Gestational diabetes is a condition whereby the blood glucose levels of the pregnant woman increase. This is due to the fact that in some occasions the hormonal changes that occur can block the action of insulin, and some symptoms can occur in women and in the future of pregnancy and childbirth if that glucose level is not controlled (the baby may be larger, the risk being greater during childbirth for this reason, you may suffer low blood glucose the first days after birth, there is a greater risk of death of the baby, etc).
To know if a pregnant woman is controlling glucose levels well, it is usually done the O'Sullivan Test, which takes place between the 24th and 28th week of gestation, which is done no need to be fasting (unless that day they program at the same time determinations that require it) and that is to give an important amount of glucose to the pregnant woman over 25 years (now I explain this) doing a blood draw one hour later.
When is the O'Sullivan Test
As I said, it is usually done between week 24 and 28 of gestation because it is when hormonal changes can alter the functioning of insulin. Now, according to the protocol, the test can be done on more occasions.
For example, if in a previous pregnancy a woman had gestational diabetes it is not expected in the second trimester, but already in the first, in the first analysis, the test is done in case a high glucose level already arises. They may also do the test in the first and third trimester if there is a family history of diabetes (if the woman's father or mother has diabetes), if the pregnant woman has over 35 years, if there is overweight before pregnancy or if the woman has already given birth to a baby over 4 kg in a previous birth (I say, it depends on the protocol of each center).
Is it the most useful test to diagnose gestational diabetes?
No, because the O'Sullivan Test does not have that purpose. By international agreement it has been accepted as the best test in terms of cost, benefit and effectiveness for rule out gestational diabetes. Come on, that if the results are correct, it is useful to verify that the woman does not suffer from the disease. However, if the results appear altered it is necessary to do a second test that is called Oral Glucose Tolerance Test (TTOG), better known as the "glucose curve", which we will talk about in a few days, which is what can be used to diagnose gestational diabetes.
Should all pregnant women do it?
It is an optional test, although it is recommended because gestational diabetes, as I have explained, increases risks to the pregnancy and childbirth process. According to the latest recommendations, the women under 25 with normal weight and without other risk factors (who do not have a family history of diabetes, who have not had a previous gestational diabetes, who have no previous obstetric pathology and who are not obese) may be excluded from being tested. However, as in our environment the number of pregnant women who meet that criterion is only 7% of all pregnant women, the screening is not being done and the test is being done to all.
What does it consist of
To give the test the pregnant woman is given a solution of 50 g of 25% glucose in 200 cc. An hour after the taking, a blood extraction is performed, with which the blood glucose level is analyzed, or what is the same, how insulin has done its work.
As I have already mentioned, in many centers they have the probability that it is relatively annoying and no need to go on an empty stomach. In fact, it is recommended that before eating the woman eat something, since the fasting glucose solution usually feels pretty bad for many pregnant women, who get dizzy or even vomit before spending 60 minutes of waiting, causing the Try no longer good for anything.
In some centers they give women the preparation to take it at home and go later, at the time, for the extraction. It is an erroneous measure because 60 minutes can be very variable and because at that time the woman may be sitting on the sofa or may be picking up the whole house, the result being logically different. Ideally, the woman goes to the health center to take the preparation and remain there until, an hour later, the test is done (in addition, at that time, you can not eat or smoke).
Possible results of the O'Sullivan Test
The possible test results are:
- Negative: if it is less than 140 md / dl of blood glucose (7.8 mmol / l).
- Positive: if it is equal to or greater than 140 mg / dl of blood glucose (7.8 mmol / l).
If it is positive, the presence of gestational diabetes will be suspected and the TTOG will be performed to make the diagnosis.
Can't it be done differently?
There are women who tolerate the glucose drink from bad to fatal, to the point of vomiting it almost at the time of drinking it. In women like this, obviously, the test must be repeated another day, often getting exactly the same, to vomit it again. It is usually said that "it is what there is", that "you have to do it that way because there is no alternative". However, there is, and could be considered when a woman fails to tolerate the drink or gets very dizzy during that time until the analytical (and later, perhaps).
I'm talking about replace the glucose load with a well-loaded breakfast of hydrates, for example, or to have the woman control blood glucose levels at various times of the day, with a blood glucose control machine, before eating and two hours after doing so, for several days, and then analyze the results (which is the way by which treatments and diets are usually controlled and adjusted to diabetics).
They are not consensual alternatives, but could be used if, as I say, a woman will live an ordeal on the day of the test or, directly, she will not be able to do it repeatedly because she will always vomit it. Everything is to discuss it with the professionals (obstetrician or midwife) and look for a solution that can satisfy both parties.
