Gestational Diabetes Guidelines — Revised

I declined the glucose tolerance test both times I was pregnant. This was my reasoning — if I were to develop true diabetes, there are signs and symptoms of that happening, and I figured my risk of getting diabetes was low. The likelihood of my needing insulin or medication was even lower, so likely all that would be done is that it would be recommended that I follow a diabetic diet and/or watch my intake of sugars. I was doing that anyway.

Even at that time, I had a distinct dislike of presuming there to be a problem when the likelihood was that there would be none. Also, it just didn’t make sense to me to shock the body with that much sugar after fasting for so long — the solution for the test has the equivalent of a can of Coke or a candy bar (more or less, depending on the actual solution and the particular candy bar). First, it didn’t make sense to me to fast during pregnancy — that just sounds like a dumb idea. Second, it makes even less sense to go from fasting to downing a Coke in 5 minutes, and then continuing to fast. Some women experience quite a bad reaction to the test — nausea and lightheadedness are not uncommon.

Also, the first test is not a test — it’s a screening, which means that it will have a high number of false positives. This means that a lot of women will think they have diabetes when they don’t; and a lot of women will be unnecessarily subjected to the more rigorous 3-hour glucose testing. Then, not all practitioners have the same cut-off levels for gestational diabetes — some doctors will diagnose GD when other doctors will not.

So, I was glad to read that the U.S. Preventive Services Task Force “concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes mellitus (GDM), either before or after 24 weeks gestation.” You can read more here. It is possible for sub-clinical diabetes to become full-blown diabetes during pregnancy, so it would be wise for some women to be tested (although I wonder why they can’t just have the women monitor their blood sugar several times a day for several days, instead of guzzling the glucose solution while in the middle of a several-hours-long fast); but what this is saying is that there isn’t enough benefit to recommend the screening universally (which is what doctors typically do). You know what this means? Henci Goer was right all along.


3 Responses

  1. I, too, found monitoring my blood sugar by accucheck to be more reliable than the glucose challenge tests which I failed. It made much more sense for me to watch my diet. Ina May addresses this topic in her Guide to Childbirth as I am sure you know.

  2. I would like to thank you for this post. I had a very stressful day when I went to take the test. I couldn’t make the 8 hour fast without puking and they said I’d have to come back another day. After a prior clean bill of health from my OB, I realized that I was just being forced to take this test because “everybody gets it.” What a load of bull!

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