Think Before You Drink: A Closer Look At Glucola

Heather Dessinger

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what is the gestational diabetes test


“Now, remember to eat lots of protein, missy” . . . and don’t forget those vegetables. Healthy fats are essential, of course, and don’t skip meals! You dutifully nod your head, and then look down at the bottle of glucola that’s just been handed to you.

All of a sudden you’re in a “choose your own adventure” story. Which path will you take? What are the risks and benefits of this test?

Today I’m going to share my personal process in deciding whether or to take the oral glucose challenge test (OGCT). Please keep in mind that as I wrote in my posts on the vitamin K shot and Group B Strep, “Best Boo-Boo Kisser South Of Puckett’s Gas Station” is about as official as things get for me professionally. I am not a doctor, this is not medical advice, and your decision is completely up to you. If you need some convincing on this, read my full disclaimer where I say it over and over again.

Okay, let’s jump in!

What is gestational diabetes? ^

Most doctors say we don’t really know why gestational diabetes happens, but there is a theory out there that makes a lot of sense to me personally, and it’s this:

Before modern conveniences like grocery stores, people ate what grew in their backyard. Our ancestors’ staples were sometimes starch heavy (like the maca root consumed by Peruvians), and other times they were more fat and protein-based (like the Inuit).

Our bodies do an amazing job adapting to whatever’s available, but there are certain things we all need to thrive. Glucose is a particularly essential nutrient for babies, but in some regions it can be scarce. According to this theory, our bodies adapted to the risk of scarcity by giving our babies preferential access to it during pregnancy.

How does that work? As Chris Kresser has observed, “Pregnant women are naturally insulin resistant.” In other words, increased insulin resistance is a “totally normal physiological mechanism” that increases throughout pregnancy. (source 1, source 2)

You see, normally when we eat carbs, they convert to glucose, which circulates in our blood. In response, our body releases insulin which pulls the glucose out of the blood and puts it into our cells, where it is used for energy. However, when we’re pregnant that insulin response is dampened, which essentially keeps more glucose in the blood so that it can be transferred to the baby through the placenta.

Unfortunately, sometimes blood sugar levels go too high, and that’s not good for mom or baby. It may be because we have access to more carbs/sugar than we used to historically, but other factors may play a role as well: stress, autoimmune issues and sleep deprivation for example. (source) When our blood sugar reaches unhealthy levels we have hyperglycemia, or gestational diabetes.

What are the complications of gestational diabetes? ^

Glucose is a nutrient that helps babies grow, so as you might imagine too much of it causes them to grow larger than normal for their gestational age. According to this study of over 25,000 women, the complications associated with gestational diabetes are:

  • Babies that are larger than normal for their gestational age. It’s important to note here that according to Dr. Brian M. Casey “70-80% of overgrown infants are born to women WITHOUT GDM [gestational diabetes].” (Source: Evidence Based Birth) So gestational diabetes is not the main cause of “big babies,” but it can be a cause.
  • Increased C-section rates
  • Shoulder dystocia or birth injury. Because baby is bigger than normal, their shoulders may get stuck in the birth canal during delivery.
  • Neonatal hypoglycemia (Low blood sugar)
  • Fetal hyperinsulinemia (A “condition in which there are excess levels of insulin circulating in the blood than expected relative to the level of glucose.” (source) In other words, the baby is used to receiving large amounts of glucose and has adjusted his/her insulin production accordingly. When the amount of glucose available drops after birth, the baby ends up with too much insulin.)
  • The need for neonatal intensive care
  • Newborn jaundice
  • Preeclampsia

Does GD increase the risk of infant death? No. According to the researchers, there is no association between gestational diabetes and infant deaths.

However, mothers who develop gestational diabetes do have an increased risk of developing type 2 diabetes later in life. (source)

Am I at risk? ^

As Dr. Romm writes, “According to the American Dietetic Association, pregnant women with any of the following characteristics appear to be at increased risk of developing gestational diabetes; the risk increases when multiple risk factors are present:

  • Personal history of impaired glucose tolerance or gestational diabetes in a previous pregnancy
  • Member of one of the following ethnic groups, which have a high prevalence of type 2 diabetes: Hispanic American, African American, Native American, South or East Asian, Pacific Islander
  • Family history of diabetes, especially in first-degree relatives
  • Pre-pregnancy weight ≥110% of ideal body weight or BMI >30 kg/m2, significant weight gain in early adulthood and between pregnancies, or excessive gestational weight gain
  • Maternal age >25 years of age
  • Previous delivery of a baby >9 pounds (4.1 kg)
  • Previous unexplained perinatal loss or birth of a malformed infant
  • Maternal birth weight >9 pounds (4.1 kg) or <6 pounds (2.7 kg)
  • Glycosuria at the first prenatal visit
  • Medical condition/setting associated with development of diabetes, such as metabolic syndrome, polycystic ovary syndrome (PCOS), current use of glucocorticoids, hypertension”

Women who have the following characteristics are at low risk for gestational diabetes:

  • Less than 25 years old
  • Weight normal before pregnancy
  • Member of an ethnic group with a low prevalence of GDM (According to the Mayo Clinic, “women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.”)
  • No known diabetes in first-degree relatives
  • No history of abnormal glucose tolerance
  • No history of poor obstetric outcome (Source: American Diabetes Association)

What are the signs and symptoms of gestational diabetes? ^

  • Sugar in urine (revealed in a test done in your doctor or midwife’s office)
  • Unusual thirst
  • Frequent urination
  • Fatigue
  • Nausea
  • Frequent infections of bladder, vagina and skin
  • Blurred vision

Obviously, some of these symptoms are common to pregnancy even without the presence of gestational diabetes, so they cannot be used exclusively to diagnose GD.

So how do we test for gestational diabetes? ^

Normally, a woman is given “glucola”- a drink that sometimes contains an ingredient banned in other countries. The point of the test is to see how well a woman’s body handles and influx of 50 grams of glucose over the course of an hour, but obviously many women object to drinking it. If you’re considering glucola, here are some ingredients commonly found in the drink that you may want to research before deciding. . .

Common Ingredients In Glucola ^

Brominated vegetable oil

This product, which is also approved as a flame retardant, is banned in the European and Japan.

According to Aviva Romm, a midwife and MD who specializes in the health and wellness of pregnant mamas, “Research has found that brominated flame retardants build up in the body and breast milk. BVO leaves residues that accumulate in body fat, the brain, the liver, and other organs. Studies in animals demonstrate that BVO is transferred from mother’s milk to the nursing infant. BVO has been associated with heart lesions, fatty changes in the liver, and impaired growth and behavioral development, and both animal and human studies have linked BVO to neurological problems, fertility problems, changes in thyroid hormones and precocious puberty.”

