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Do you find it difficult to sort through all of the health information coming at you from the television, radio advertisements, Web sites and articles in magazines and newspapers? It’s tough to know if the information is valid. Sometimes it’s even inaccurate and misleading.
Did you know there is a great service right here at MSU called Healthy E-Mail where you can sign up to receive weekly e-mails with patient-oriented, evidence-based medical information from high-quality studies on numerous and varied topics of interest to both consumers and health care providers?
This service is made available by the Office of the University Physician-Health4U program. To learn about the service, including how to sign up and view archives of past e-mails, go to https://healthyemail.msu.edu/
To give you an idea of the type of information available to you via the Healthy E-mail Service, we’re pleased to provide text from a sample Healthy E-Mail below (with special thanks to and permission from the Health4U office!)
Healthy E-Mail Topic: Gestational Diabetes
The Question:
Is screening all pregnant women for diabetes the best approach?
A Closer Look:
A woman with gestational diabetes may or may not have the usual symptoms associated with diabetes such as increased thirst, hunger, and urination. Since these are symptoms common in pregnant women, recognizing that there may be a problem with diabetes can be challenging. This is one of the reasons why women have their urine checked at each prenatal visit. Any woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include:
- Age. Women older than age 25 are more likely to develop gestational diabetes.
- Family or personal history. The risk of developing gestational diabetes increases if:
- you have pre-diabetes, your blood sugar is higher than normal, but not high enough to be called type 2 diabetes;
- A close family member, such as a parent or sibling, has type 2 diabetes;
- you had it during a previous pregnancy;
- you delivered a baby who weighed more than 9 pounds;
- you had an unexplained stillbirth.
- Weight. You're more likely to develop gestational diabetes if you're overweight before pregnancy.
- Ethnicity. For reasons that aren't clear, women who are African-American, Hispanic, American Indian or Asian are more likely to develop gestational diabetes than are other women.
Once the baby is delivered and the mom’s physiology changes back to “normal”, the high blood sugar goes away as well.
The U.S. Preventive Services Task Force (USPSTF) is the organization which reviews and makes recommendations for medical screening tests. This organization recently evaluated current research on screening for gestational diabetes to determine if pregnancy outcomes are better for women who are screened compared to women who do not participate in screening. It is known that treating gestational diabetes does reduce the risk of delivering a large baby; however there is not enough information to know if there are other benefits from screening.
Results of the review indicated that there is not enough good, current research to determine if there are additional benefits to screening for gestational diabetes.
One identified risk of screening was a high rate of false positive results on the initial screening test. This means when a woman had further testing it showed that the woman did not have gestational diabetes. This false positive risk is an inconvenience, and possibly causes short term anxiety for the woman; however it dose not cause long lasting harm.
The USPSTF has stated that more good, evidence-based research is needed on this screening test to identify other risks and/or benefits that may be associated with the screening.
Take Home Message:
At this time, the USPSTF recommends that screening for gestational diabetes is a decision that should be left up to the physician and the pregnant woman.
Editorial Comment:
The MSU Healthwise Knowledgebase has excellent information on gestational diabetes. Visit the www.healthwise.msu.edu and enter Gestational Diabetes in the search box.
While the USPSTF has no recommendations for gestational diabetes screening, the test is not harmful. If the screening test shows high blood sugar, a different test is done to confirm the result. If the second test confirms gestational diabetes, treatment is needed.
The treatment for a woman diagnosed with gestational diabetes is controlling the blood sugar level in a normal range, if possible, through diet. Blood sugar level control is achieved through:
- Blood sugar monitoring. You may need to check your blood sugar level multiple times a day to make sure your blood sugar stays within a healthy range. This can be done in your own home with a home blood sugar monitor.
- Diet. Eating the right kind and amount of food is one of the best ways to control your blood sugar level. This often means more fruits, vegetables and whole grains. Consultation with a registered dietitian or a diabetes educator is a good way to create an appropriate individual meal plan.
- Exercise. Exercise lowers your blood sugar level by transporting sugar to your cells where it is used for energy. Exercise also increases your sensitivity to insulin, which means your body may require less insulin to transport sugar to the cells. Regular exercise can help prevent some of the discomforts of pregnancy, such as back pain, muscle cramps, swelling, constipation and difficulty sleeping. Exercise can also help prepare you for labor and delivery. With your health care provider's OK, aim for 45 minutes of moderate aerobic exercise on most days of the week. If you haven't been active for a while, start slowly and build up gradually. Walking, cycling and swimming are often good exercise choices during pregnancy. Water exercise may be the easiest exercise during late pregnancy. Ordinary activities such as housework and gardening also count.
- Medication. If diet and exercise aren't enough, you may need insulin injections or oral medications to lower your blood sugar level.
The baby will need close observation, too. The baby’s growth and development can be monitored by ultrasound evaluation.
There are no guarantees when it comes to preventing gestational diabetes for any woman, however the more healthy habits you can adopt before pregnancy, the better. Any woman considering pregnancy should:
- Eat healthy foods. Focus on a healthy variety of fruits, vegetables, whole grains, and proteins. Additional calcium and iron may be needed to maintain the nutritional demands from both mom and baby.
- Be physically active. Aim for 30 minutes of moderate physical activity a day. For example a brisk daily walk, bike ride, or lap swimming. If you can't fit in a long workout, break it up into shorter sessions spread throughout the day.
- Maintain a healthy weight. Focus on permanent healthy changes to your eating and exercise habits. Motivate yourself by remembering the longer term benefits of a healthy lifestyle, such as a healthier heart, more energy and improved self-esteem.
Research Quality Grade: 5=D
Research Quality Grades: (1) = A+, (2) = A-, (3) = B, (4) = C, (5) = D *
*Quality of Evidence
(1) I: Evidence obtained from at least one properly randomized controlled trial. Well-designed and well-conducted meta-analyses were also considered, and were graded according to the quality of the studies on which the analyses were based (e.g., Grade I if the meta-analysis pooled properly randomized controlled trials). Please also note: occasionally randomized controlled trial studies may be given a lower grade due to other issues in the research design.
(2) II-1: Evidence obtained from well-designed controlled trials without randomization.
(3) II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
(4) II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.
(5) III: Opinions of respected authorities, based on clinical experience; descriptive studies and case reports; or reports of expert committees.
Reference and Further Reading
U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008; 148:759-765.
USPSTF
The information contained in the abstracts is not a personal health recommendation. You should consult your own healthcare provider about decisions involved in your care.
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