Glucose Test – Refusing The Gestational Diabetes Glucose Test
Gestational Diabetes – Treatment…
Does it Improve Outcomes?
The entire medical industry has built a huge business around the diagnosis and treatment for Gestational Diabetes fully believing that it prevents fetal deaths, congenital anomalies, newborn complications, macrosomic babies, lessens birth injuries due to macrosomia and decreases c-section rates.
Diagnosis and treatment for Gestational Diabetes has not changed outcomes AT ALL! No more moms or babies are saved with current treatment of GD than without. The death rates, birth injury rates, congenital anomaly rates, everything, have stayed the same.
Today, nearly ALL women with GD, even those whose GD is well-controlled, will have their babies by induction or planned c-section despite NO evidence that this improves outcomes.
Because the standards by which treatment for gestational diabetes is determined are biased against racial groups and do not take the truely diabetic mothers out of consideration, hundreds of women are mistakenly diagnosed with GD. Their pregnancies are then labeled “high-risk” and they are pushed into needless interventions that don’t improve outcomes anyway!
Glucose level in itself is a poor predictor of macrosomia. Other factors such as race, age, number of previous pregnancies, sex, and especially maternal weight, far outweigh glucose intolerance in determining birth weight. Birth weight and glucose are only correlated in babies over the 90th percentile for weight, which typically represents mothers with true diabetes that wasn’t diagnosed until pregnancy. They don’t have GD, they actually have Type II Diabetes!
Late term ultrasound is also notoriously inaccurate as a measure of fetal weight. A one-time late term ultrasound has a measure of error of +/- 2 pounds! That means a baby estimated to weigh 8lbs could it reality weigh as little as 6lbs and as much as 10lbs. In either case, weight is also not a true predictor of which babies will experience birth injuries or be difficult to birth. Too many factors go into the equation, from head circumference and baby positioning to your birthing positions, interventions used, and maternal pelvis size. The only way to know if a baby is “too big” is a trial of labor.
The definition of GD itself is shaky because blood sugar levels rise linearly as pregnancy progresses, meaning that your sugars will and should be higher during pregnancy. The Oral Glucose Tolerance Test (OGTT) has also been abandoned as an indicator of true diabetes because its results are too variable. This is also true of the Glucose Challenge Test (GCT).
In addition, the cut-off scores of treatment for gestational diabetes were arbitrarily determined by the control group (which was flawed) and do not represent the levels under which complications occur.
What should I do if I am diagnosed with GD?
First of all, decide if you even want to be screened. If you don’t have any risk factors and are symptom-free, then consider declining it. Remember, treatment for gestational diabetes does not improve outcomes unless you were truly an undiagnosed diabetic.
Instead of submitting to the GCT, ask for a hemoglobin A1C: it’s a blood test that gives a three-month measure of your sugars over that time. It’s a much better snapshot of what your sugars have done over time than the GCT or OGTT. If they’ve been high during the past three months, then the odds are greater that you do have GD.
If you are diagnosed with GD, work with a nutritionist or dietician to control your sugars. If they are within normal limits, then you have no increased risks of complications and should be treated like any other patient. You may have to undergo Biophysical Profile (BPP) and non-stress tests at the end of pregnancy, but if they are fine there is NO REASON to have an induction or c-section. You should be able to birth freely in whatever position you choose. Also, advocate for food and drink during birth! If your sugars get too high/low, it will impact the baby’s sugars.
Once the baby is born, nurse IMMEDIATELY! This will stabilize the baby’s sugar. Do NOT let anyone take the baby for a blood test right away. By depriving the baby of food right away, they will cause the baby to become hypoglycemic. Also, mild hypoglycemia without any other symptoms isn’t usually cause for concern.
References
Tuffnell DJ, West J, Walkinshaw SA. Treatments for gestational diabetes and impaired glucose tolerance in pregnancy. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003395. DOI: 10.1002/14651858.CD003395
Lamar ME, Kuehl TJ, Cooney AT, Gayle LJ, Holleman S, Allen SR.
Am J Obstet Gynecol. 1999 Nov;181(5 Pt 1):1154-7.
Atilano LC, Lee-Parritz A, Lieberman E, Cohen AP, Barbieri RL. Alternative methods of diagnosing gestational diabetes mellitus. Am J Obstet Gynecol. 1999 Nov;181(5 Pt 1):1158-61.
Goer, H. OBSTETRIC MYTHS VERSUS RESEARCH REALITIES: A GUIDE TO THE MEDICAL LITERATURE. Westport: Bergin and Garvey, 1995.
“Gestational diabetes,” INTERNATIONAL JOURNAL OF CHILDBIRTH EDUCATION. 1991;6(4):1991.
Stephenson MJ. Screening for gestational diabetes mellitus: a critical review. J FAM PRACT 1993;37(3):27-283.
http://www.aafp.org/afp/20031101/1767.html
http://www.aafp.org/afp/20040301/putting.html
Brody SC, Harris RP, Lohr KN. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003; 101:380-92.
Catalano PM, et al. Reproducibility of the oral glucose tolerance test in pregnant women. AM J OBSTET GYNECOL 1993;169(4):874-881.
Keller JD. et al. Shoulder dystocia and birth trauma in gestational diabetes: a five-year experience. AM J OBSTET GYNECOL 1991;165(4 Pt 1)928-930.