In addition, the vegetable oil of choice is often soybean, which is one of the top eight most common allergens.

Modified food starch

Like autolyzed yeast extract and hydrolyzed protein, this is a cousin of MSG.

Food Dyes such as FD & C yellow #6, Red #40

Chemical food dyes pose a “rainbow of risks” – cancer, hyperactivity, and more. Children seem to be especially vulnerable to them, and yet manufacturers still use them in products consumed by children (or in this case, babies). Well, not everywhere, of course. Manufacturers use natural food dyes in other countries because the risks of synthetic dyes are acknowledged there.

Dextrose

This is corn sugar, which is most likely derived from GMO corn. Though it hasn’t yet made the top eight allergens, the number of individuals allergic to corn is rising.

“Natural” flavoring

Though derived from natural sources, these flavorings are made in a lab. I guess we have different definitions of what natural means.

Other possible ingredients to look into: sodium hexametaphosphate, butylated hydroxyanisole (BHA), and sodium benzoate. (There are likely more, but this is the list I compiled after calling a diagnostic lab for help locating the ingredients in just one formula.)

Glucola may cause side effects like nausea, vomiting, bloating, diarrhea, dizziness, headache and fatigue. (source) Just what everyone needs during pregnancy! Of course, we’re all going to weigh the pros and cons of this drink differently, but I think one of the most important questions to ask is . . .

How accurate is the gestational diabetes test, anyway? ^

A common misconception is that the oral glucose challenge test (OGCT) given to most women offers a definitive answer on whether or not gestational diabetes is present. In reality, it is a SCREENING test, not a DIAGNOSTIC test.

It has a 76% sensitivity rate, which means that for every 100 women that have gestational diabetes, the glucose screening test will only identify seventy-six. That means twenty-four pregnant moms will think everything is within range, when in fact they have elevated blood sugar levels. (source 1, source 2)

On the flipside, 24% of women who test positive for gestational diabetes don’t actually have it, so unless they insist on confirming with the oral glucose tolerance test (OGTT) they will be labeled as high risk for no reason and may be subject to unnecessary interventions and medical procedures.

Another problem with the OGCT/OGTT, is that “you could ‘fail’ a test in week 28 that you would have ‘passed’ had you taken it in week 24.” (17) This is because blood glucose values rise as pregnancy advances, but no adjustments are made for this.

And not only does what week you take the test matter, what time of day can affect the result as well. This study found that our response to oral glucose is tied to our circadian rhythm, and unless our rhythm is impaired we will do better on the test at 8am rather than 4pm. As you can see, there are a lot of things that can sway the results.

Now let’s say a mama gets her test done as soon as it as offered, and she schedules the test for 8am. The test comes back positive and is confirmed with an OGTT. Is it really confirmed? That’s an interesting question, which we’ll explore in the next section.

I’m paleo and I failed the test. Why? ^

I’ve recently heard about several paleo moms failing the OGCT test, which I thought was odd. After all, hasn’t the paleo diet been shown to be very effective in managing (and even sometimes reversing) diabetes?

Though it’s impossible to know the details of every case or speak definitively without double blind studies, here’s why I think the OGCT test may not be a “one-size-fits-all” diagnostic tool:

As we talked about earlier, different societies have subsisted on different staples, some which were carb heavy (which would produce large amounts of glucose in the body) and some which were low carb (which would yield smaller amounts of glucose).

What if our bodies adapt our glucose tolerance to match our diet? We know that hyperinsulinemia (too much insulin) can occur when the body expects large amounts of glucose, prepares for large amounts of glucose, and then receives less glucose than expected. The body is anticipating future needs based on past food intake.

What if the opposite is also possible? For individuals who consume fewer sugar/carbs than the standard modern diet, wouldn’t the body adjust by producing less insulin based on expected glucose load? When those individuals are given 50 grams of glucose, should we expect their bodies to handle just like a person who eats a typical modern diet?

Or to pose this question in a more interesting way . . .

What would happen if we gave African bushmen (and women) a bottle of glucola? ^

Thanks to neurobiologist and obesity researcher Dr. Stephan Guyenet, we know the answer to that question. In this post, he compares how well the Tukisenta of Papua New Guinea, African Bantu, Native Americans of central Brazil, and iKung African Bushmen handled the OGTT – the diagnostic glucose tolerance test.

The first three groups were given 100 grams of glucose (which is twice the amount given to pregnant women during the OGCT) and passed the test with flying colors. All three groups ate a diet that was very high in carbohydrates.

The last group – the iKung – typically eat a low-carb diet. When given just half the amount of glucose that the other groups received, they failed the test. Though the researchers said that they consumed adequate amounts of carbs prior to the test, Dr. Guyenet says:
“Acknowledging that prior carbohydrate intake may have played a role in the OGTT results of the San, [the researchers] made the following remark:

a retrospective dietary history (M. J. Konner, personal communication, 1971) indicated that the [San], in fact, consumed fairly large amounts of carbohydrate-rich vegetable food during the week before testing.

However, the dietary history was not provided, nor has it been published, so we have no way to assess the statement’s accuracy or what was meant by ‘fairly large amounts of carbohydrate-rich vegetable food.’ Given the fact that the San diet typically ranges from moderately low to very low in carbohydrate, I suspect they were not getting much carbohydrate as a percentage of calories.

Looking at the nutritional value of the starchy root foods they typically eat in appendix D of The !Kung San: Men, Women and Work in a Foraging Society, they are fibrous and most contain a low concentration of starch compared to a potato for example. The investigators may have been misled by the volume of these foods eaten, not realizing that they are not as rich in carbohydrate as the starchy root crops they are more familiar with.

You can draw your own conclusions, but I think the high OGTT result of the San probably reflect a low habitual carbohydrate intake, and not pre-diabetes.” (source)

So what are we supposed to think about this? Personally, it makes sense to me that the first three tribes passed the OGTT test – they were healthy individuals whose bodies were used to handling significant quantities of glucose. From what we know, the iKung were also very healthy individuals, but their bodies were not used to large amounts of glucose. Does failing the test mean they were diabetic? I don’t think so. I think their bodies had just adapted their glucose tolerance to match their diet.

Some moms who failed the OGCT requested a different type of test to confirm or rule out gestational diabetes. In the cases I’ve read, it turned out they did not have gestational diabetes. More on the alternative test later on in this post.

Who should be tested? Can I refuse this test? ^

According to Dr. Romm, “Tests should be done on the basis of individual risk. It’s rare that a test needs to be universally done – meaning that everyone gets it, pretty much no matter what. And healthy women should not be bullied into getting tests, as many pregnant women report happens when the 24 week mark rolls around signaling their doctor or midwife that it’s time for glucose testing.”

