Gestational diabetes is a big issue we should be aware of! But does that mean we need universal screening of all pregnant women, and are oral glucose drinks (called “Glucola”) our best – or only – option for testing?
A few notes to start:
Diabetes or gestational diabetes testing is mostly routine in the U.S. That means that pretty much every pregnant woman is subject to this testing.
The American Diabetes Association presents a list of low risk women who should not need the glucose test.
The word diabetes was decided to be used instead of something sort of less serious like glucose intolerance- so that insurance companies would cover costs. Gestational diabetes is very different from what we know as true diabetes. (For example;Type 1 diabetes is an illness. It’s serious and can be serious in pregnancy.)
The most common method of screening for gestational diabetes in the United States is the 50-gram, 1-hour glucola test, also called the glucose challenge test. This test was first introduced in 1973. To take glucola test, you eat a normal diet beforehand. Then you drink 50 grams of a glucose polymer solution. One hour later, your blood is drawn to measure the glucose level (O’Sullivan, Mahan et al. 1973). If your blood glucose is 130-140 mg/dL or higher, then you have screened positive for gestational diabetes, and you qualify for a follow-up 3-hour oral glucose tolerance test (OGTT) to officially diagnose the condition. The 75-gram and 100-gram OGTTs are the gold-standard for diagnosis of gestational diabetes.
The potential adverse effects are nausea (30%), vomiting, bloating, diarrhea, dizziness (11%), headache (9%), and fatigue (Lamar, Kuehl et al. 1999). The main drawbacks of using this test are the un-pleasant nature of the exam and the cost.
The U.S. Preventative Health Service does not recommend routine screening (2008), citing insufficient evidence for this practice.
When the researchers compared women who received treatment with GDM to those who received no treatment:
- There was no statistically significant difference in C-sections
- The C-section rate was 29% overall
- Inductions were higher in the treatment group
- Women treated for GDM had more prenatal visits
- There were no differences in anxiety, but there was less postpartum depression in the treatment group (1 study)
- There were no differences in small for gestational age between groups.
- There were no differences in NICU admissions between groups.
- There was no increased risk of neonatal hypoglycemia with treatment
- If you are in your first or early second trimester, consider a Hemoglobin A1C test. It is a simple blood test that doesn’t require you to ingest anything prior. While there is no set level that determines gestational diabetes (there are levels for non-pregnancy-related diabetes), done early enough in pregnancy it can determine whether you already had undetected diabetes before even becoming pregnant, and a level of 5.45% may be associated with gestational diabetes, in which case you can make dietary changes and wait until 24-28 weeks gestation, when the glucose challenge and GTT are typically done, and then decide whether to test.
- Consider an excellent diet and random glucose testing. This just requires finger stick blood testing which can even be done by you at home, and is a commonly used alternative for women who can’t tolerate the Glucola. However, one test result alone is not enough to diagnose or rule out GDM, so you’ll want to work with your doctor or midwife to come up with a reasonable schedule for testing and assessing your results.
- Consider “The Jelly Bean Test.” This test, which has you eat 28 jelly beans, which also provide 50 grams of sugar, has been popular amongst midwives for decades, and now there are GMO-free and naturally-colored brands to choose from. While some data suggests that the results are not entirely as reliable as using the oral glucose test drinks, an article published in a major obstetrics journal states that jelly beans are a reliable alternative that are actually preferred by women and have fewer side effects.
- Tell your provider you want to drink organic OJ at 50 grams instead
I ask you to read and take charge of your birth. Would you consider an alternative?