The Contrarian Mom 
Hi there – I was just diagnosed with GD and am feeling pretty lousy at the moment. Wondering which article/study specifically supports this statement: “No more moms or babies are saved with current treatment of GD than without. The death rates, birth injury rates, congenital anomaly rates, everything, have stayed the same.” I would LOVE to see this research.
From the small amount of research I have done, chromium can help a lot… research it. And check to see if you are getting 80 grams of protein a day.
My doctor wants me to have an Ipro monitor inserted for 3 days to monitor me. My 1 hour test came back at a 137, and so I took the 3 hour test. Those scores were all normal, but my 2 hour test score was 163, and I was told above 155 is normal.
I have refused my ipro, and my doctor says she refuses to allow me to prick my finger to check my sugars . I purchased a One Touch Ultra at Walgreens and plan to do it myself. I also have an appointment with a dietician.
I am worried I am going to hurt my baby, but because my numbers were so low, with the exception of 1, I thought this monitor was unnecessary.
Thoughts?
If it were me, I would find another opinion or two and go with your intuition (not your fear). A midwife would be really resourceful and be able to give you some advice that you won’t find easily in the medical field. And it is totally fine to change care providers if you decide this is not a right fit for you. Some mama’s change providers a couple weeks before baby is due… Hugs!
Thank you for the information. My Dr is trying to say that I am gestation diabetic. I am now having to test myself at home 4x a day. According to my OB, you can not refuse to take the 3hr glucose test, as I tried to refuse it and was told it is mandatory. This is my second pregnancy. I never had GD with my first, 5 years ago. I am now being told I have to see a diet consult about GD, and they are now wanting me to go and get the NST done twice a week, and the bio physical ultrasound once a week, and on the day that I have both done at once, I have to turn around and see one of the OB’s in the office. I feel as though I am being given the run around. I was not even told the ranges for the glucose levels, so I have no idea. I only have 4 weeks left of my pregnancy left until I have my scheduled c-section (I am unable to have children naturally). Had a c-section with my first. According to almost every one of my ultrasounds I have had though, Baby’s development is a week ahead then where they say I am. I explained that to the OB and he said that, it doesn’t matter about that. That they will deliver the baby on the date that is already been set for the c-section.
Remember it is your body. You are the customer/client. They are a service provider. HUGS!
Thank you for this post! It is nice to know that I am not the only person that sees a problem with this “mandatory” test.
I was highly active before pregnancy, (ran three miles four times a week and did weights at the gym). I’ve stayed in a good weight range, have no family history of diabetes, my bp is consistently low (like 100/60 something), my baby was weighed at 16 weeks and 19 weeks with ultrasound and is right where he should be with regards to weight and growth, I also don’t have excess amniotic fluid. (all which are supposed to point to GD). I see this test as one more defensive medicine test pushed by nervous Obgyns afraid of being sued.
It’s sad to me, being in healthcare myself, and to my husband who is a Dr, that so much of the things we just ‘accept’ as necessary are the product of doctors trying to cover their own butts, not actually for the good of the patients!
I was high risk for diabetes due to family history and hypoglycemia. I actually took the test mentioned above twice…once at 18 weeks and again at 30 weeks. I was not diagnosed with gd until the 30 week test. We attempted to control with diet but my response was so distinctly diabetic that I had to go on insulin shots. However, I was Not pressured to have a c-section. In fact, I know more women who had csections with no gd then with. We were monitored with biophysical tests weekly from 36 weeks on and our doctor recommended we wait as long as possible and let nature take its course. I want to note that our doctor specialized in csections and is top rated for his successful care and delivery via csections. But again he never once pressured us. Our son kicked himself out at 38 weeks and we had natural delivery. I think this article does have good advice in general but I do not think that people should refuse the test. Rather they should be educated about their choices and find a doctor who is reputable and respects the process and holds high risk for truly as necessary cases.
THANK YOU. I refused the glucose challenge when offered. Then I spilled sugar in my urine later and my midwife gave me 2 options: 1-go and take the glucose challenge test and then if positive change your diet to a strict ADA diet or 2-just check your sugars after you eat a healthy ADA diet. I wasn’t about to go drink some sugary concoction when I knew I needed to start avoiding sugar…duh!
I was able to figure out which foods were causing hyperglycemia and ultimately enjoyed a beautiful home birth with a perfectly sized 7 1/2 pound baby. My sugar issues were immediately resolved even before the placenta was delivered, so there was no point in poking my infant to give us a random glucose number.
Unfortunately several of my friends that were diagnosed with GD had no nutritional counseling and they all had C-sections because of their “high risk”. (and I’m still the weirdo for choosing a natural birth)
ps. what have you discovered about tubes in kids ears???
haven’t studied it much… but I definitely would look into what is causing the ear infection…general diet, sugar, milk? And what about getting chiropractor adjustments? And there are some amazing herbs that are super great for bacterial and viral infections… good luck!
ahmen. i searched long and hard for this info when i was preggo. with my naturopaths advice we declined the gross test. funny how this isn’t pushed:( good work!!
So u declined the glucose test and they were fine with it? Like I’m trying to figure out if I can decline it all together. This is my first baby and there are no family history of this.