A gestational diabetes diagnosis can have serious implications in pregnancy. That’s why I chose an alternative screening method that may have helped me avoid a false positive.
Long before I became pregnant, I learned that procedures within the mainstream medical system aren’t always as clear-cut as they’re made out to be. I read stories of birth trauma and obstetric violence and promised myself I’d do everything I could to avoid such an experience.
I learned more about the seemingly endless gamut of diagnostic tests aimed at reducing risks during pregnancy as I entered the world of prenatal care. One of these tests, commonly called the glucose challenge, struck me as particularly onerous. Women online used language like “passing” and “failing,” as if high fasting blood sugar and the accompanying gestational diabetes diagnosis were shortcomings that needed to be micromanaged into safety.
The concept of risk management in medical care has its place. But I’ll admit I’ve become wary of providers’ attempts to reduce risk that may have more to do with protecting healthcare professionals from lawsuits than ensuring my continued good health.
When did we outsource so much responsibility for our own health to professionals who often answer primarily to the medical establishment rather than the person they’re supposed to be helping? Even in this seemingly small decision, I felt I was taking responsibility for my health – and it felt good.
What Is Gestational Diabetes?
Gestational diabetes is the onset of diabetes during pregnancy. It means pregnancy has caused you to have higher-than-usual blood sugar levels, or glucose intolerance.
As rates of obesity and type II diabetes increase worldwide, so do instances of gestational diabetes. Currently, it impacts anywhere from 1 to 20% of pregnant women. But 2015 research suggests that the recent uptick in cases is also connected to standardized criteria with a lower threshold for diagnosis.
There is little consensus about how the screening should be done and what warrants a diagnosis.
The Ins and Outs of Diagnosis
It wasn’t until 1984 that medical experts decided to include screening for gestational diabetes as part of standard prenatal healthcare rather than only screening those women whose health history suggested they could be at higher risk.
But despite the fact that health experts have discussed screening strategies for decades, there’s still little consensus about how the screening should be done and what warrants a diagnosis. For example, different countries, regions, and doctor’s offices have varying criteria for diagnosing gestational diabetes. With the same test results, you might have gestational diabetes according to one OB/GYN practice, but not another.
False positives also aren’t uncommon when it comes to gestational diabetes. One older study from 1997 found that false positives were six times more likely than true diabetes diagnoses. It even suggested that getting a diagnosis negatively impacted women’s perceptions of their own health.
As recently as 2020, international groups endorsed by the World Health Organization have sought to standardize the diagnostic criteria and screening for gestational diabetes despite the likelihood that this would increase the rate of diagnoses and that the potential harms of this decision are still unknown.
What Is the Glucose Challenge?
The glucose challenge, or the oral glucose tolerance test, involves drinking a beverage called “glucola,” which contains 50 grams of sugar – the same amount as 20 gumdrops or about 150 raisins. Women are usually required to take the test around 24 to 28 weeks of pregnancy.
After waiting one hour, you check-in for a blood test which gauges how well your body responds to the sugar. If your blood sugar is too high, you might be asked to return for a 3-hour test, before which you’ll drink 100 grams of sugar and have your blood tested once each hour.
The glucose challenge involves drinking “glucola,” which contains 50 grams of sugar.
The first time I learned about the sugar content of glucola, I did a double take. I don’t usually consume that much sugar in the first place – how could I expect my body to react normally to overloading it with sugar on purpose? Consuming a highly sugary beverage and not eating anything else for an hour afterward did not bode well for my stomach. Even at 24 weeks pregnant, I had trouble keeping food down, and I confirmed that vomiting before making it to the blood draw meant a total do-over.
In addition, medical settings already cause me to experience high levels of stress and elevated blood pressure. I worried that this, in addition to the pressure to comply with certain medical practices during Covid-19, could artificially spike my blood sugar in a similar fashion to white coat high blood pressure, leaving me with a false diagnosis.