The American Congress of Obstetricians and Gynecologists (ACOG) affirms an individualized approach, saying that their guidelines “should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice.” (source 1, source 2)

They also affirm your right to refuse the test if you wish to. In their own words, “Pregnant women’s autonomous decisions should be respected. Concerns about the impact of maternal decisions on fetal well-being should be discussed in the context of medical evidence and understood within the context of each woman’s broad social network, cultural beliefs, and values.

In the absence of extraordinary circumstances, circumstances that, in fact, the Committee on Ethics cannot currently imagine, judicial authority should not be used to implement treatment regimens aimed at protecting the fetus, for such actions violate the pregnant woman’s autonomy.” (source)

What are the benefits of testing for gestational diabetes? ^

Obviously, the most important reason it that it may help identify gestational diabetes if present. The rate of diabetes – both in pregnant and non-pregnant individuals – is rising in our nation, and it’s definitely something we need to be aware of.

Something to keep in mind is that the recommended treatment for mild cases of gestational diabetes is typically to eat healthy, balanced meals (without going carb crazy), exercise, and monitor blood sugar. After evaluating their risk factors (or lack thereof), some people opt not to take the test because they have already made the two primary lifestyle changes that would be recommended.

However, because even slightly elevated blood sugars may have a detrimental effect, many of these women choose to test their blood sugar at home at different times of day to make sure it’s consistently within range.

What are the downsides of the OGCT test? ^

You could get a false negative, which could deprive you of helpful guidance in terms of nutrition and lifestyle. Or you could get a false positive, which would place you unnecessarily in a high-risk category. As patients, we need to be aware that a diagnosis of gestational diabetes can change the trajectory of our pregnancy. 

As Dr. Dekker writes, we “cannot underestimate the effect of ‘labeling’ women with GDM. The label of GDM has a profound effect on how healthcare providers treat women.”

Doctors tend to fear shoulder dystocia, which is associated with GD, so they are more likely to push for a c-section. They’re also more likely to recommend induction unnecessarily for a suspected “big baby,” which can result in a baby needing admission to the NICU. (As I mentioned earlier, 70-80% of “big babies” are born to moms without gestational diabetes.)

For this reason, I would personally would absolutely insist on confirming my diagnosis and discussing options thoroughly with my healthcare provider.

Are There Alternatives To Glucola? ^

Yes, there are. Here are some suggestions from Dr. Romm:
1. “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.

2. 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.

[Note from Mommypotamus: Several paleo mama’s have reported that after receiving a preliminary diagnosis of gestational diabetes from the OGCT test, they opted for this method rather than the OGTT and it was determined that they did not have diabetes.]

3. 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.” (source)

[Note from Mommypotamus: Here is a link to the study mentioned. Depending on the jelly bean you may need to consume more or less. The point is to equal 50 grams. These instructions call for 28 Brach’s jelly beans, which would equal 54 grams of sugar according to this site. However, it seems that with these natural jelly beans, you’d need to eat 54 jelly beans to equal 50 grams of sugar.

What About Juice? ^

Orange, apple and other juices are a combination of glucose and fructose. Though both are simple sugars, fructose does not stimulate insulin the same way that glucose does. (source) Because the goal here is to measure the body’s insulin response to glucose and we’re not exactly sure how much is contained in a glass of juice, I think one of the other methods is likely to be more reliable.

What Did You Do, Heather? ^

Using juice instead of glucola, I did the challenge test during my first pregnancy. At first we thought I failed, but then we realized I consumed far more sugar I was supposed to. Oops! Once we sorted through all that, I passed with flying colors. Of course, later on I realized that juice may not be an appropriate substitute for glucola, so I don’t really consider that test valid.

With my next two pregnancies, I discussed my risk factors with my midwives. Other than being over twenty-five I have none at all. Given my medical history and lifestyle (which included a mostly paleo diet with rice and potatoes added in), I opted out of testing. My urine samples were always negative for sugar during all three of my pregnancies. If I had been spilling sugar, of course I would have followed up with more testing.

My care providers were comfortable with my choice, and I personally didn’t feel the OGCT was accurate enough to rely on. (Especially since I don’t eat a modern super-high carb diet). I could have gone with at-home glucose monitoring, but given the fact that I had no symptoms associated with the condition, no sugar in my urine and no risk factors other than age it seemed like overkill. I gave birth to three healthy babies at home.

Would I do it the same way again? Honestly, probably not. Based on what I’ve learned, I would opt for the HbA1c (hemoglobin A1c) test described by Lily Nichols, RDN, CDE, CLT in this post on managing gestational diabetes with real food. It’s done during early pregnancy and is 98.4% accurate, which is significantly more accurate than the OGTT. If those results came back all clear, I would continue to monitor as I have in previous pregnancies, which was to measure sugar in urine. If the test suggested a concern, I would have followed up with at-home testing monitored by my healthcare provider.

Did you drink the glucola? Why or why not? ^

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About HEATHER

Heather is a holistic health educator, herbalist, DIYer, Lyme and mold warrior. Since founding Mommypotamus.com in 2009, Heather has been taking complicated health research and making it easy to understand. She shares tested natural recipes and herbal remedies with millions of naturally minded mamas around the world. 

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54 thoughts on “Think Before You Drink: A Closer Look At Glucola”

  1. I did the glucola test in my first pregnancy, and was borderline, but was referred to the Diabetes Clinic.

    On my second pregnancy, I was more informed, and opted out, and did option 2 of the alternatives you listed.

    Both babies came out normal weight and healthy. Looking back, I wish I hadn’t done the test the first time, but you live and learn.

    Thank you for putting this information out there for first time mothers who aren’t sure what they should do.

    Reply
  2. I’m so glad you wrote this post. I had gestational diabetes even though I only have one of the risk factors (I was 31). My nurse-midwives frustrated me with their assumptions that my diet was at fault, and I find that in general that’s what most people believe. There’s a What to Expect article floating around that blames gestational diabetes on overeating, etc. I had been gluten free and off and on casein free for 7 years and was at peak health at the beginning of my pregnancy. I do eat sugar, but my diet is far and away better than the average American diet. My sister also had gestational diabetes with both of her pregnancies and she was on the GAPS diet before and during her pregnancy. I was not overweight, she was underweight. The common denominators between us are autoimmune issues and we both had our gallbladders out in our twenties. The medicine I had to take for the GD caused phantom gallstone pain and never really helped my numbers. It was a miserable three months of checking blood sugar four times a day and documenting everything I ate. In the end my son was born full term at 8 lbs. 8 oz. and not macrosomic. The kicker is that he is now allergic to all the primary foods they made me eat on the GD diet – dairy, eggs, and chicken. And I can no longer tolerate oats which they told me to eat every day. I think if we’re blessed with another baby I will refuse the test and just ask to eat a balanced diet, rotating foods, and randomly sampling my blood sugar.

