medicine, hopes to change attitudes and policies through his new study. In the US, Israel and Europe, HMOs are considering the elimination of the glucose battery test from their covered procedures, says Dr Chodick. If so, foetal health may be in danger. The test results also provide invaluable predictive information for women's health in the long run.

Gestational diabetes currently affects 3 to 5% of all pregnant women in the US, and rates are continuing to rise, Dr Chodick says. "It's an epidemic that can be stopped with information and action."

(Source: Tel Aviv University: Diabetic Medicine: July 2010)