Screening Pros and Cons
According to 2021 research, gestational diabetes screening (and in some cases, treatment) could result in:
Stress, anxiety, or depression
Low blood sugar in the mother and baby
Low birth weights
More medical intervention, such as cesarean section or inductions
Difficulty breastfeeding due to negative impacts of being labeled with the diagnosis
Some women also experience blood sugar crashes after the test, causing nausea and extreme dizziness.
If you ask an OB/GYN about the necessity of screening when you’re low risk, they’ll likely warn you about the costly negative impacts of undiagnosed gestational diabetes, including:
High blood pressure or preeclampsia
Having a baby too big to deliver vaginally
Newborn low blood sugar
No doubt, these are serious impacts. And if you feel you might encounter these effects, the regular screening might not be a bad idea.
Your healthcare provider may also caution that gestational diabetes often occurs without noticeable symptoms, which makes a formal screening necessary. Meanwhile, standard diabetes comes with symptoms like weight loss, frequent urination, and excessive thirst and hunger.
To me, testing for an asymptomatic condition for which I was low risk seemed increasingly pointless. And when I evaluated my chances of encountering the serious impacts of undiagnosed gestational diabetes, I felt confident in my decision to opt out of the regular screening.
What Are the Alternatives?
I arrived at my 24-week prenatal appointment prepared to opt out of the test. My midwife was understanding of my wish not to consume glucola, but shared that to stay under the care of their midwifery practice, I needed to undergo some form of screening.
She then offered some alternatives for me to review before my next appointment. If you’re curious, some common alternatives are:
Consuming a different beverage like the Fresh Test. These beverages don’t contain potentially harmful ingredients like food dyes and brominated vegetable oil (BVO), which some women seek to avoid.
HbA1C testing, a simple blood test taken in early pregnancy that can estimate your average blood sugar level over the past 3 months. Some research suggests this test could help low-risk women avoid further testing.
At-home blood glucose monitoring, a method that involves pricking your finger four times per day to test how your body regulates blood sugar levels in response to your eating habits.
I chose to monitor my blood sugar at home, an option that some practitioners won’t allow as they consider the associated risks too high.
What I Learned
My screening involved one week of at-home blood glucose monitoring — or rather seven days of monitoring spread out over the course of several weeks. This is important, because it allowed me to give my fingers a break between testing days.
First, I picked up a glucose meter and some test strips from the diabetes management section of the drug store. On the days I monitored my blood sugar, I did four finger pricks: once in the morning before I ate, and then once an hour after breakfast, lunch, and dinner to see how my body regulated blood sugar after eating.
Since I saw how my body responds to processed foods, I’ve found myself less interested in eating them.
Pricking myself with the lancets was a hurdle at first, but I still preferred it to the standard clinical screening. Sometimes I even looked forward to testing because I was curious how what I’d eaten would impact my result. I became intimately involved in the numbers part of the process as I logged each result in my chart. I also kept a record of each meal and snack I consumed during this time, allowing me to gain unique insight into how my body responded to these foods. By the time I finished testing, I had gleaned knowledge that changed the way I eat to this day, nearly four months postpartum.
For instance, I learned:
Combining proteins and carbs works. My breakfasts of eggs and fruit had the lowest impact on my blood sugar out of any meal I ate during that time.
Walking after eating helped my body regulate blood sugar levels more efficiently.
Fast food is worse than I thought. One Taco Bell bean burrito was the only food that caused my post-eating glucose levels to spike over the accepted number, higher even than the white rice and Christmas cookies I had also eaten that week.
My midwives determined one errant result, especially since it was caused by fast food that I rarely consume, was not enough to warrant a gestational diabetes diagnosis. But these results stuck with me. Since I got the chance to observe how my body responds to processed and fast foods, I’ve found myself less interested in eating foods I know have a measurable negative impact on my health.
I believe mainstream medicine has helped many people. It can also be true that when medical care becomes overly prescriptive and denies people agency to make their own health decisions, trust in the mainstream medical establishment will decline. In as many ways as I could, I opted out of standard care because I didn’t want my pregnancy to be treated like a sickness that needed to be managed. I operated from the belief that I should have the freedom to claim the driver’s seat in my own health journey — not ride shotgun.
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