    Reply
  3. I had a big baby with my second, though no other symptoms of GD (increased urination, increased thirst) and baby had no problems at birth or after. With my third I got standard prenatal care but refused the GTT. The {hospital} midwife said that I could do blood draws after meals but it wasn’t really important. The nurse was more ‘concerned’ due to my 2nd’s size, but it didn’t make a whole lot of sense to me that she was concerned due to size alone when I had no trouble birthing a baby that big and he was healthy.

    My 3rd was average size and again healthy at birth and continues to be healthy.

    Reply
    • regarding hgbA1C blood test. This test is NOT an alternative to the 50 gram glucola or the 100 gram 3 hour test.
      The A1c will show the average blood sugar over the last 3 months. The problem with this- is gestational diabetes has highs and lows, it’s the highs that we are concerned about here. The glucose test will show how high the sugar levels are getting. The A1C is just showing the average which would never be able to diagnose gestational diabetes. You’re kidding yourself if you think this is an alternative. ACOG does not recommend HgbA1C as an alternative and the glucola testing is the gold standard.
      Even if you get the A1C test- your midwife or Doctor will still need to treat you as though your an undiagnosed diabetic and we have to start fetal testing at 32 weeks. Which means every week- you will need NST’s and BPP ultrasounds.
      Also- after your baby is born- the nursery will have to poke your baby’s heel and check the blood sugar for the first 24 hour to ensure the sugar isn’t really low to cause a seizure.
      And GDM increases a lot of risk to the fetus and the mother.
      Fetus risks include stillbirth, macrosomia (large baby), hypoglycemia (low blood sugar after birth), neurological problems., and a shoulder dystocia- this is a medical emergency, you babies head is out of your pelvis, but the shoulders are stuck. The cord is being compressed- this is where your baby gets it’s oxygen before it takes it’s first breath. There are maneuvers that the delivering provider will do, and they work 90% of the time. There is 10% that don’t work- and cause broken clavicles (collar bone), and nerve damage to the babies arm- this can mean complete nerve damage. That means you baby cannot move it’s arm at all- for the rest of its life.
      Not to mention the risk c-section- because your baby is so big- it won’t fit through your pelvis. This happens too.
      Why risk all this for your child? Just do the testing. Is it that serious to you that you’d risk your baby’s life?

      Reply
      • The doctors and midwives who bully moms into stuff… I can only assume you’re one of them. For one, what about people who are allergic to ingredients in the standard glucose drink? Or people like me who have horrendous migraines from some things like corn syrup? Fyi, I was pressured into the test the first time and it was a wretched experience, especially since pregnant moms are limited on what they can have for migrains.
        Secondly, my midwife for my second pregnancy watches for sugar in the urine, discusses diet if there appears to be a problem, and will do the blood test if it continues because it is more accurate. She doesn’t have to deal with false negatives or missed GD diagnosis. Additionally, some doctors have stopped doing the glucose test for suspected diabetics all together because some that were actually diabetic were going into shock in the lab. Why potentially create a medical emergency if there’s other ways to diagnose the problem?
        Thirdly, healthy people can and do fail the test because the body is not used to having to process all that sugar and an very unhealthy sugar at that.
        Fourth, babies are rarely too big to be born vaginally. Ask the few women who’ve done it with 12lb babies. The pelvis is made to move so that the baby can fit through. “Not fitting” is usually the result of trying make mom birth on her back which is an very unnatural position and/or other medical interventions which cause labor to progress in an unnatural manner resulting in the body not being fully prepared when it’s time to push.
        And lastly, saying something along the lines of “your baby will die if you don’t do this” is not, never has been, and never will be appropriate medical behavior. Patients should be able to make informed decisions based on ALL of the facts (not just the facts you as the Dr./nurse want to give), reliable studies, personal health, and personal medical history. Doctors and nurses are supposed to work for their patients, not lord over them. You should never pretend to know the patient’s body better than they do. Except for in the most emergent situations, a doctor or nurse should advise then treat according to what is truly best for the patient while respecting their autonomy and beliefs. Patients are people, not text books, and people need to seek out medical providers who treat them like human beings capable of making sound decisions.
        Sincerely, someone who has spent years recovering a horrible, but easily preventable, medical experience which was the direct result of medical staff who thought they knew better than I did, someone who’s first baby suffered months of preventable stomach trouble despite breastfeeding and probiotics because a nurse thought she knew better than I did, someone who’s husband could have died mere hours after birth because a nurse though she knew better than my MIL did, someone who had a loved one die because he was given the wrong medication despite his reservations about it, some who had a loved one nearly have a serious condition go irreparably undiagnosed because doctors wouldn’t listen to him or his parents. Accidents and misdiagnosis happen, but they would happen less often if doctors and nurses didn’t pretend like they were the end all of medical knowledge. My life has litterly been saved by respectful and competent medical professionals. My brother, sister, and mother are also alive today because of such wonderful medical professionals – so I’ll say it again, find a respectful medical provider that you can trust, not someone who tries to manipulate you into something with one-sided information and fear.

        Reply
  4. I failed the test and refused to take the second one. This meant I was sent to the diabetes specialist and made to track my blood sugar for several weeks. I turned out to be just fine. I wasn’t surprised since my diet consisted of no processed sugar and few grains. I also felt like crap the whole day after taking it and my baby didn’t move all day inside me. And even after the diabetes specialist gave me the all clear, they still considered me a gestational diabetic. They even wanted to take my baby’s blood sugar in the hospital every few hours. If I had to do it over, I would have come up with an alternative substance like mentioned here or not do the test at all, since I had hardly any risk factors.

    Reply
  5. I’m sorry but this is the first time I have a big issue with something you’ve written. Gestational Diabetes IS linked to stillbirth and fetal death. I know bc I lost my son because of it. I see many specialists who all agree it was GD, or side effects of, caused my son’s death. Any baby over 9lbs is at a higher risk for stillbirth. That fact came from my Perinatologist. I don’t agree with the drink for glucose intolerance but you need to monitored somehow. Most doctors don’t want to scare patients and won’t come out and say it can kill your baby but I’m living, grieving, proof of that very fact. This disease is often brushed off and underestimated. I remember person after person telling me it was no big deal when I was diagnosed. That “not big deal” cost me my child and a lifetime living without him. The article is good with the exception of GD not increasing risks. It does.

    Reply
    • LeAndre, I know we have been talking over on Facebook but I want to say it here, too. Thank you for sharing your son’s story with us. My heart aches for what you have been through. My goal in writing this post was to communicate the possibility of false positives (and the unnecessary and possibly risky interventions that may bring) and false negatives (and the false sense of security that could bring), as well as which alternative tests are likely to yield reliable results and which are not.

