Gestational diabetes is the type of persistent high blood sugar that’s first detected during pregnancy. Pregnancy increases glucose levels and insulin production—both of which are measured in the Gestational Diabetes Test (GDT). Though the test is routinely given by most physicians—even to low-risk women—gestational diabetes (GD) only affects about 6% of women.
GD can cause a lot of health problems for both mom and baby so if the condition is real, the test could be life saving. But the test is not 100% accurate—it’s about 76%—so women without GD could be diagnosed as having it (false positive), and women with GD could be missed (false negative).
Being diagnosed with it shifts you from low-risk status to high-risk, and that means a lot more tests, appointments, and usually, interventions during labor.
What is the test?
In the US, women are usually tested for GD between weeks 24 and 28 by drinking a 50 gram glucose-laden syrupy drink (glucola) within 5 minutes and are tested an hour later to see if their blood sugar level is too high.
If it is (about 15%-23% of the time), the glucose tolerance test (GTT) is given where they drink 100 grams then are tested after 3 hours. In other countries, the dosage and times differ slightly.
Who needs it and can I refuse it?
- Remain low-risk throughout pregnancy (good weight, healthy diet, sufficient exercise, enough water, reasonable portion sizes)
- Are 25 years old or younger
- Not a member of a racial group that tends to have higher risk due to obesity: African American, Mexican-American, Native American, Native Hawaiian, Pacific Islander, or Asian-American
- Have BMI (body mass index) of less than or equal to 25—the Center for Disease Control (CDC) classifies 25 as overweight
- No personal history of high glucose level or having had a very large baby
- No first-degree relative who has diagnosed diabetes
If you match these criteria, do you need the test? It’s an on-going debate, but many low-risk women refuse it.
But some hospitals or birthing centers won’t allow you to refuse it, so check with the facility you’re planning to birth in.
Your hospital medical records list your GDT results. If those results were borderline, the staff often approaches your labor from the perspective that C-section or other interventions are likely instead of trusting you and your body to give birth naturally.
What’s the treatment?
ACOG (the American College of Obstetrics and Gynecology) used to recommend that every woman be tested. And many physicians still do regular GD screening as a matter of habit and liability prevention.
But now ACOG says if you meet the above criteria and maintain your low-risk status throughout pregnancy, you could safely refuse the test. ACOG recommends medication only if nutritional and lifestyle changes don’t control blood sugar levels.
Your care provider could do random blood tests throughout pregnancy to monitor your blood sugar, like half the women in the UK and Netherlands do.
According to Evidence-Based Birth (EBB), ACOG affirmed that all women, but especially low-risk, have the right to refuse the GDT and prevent the inclination of care attendants to interfere.
“Pregnant women’s autonomous decisions should be respected. … In the absence of extraordinary circumstances, … judicial authority should not be used to implement treatment regimens aimed at protecting the fetus, for such actions violate the pregnant woman’s autonomy.”
Bottom line: the first approach to GD is nutritional counseling and lifestyle changes like upping your exercise—the same changes recommended to any diabetic.
If you are low-risk and have a diet and lifestyle that keeps you that way, EBB suggests you ask yourself, “What will I change if the test is positive?” If your answer isn’t diet and lifestyle because you’re already awesome on those points, then you could consider yourself as a diet-controlled gestational diabetic.
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Published: September 30, 2017 | By SP Turgon, Certified Labor Doula | Reviewed by: The Best Ever Baby Expert Team | Last reviewed: September, 2017