      Regarding gestational diabetes and stillbirth, all I can say is that the literature I read (specifically the Relative Hyperglycemia and Health Outcomes for the Mother and the Fetus listed here) found no difference in outcomes for women with GDM compared to women without GDM. I’d much rather invite you over for a cup of tea to talk and cry together than argue, but I wanted to share one of the sources I got that information from so that you could review it if you desire. This study was the one I referenced in the post.

      Much love to you, mama.

      Reply
      • I’m so, so very sorry for the loss experienced by LeAndre. My heart aches for you.

        I just wanted to add that my perinatologist told me that having GD doesn’t necessarily increase the risk, but having uncontrolled (high) blood glucose does. If there is any possibility that a pregnant woman could have high blood glucose, the only safe and responsible choice is to get tested (by any means or method). With early intervention, careful monitoring, and proper treatment most women with GD can have a healthy pregnancy (and outcomes similar to that of women without GD). This is obviously not always the case, but most women do not need to experience a fearful pregnancy because they have GD. Just my two cents…

        Reply
      • I’m sorry. I’m totally not trying to be argumentative. I follow you because I appreciate your research and alternative methods. Until a year ago I had no idea there were other methods for things like this. From my perspective, especially now, a ton of sugar consumption is never ever a good thing for any reason and I appreciate you bringing light to that. My sugars were never “that” high and controlled quickly. My goal is to shed light because so many have predisposition or warning signs and ignore it. I just don’t want anyone ever to walk in my shoes, the guilt and pain are immense.

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  6. I ‘failed’ the 1 hour test (after choking down that nasty stuff and VERY nearly vomiting right in the waiting room). When I went back for the 3 hour test, I had researched other options & told them I could not drink that poison again and that I wanted to do the ‘eating test’. They gave me a list of foods/portions and sent me to the cafeteria. I had a banana and a muffin and then sat for 3 hours (with a blood draw every hour) crocheting in the waiting room. At the end of it all, I was on the ‘high side of normal’ and was given a green light. Next time, I’m skipping the disgusting, less-than-accurate 1 hour test and going right to the 3 hour.
    My question is this: if a mom is eating healthy and getting moderate exercise, what are they really gonna do if she IS gd? ‘Monitor her more closely’? And what does that mean? The truth is, any extra monitoring would probably be in the regular routine anyway. I understand that there are risks, but in my experience, they stuff all mommies into one mold that does NOT fit all and is unnecessary for many.

    Reply
    • I was diagnosed with GD on my 2nd baby. I was borderline, but still considered to have it. They made me check my blood sugar 4x a day (fasting, and 2 hours after each meal). They also put me on a special diet, which to be honest, had me eating more carbs than I normally do! The point of this diet is to regulate blood sugar and avoid the highs & lows. After a month of testing, my doctor was confident that I was able to control my blood sugar with the diet and I was no longer made to check my blood sugar 4x a day.

      Reply
    • It’s super helpful to know that there are other alternatives to the nasty drink out there. I didn’t pass my first test – I suspect because it had been a while since I’d eaten breakfast and I don’t normally eat high amounts of sugar. On top of that, I felt like I was going to pass out and was lethargic/tired all day. It just didn’t feel like a healthy thing to do for my body or baby once, let alone twice.

      Of course, they want me to come back for the 3-hour test but I now feel empowered to say that I want to do it differently – be it an eating test or even at-home monitoring. I wish there were more official resources and information out there for moms-to-be on these alternatives!

      Reply
  7. I live in Norway and here they test for gestational diabetes by checking for sugar in the urine every 4 weeks or so throughout the pregnancy (and more tests if you have any symptoms…). They also dont test women for Group B Strep during pregnancy… Interesting how there are such differences between countries ….

    Reply
    • Sugar is only shed in the urine when your blood sugars are wildly out of control. So such a mechanism would miss diagnosing most women with moderate or milder GD and only really pick up extremely severe cases.

      Reply
  8. Reading whats actually in this stuff makes me cringe. Especially to think with ny last pregnancy I had to take it two different times because the first time my doctors gave it to me it was two weeks too soon. Just goes to show you can’t just assume because it’s from a medical professional that it’s safe

    Reply
  9. thanks for writing this article. the glucola makes me projectile (no kidding) vomit. it’s awful. i did the test once in my first pregnancy, as i have a history of hypoglycemia. the midwife let me eat high carbs instead of drinking the glucola.

    Reply
  10. I’m so glad you mentioned the paleo diet in your post. With my first pregnancy 3 years ago I was 100% paleo (rarely if ever even a cheat besides some chocolate) prior to conceiving and during my pregnancy. My first test came back just barely over the “normal” range and one OB in my practice said he would’ve accepted it if he were my primary doctor but I was asked to do the 3 hour test and passed. My assumption the whole time (not realizing at the time I could opt out at all!) was that I never ate fake/processed sugar at all and of course I would have a different reaction to it than someone who does typically consume it. I’m currently almost 18 weeks into my second pregnancy and unfortunately have not been able to maintain paleo perfection but since my first trimester ickies are now over, I’m hoping I can wean myself off of the carbs that were sustaining me the first few months and get back to a more primal diet in time for my GTT.

    I have no medical background at all, but my good friend had GD and while she has no family history at all and was 30 at the time, her husband’s mother likely had it but was undiagnosed as it wasn’t a routine test 30+ years ago. Her husband was born 11 lbs and his sister over 10 lbs so I don’t know if the father’s family history can impact this as well? She delivered at 39 weeks and a day and her son was a healthy 8.5 lbs

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  11. I refused it. I said since I don’t eat sugar I didn’t want any dodgy side effects. It worked and they didn’t ask again. But here in Scotland I think it’s a large bottle of Lucozade sports drink with yellow colouring dyes and caffeine which I’m also not into taking

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  12. I did the one-hour test and failed. I also came very close to throwing up and felt absolutely awful all day after doing the test first thing that morning. I told my midwife there was no possible way I was going to do the three-hour test and we agreed that I would buy an at-home blood sugar test like diabetics use and monitor my blood sugar for two weeks. My results were well within normal and everyone was happy, so to me it was worth all the finger pricking. Just be sure to buy the kit and test strips from Amazon (or shop around) because they were less than half the price they were at CVS or Walgreens. I kept the kit and plan to refuse the glucose test altogether for future pregnancies.

    Reply
  13. With my first pregnancy (pre-crunchy days!) I failed the one hour test and passed the three hour test. This time I asked about alternatives and the midwife had me do a fasting test first thing in the morning, then eat a ‘normal for me’ breakfast and do a test 2 hours after eating, which I passed. It wasn’t an option I had heard of before, and I don’t see it mentioned often so I thought I’d bring it up.

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  14. Like you, I discussed this decision with my midwives and thoroughly read the Informed Choice Agreement they gave me that included many alternatives to the standard glucose screen. I am a midwifery student in Portland, Oregon, and I’m planning a home birth. My only risk factor was that I’m over the age of 25 and I never had glucose in my urine so I opted only for a finger prick. In out-of-hospital birth practices in Portland, standard care does not involve an automatic glucose screen. Instead, clients are given Informed Choice Agreements to read ahead of their next appointment and their urine is dipped at every visit. One size does not fit all – I am all for informed choice! Thank you for providing alternatives to the standard in this very important post!

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  15. Like someone else has mentioned, my crunchiest OB only gave me one option, which was to eat a prescribed breakfast (2 eggs, two pieces of toast, two tablespoons of butter, a cup of milk and a cup of orange juice). I took the test (I believe) two hours later and passed. The lab tech commented on how he hated how doctors thought they could do whatever they wanted. Lol! I have biggish babies (8lbs up to 9lbs 6oz) but none have had glucose issues at birth. And I have gained exactly 34 lbs with each pregnancy. I won’t be taking it this time. Just wanted to put the breakfast idea out there. Thanks for the info!

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  16. Wow, thanks for this! I had been wondering. During my last pregnancy the midwife gave me this test at like 36 weeks which I failed as well as the follow up. She prescribed me all kinds of diabetes moderation things and a diet that was less healthy than the one I currently had. She never even asked about my diet! Which if anything was not high enough in calories. I didn’t even eat sweets! I refused her protocol so she tried to refer me to the at risk ward of the hospital which I also refused. I ended up having an unattended delivery in my shower. Which happened to be way better than any I’ve had in the hospital! (I use hypnobabies which helps a lot!) It makes sense about the body adjusting to sugar intake. I should write them a letter. So frustrating!

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  17. I was tested for it for both pregnancies. I failed the 1 hour and 3 hour test with my 1st pregnancy and was sent to an endocrinologist and dietician who bullied me to lose weight (I was underweight to begin with and had only gained about 29lbs during the pregnancy). I was told to test my sugars 4x/day and never had a bad reading. My “giant” gestational diabetes baby was born at 5lbs 13oz at 38 weeks. With my 2nd pregnancy I failed the one hour (after becoming so sick after drinking the glucola that I had to lay down in my OB’s office until I could recover enough to drive home) but I refused the 3 hour test. I did test my sugars a few times/week and again, they were fine and my son was born at 7lbs at 39 weeks. I just don’t understand all of this. I know people who “cheat” the test, who are in the high risk range. They carb load and exercise like crazy for the test, then go back to their normal lifestyle after “passing.” Seems like a very inaccurate test to me.

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  18. I refused. With my first. I completely refused, but my doctor convinced me to test with the second. I absolutely refused the garbage they consider an acceptable test. We came to the agreement that I could do the 8hr fasting. That meant that I ate my last meal at midnight, went to bed, and came into the office in the morning to get blood drawn. I had a perfect score. No extra carbs, no poisons, no irregular feedings. Like you said, blood sugar is naturally higher in pregnancy, and a refined-sugar-free diet won’t handle (and shouldn’t have to handle) a total over load on sugar/poison just “to see” how the body will respond. My baby did come out over 9lbs. But considering my dad is 6’3″, my brother is 6’4″, my husband is 6’2″, yeah, I’m going to have a big baby — it’s in the genes. The doctors repeatedly took blood sugar tests on my baby. They threatened to take him away and feed him formula (because they thought his insulin would be over producing so they were going to force feed him formula for the sugar). It was awful. I refused the formula, though. I know my rights. If he’s satisfied at the breast, he doesn’t need to be force fed. But… I’m getting carries away with my story. I hate “medical professionals” when it comes to birth (despite that I’m a nurse! I don’t agree with pharmaceuticals, vaccines, and all the other medical politics. Ironic, huh?)

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  19. My midwife was fine with me doing juice instead; it was her suggestion when I asked if there was something else I could use. I picked what I wanted to drink, called her with nutrition info, and then she calculated how much I needed to drink.

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  20. I drank orange juice plus half a banana that equaled a total of 50 grams per my midwife’s instructions. However, I am a reactive hypoglycemic, so we weren’t really concerned about GD. Plus, I was 23, Caucasian, and a normal weight, so that lowered my risk. My blood sugar plummeted when I tested, and went from the low 100’s to barely 80. Lol.
    I am not super concerned about GD for me personally, but even if I was, I would NEVER touch the glucola! Thanks for listing other alternatives!

    Reply
  21. I also opted out of the the test. I have none of the risk factors so I’m not too concerned. I did do the random glucose test at the recommendation of my midwives. I’m 31 weeks pregnant and as my midwife said at my last appointment, “everything is measuring perfectly average and that’s the way we like it.”

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  22. I stumbled across this post on Facebook today and I wanted to share my experience with Glucola. When I was 25 weeks pregnant with my daughter, my water broke. I was admitted to the hospital and put on strict bed rest – I was only allowed to get up to use the bathroom and for 5 minutes every other day to shower. My baby was still moving which was a good sign and I was just trying to hang on for as long as I could before giving birth. At 27 weeks they had me take the test for GD, as was standard procedure. About an hour after drinking the Glucola my entire body began shaking uncontrollably and I called for the nurse. She immediately put the heart monitor on my belly and within minutes my doctor was there and I was being taken to the OR for a c-section because my baby had become tachycardic. My daughter was born at 27 weeks and weighed under 2 lbs. She spent the next 10 weeks in the NICU fighting for her life. I’m happy to say that she is now a happy, healthy and brilliant 10 year old, but I have always felt that I could have held onto my pregnancy longer had they not subjected me to this test.

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  23. I have a different feeling towards testing for GD in pregnancy. I agree the OGTT is
    not the best (in Europe they make you drink 75g glucose with water and lemon juice)
    and home testing with a glucose monitor is much better (if you trust the patient),
    but testing me was a good thing. I had no risk other then age, I was all my life
    slightly underweight, I had a first normal pregnancy with an average birth weight
    for the baby (and no proper testing that time) and I did not know anyone in my large
    family with a history of diabetes. So, to be honest I was quite uninformed about
    diabetes and would have never considered myself home testing before. And then I had
    GD with my second pregnancy, which moreover refused to go away until 5 months
    postpartum and even now it’s still not very clear in which direction my ‘anomaly’ is
    going. It could be the fact that I was truly severely sleep deprived for 2 years
    after my first baby and before getting pregnant with my second, but even if this was
    just a ‘scare’, I think it was useful to know about it, because it prompted me to
    read and learn and adapt my diet which I thought at the time was already very
    healthy and not very high on (bad) carbs (I have cut down much more on crabs since
    then). What you say applies to a small community of people very dedicated to
    understanding what foods are healthful, but this is not representative of the large
    population. And even if you consider that each woman is responsible for her own
    lifestyle and decisions, some women could put the health of their babies at risk and
    doctors have to make decisions also based on this, to protect those babies.
    Personally I am outraged about how women with GD are treated after birth, the
    message is that once baby is born you are most likely ok and then, boom, 5 years
    later many women have full blown diabetes. At the 6 week appointment after birth
    they dismissed my claims that I can still measure high numbers at home if I eat more
    carbs, because their OGTT came out ok (and they only measured at 2 hours this time).
    So I had to go to a professor in diabetology who took me seriously, which was a
    relief, even if he honestly told me after various tests which were all ok, that only
    time will tell. After reading on the subject of GD my feeling is that if a woman
    gets it, then something is definitely not clicking right independently of the
    pregnancy and that woman needs to make informed changes in her life otherwise is
    almost sure she will proceed to diabetes sooner or later.

    Reply
    • I forgot to add that my fasting blood sugar was perfect throughout the pregnancy, so that is definitely not a good test. It was the one hour numbers and sometimes two hours numbers that were out of hack (this is standard progression for diabetes, first the one hour numbers fail, then the 2 and 3 hour numbers and only then the fasting numbers). Measuring after eating an average meal it’s best, but this should still be done in the hospital to insure compliance.

      Reply
      • Any updates on how you’re doing? Your situation sounds similar to mine. No real risk factors, but GD with both children. I have tested a few times since giving birth and have had elevated numbers. While it seems my meter runs higher than lab tests, it still is concerning. It was stressing me out, so I’ve been doing my best to eat healthy and exercise and haven’t been testing the last few months (I’m 8 months postpartum). I’ve had my A1C done 3x since giving birth and all have been fine. An endocrinologist (made the appt. myself since Dr. dismissed me) also dismissed my concerns.

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  24. I think it’s important to GET TESTED, whether it’s by the glucola drink or by any of the more natural alternatives. I’m all for natural, but don’t forgo the test just to avoid a few questionable chemicals. If you’re willing to drink a coke, eat M&M’s, eat Jell-o at any time in your life (all of which contain all sorts of toxic ingredients), you should be willing to take this test the few times in your life that you are pregnant. I was undiagnosed and my baby ended up in the NICU for 9 days as a result, almost going into diabetic shock, among other complications. As the saying goes, knowledge is power.

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  25. I am glad I came across your post. I have 3 children. First one was born in U.S., and the other two were born in Eastern Europe. I did the test with my first child, since I did everything the way doctor said. I did not question this procedure. But with my other two children, my doctor did not even mention this test. She said that all my test results on urine sample did not indicate any risk, so there was no need for the test. None of my friends here (in Europe) ever heard of the test.

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  26. I’ve heard that here in Australia they are thinking about phasing out the OGCT due to its unreliable results, and are going to go straight to the OGTT. However, the issue of having to drink that yucky stuff still remains…

    I’ve had my fair share of experiences with GD, false positives etc. When I was pregnant with my second child, the drink for the OGTT (I don’t know if it’s Glucola in Australia, or something else, but I guess the ingredients would be very similar) made me extremely ill – and it wasn’t your usual morning sickness as I was long past that at that stage of pregnancy. I managed to keep the drink down just long enough to have the necessary blood tests (had to lie down to stop myself from keeling over though!), but then the spewing started, and boy, was it violent! I’ll spare you the details, but it was unreal. I felt sick for days afterwards, not just in the stomach, but generally very unwell. I vowed I wouldn’t have another OGTT no matter what, and would look for alternative methods if I ever had to be tested again – so far I haven’t, thank goodness. I’m not against the testing per se, but there has to be a better option!

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  27. Thank you for posting. I don’t think there is enough information for mothers about true GD. With my second child my numbers came back high from the 1 hour test, so they requested the 3 hour. I didn’t really know what to expect but it was a horrible experience. Fasting while pregnant, drinking a high sugary drink and then blood draws every hour, left me a shaking nervous wreck. I failed, began to test, my numbers were fine, so I stopped testing around 8 months. With babies 3 and 4 I think my first numbers were elevated but not bad enough for 3 hour. Now with baby 5, they have changed the protocol number so that it easier for moms to fail. That being said I refused the 3 hour and went straight to testing my numbers at home. I have only had a couple of elevated numbers and that comes after eating any type of bread, corn or oat carb.(And now that you show the ingredients of a corn based glucose drink – no wonder my numbers were high) All my fasting numbers are within range and the 2 hour numbers are fine as long as I eat fruit, nuts, eggs, yogurt, cheese, veggies etc. I believe the type of carbs we eat has a major impact on how our bodies break down the sugars, but neither the nutritionist, nurse or midwife who I have talked to seem to have a clue. It’s all the same ole recommendations. And now that they “labeled” me GD I am definitely treated differently. I’m considered high risk b/c I’m 39- even though I have 4 healthy children delivered vaginally at 40 weeks and none over 8 lb. 1 oz. Do you have an article on here about high blood pressure?

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  28. Thank you for this! Because of this article I asked my midwives if I could do juice and they said yes. It was actually kind of nice to sit for five minutes and drink grape juice lol. I never drink juice normally, so to me this was as close to eating candy as I’m gonna get! 😉

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  29. Luckily, the midwife group I use has a “no corn starch”, “no food dye, and “no natural flavoring” drink. The ingredients listed were vegetable oil (yes, gross), water and sugar. I didn’t want to have to do the 3 hour test but went ahead anyway and felt better when I was offered the clear drink over the orange. So, if you do decide to drink the “drink”, ask if there is a clear option. In the end, I respect everyone’s decision and just believe we as expecting mothers should be able to make our own EDUCATED decisions about our bodies…they are OUR bodies and only you know your own body like you do.

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  30. Urine glucose tests are not an accurate way of measuring blood glucose. I think I read that blood sugar would need to be over 180 or 200 for sugar to show up in the urine. The A1C is much more reliable.

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  31. Not sure if it was mentioned here (many comments), but some hospitals give you options on what to eat/drink for the glucose test. At my Kaiser it is either the drink, jelly beans (you can buy whatever kind you like, as long as they are within the sugar gram range), or a McDonalds pancake plus syrup (or you can make your own pancake and use your own natural syrup, again, as long as you eat enough syrup for the amount of grams of sugar is required). At first I thought the drink was the only option, but all I had to do is ask and the options opened up.

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  32. Wonderful post! My wife and I own a chiropractic office specializing in pediatrics and pregnancy, and it is overwhelming the amount of mamas that get misdiagnosed as well as unnecessarily scared by what could be a false positive. Some have been false negatives as well which this article tackles both of those points! We shared this on our FB business page hoping that more moms will see this and make informed decisions. We just had a pregnant mom walk in our office today that just drank the Glucola drink. She didn’t know if she had any other options etc.. and was severely sick from the drink. Not only that, the ingredients in their are not good for the baby’s health.

    This is exactly what we teach our patients, but sometimes it takes them multiple times to understand information that is new. This is why I am glad to have other outside resources (like mommypotamus) to share that can help moms make educated decisions. If they do choose to drink the drink, at least they know what they are doing and made an educated decision!

    Thanks for all that you do!

    Sebastian

    Reply
  33. This is so informative- thank you! Way better than my excuse to my doc… “I won’t be drinking that it is too much sugar” now I have a bit better info to back my refusal up! ;D

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  34. I’m very happy to have found your website. My doctor has been insisting that I take the GD test, evan though I have had genetic hypoglycemia since well before pregnancy. He’s now becoming frustrated, and more demanding, at my continued refusal to take the test for fear of have a suger low and going into shock after drinking the test liquid. I’m howwever certain I don’t have GD because not only does my bloodsuger regularly drop to the 60-67 level if I go more than two hours after eating, but in never spikes above 96. I’m also a firdt year nursing student and can medically say that the test is more dangerous fornme than helpful.

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  35. I refused the drink with all 3 pregnancies. Doctors were ok with me refusing, but with 3rd baby they had me test at home 2 hours after meals and upon waking (fasting). And keep a low carb diet. My numbers were in upper 90s and nurse kept threatening me that if my fasting numbers will keep above 95, I will have to be put on insulin to control it. It was very stressful. Luckily I had my baby before they became overly pushy with insulin. He was 8lb 10 oz at 39 weeks and as healthy as could be.

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  36. I’m currently dealing with the fallout from a false positive, courtesy of the tests being improperly conducted. I’m completely fed up at this point, and beyond angry. The false positives are way too real, and I feel for any woman dealing with it. I wish I had known I had a choice. It would have saved me the headache of being labeled high risk, when I’m not even close to that.

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  37. Look, I know this is an old post, but I have to say (in agreement with the post): the drink is not a test. It’s a screening, and a dangerously inaccurate one.
    As for me, I rarely intake sodas and sugars to begin with and I cut any of that out during my pregnancy. I even cut out coffee, which I love, even though they say a cup a day shouldn’t hurt.
    I took the drink in innocence and suffered a masive migraine for more than a day afterwards. (nothing wrong with my sugar levels either). I will not be taking it next pregnancy. I’m all for testing, but my midwife will have to settle for an actual test-safe, reasonable, and reliable.
    Whats more, people are not text books. My baby was 9lb at birth but was incredibly healthy- it runs in my family. I gained double the weight that is considered acceptable despite my healthy diet, but I was healthy and I kid you not, lost ALL of the baby weight within the first six weeks while eating more than I did while pregnant because of breastfeeding… And that runs in my family too. There were a lot of things about my pregnancy that were handled poorly becuase I was treated like a text book case. Family history should be taken into account. Individual health should be taken into account. Previous birth experiences should be taken into account. What the mothers body is telling her should be taken into account. A good doctor or midwife should adapt to the patient, not force the patient into a textbook scenario becuase it’s easy. And your informed choice matters.
    Testing isn’t the problem either. One size fits all testing is, becuase many women who do this screening go undiagnosed and the results are the same as of they had not taken the test at all.

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  38. There’s a few inaccuracies in this post so even though it’s old, just wanted to make a few clarifications for anyone reading!

    First- this post doesn’t discuss the different possible steps for testing, just refers to “oral glucose testing”. Here are the general approaches:

    Two step approach (MOST COMMON- leads to fewer GDM diagnoses without incurring more adverse outcomes):
    1. One hour SCREENING test with 50g glucose – this is done because it doesn’t require fasting, and fewer people overall will need to do diagnostic testing via the 2hr or 3 hr glucose tolerance test. If your blood glucose is over 130-140 (140 is most common, has a lower sensitivity of 70-88%, but a higher specificity of 69-89% (specificity=fewer false negatives) then you would move on to a DIAGNOSTIC test, which can be one of the following:
    2. 2 hr test (75 g, blood glucose taken fasting, 1 hr, and 2hr) or 3 hr (100g, blood glucose taken fasting, 1 hr, and 2 hr)

    One step approach
    1. Diagnostic testing w/ 2 hr test (75 g, blood glucose taken fasting, 1 hr, and 2hr)

    A few other inaccuracies-

    You say “It has a 76% sensitivity rate, which means that for every 100 women that have gestational diabetes, the glucose screening test will only identify seventy-six. That means twenty-four pregnant moms will think everything is within range, when in fact they have elevated blood sugar levels.
    On the flipside, 24% of women who test positive for gestational diabetes don’t actually have it, so unless they insist on confirming with the oral glucose tolerance test (OGTT) they will be labeled as high risk for no reason and may be subject to unnecessary interventions and medical procedures.”

    Just a reminder that sensitivity and specificity are two different things- having a 76% sensitivity rate does not translate into a 76% specificity rate (where you say that 24% test positive who don’t actually have it). The sensitivity you mention is also in reference to the screening test, not the diagnostic test (the two step).

    Another thing- you mention doing an A1c in the first trimester as an alternative. That would NOT be a measure for GDM, which doesn’t develop until >24 weeks. An a1c in the 1st T would be a measure for underlying diabetes and a normal a1c in the 1st T doesn’t mean someone won’t develop GDM later on. With the studies we have now, there is currently no threshold for A1c in the 2nd and 3rd trimesters with both good sensitivity and specificity for GDM. This may be in part because the A1c is a measure of the last 3 months of glucose control, so GDM developing at 24-28 weeks wouldn’t show up definitively until 3 months after (which would be too late)

    Eating candy with 75-100 g of glucose is not as well-studied, doesn’t seem to have as high of sensitivity, and isn’t endorsed by ADA or ACOG. It’s still a reasonable alternative though as long as the individual understands the evidence and the risks. There’s also some evidence for doing a fasting blood sugar as an alternative to Glucola, though not as high of sensitivity.

    Taking your blood sugars for a period of time (fasting and 1-2 hr postprandial) at 24-28 and at 32 weeks (peak insulin resistance in pregnancy) is a good alternative for higher risk people though.

    Regardless of your disclaimer, it’s dangerous to try to give this information when you don’t have the background to evaluate the evidence or understand the methods used. If people want to read another source that actually objectively. discusses the evidence and is by a qualified person (an RN with her PhD), I would recommend this article: https://evidencebasedbirth.com/gestational-diabetes-and-the-glucola-test/

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