Gestational Diabetes Screening – is it really necessary to drink that horrible sugar-rich and chemical-laden drink between your 24th and 28th week of pregnancy?

If you have been around pregnant women or have been / are pregnant yourself, you may have heard of the infamous test done between the 24th and 28th week of pregnancy to screen for gestational diabetes. You probably heard of type 1 and type 2 diabetes, but there’s also another form of diabetes that can develop in the mother during pregnancy and go away after the baby is born.

Gestational diabetes can have big consequences for both mom and baby and it’s important to make sure your body is still able to metabolize carbohydrates (sugar and starches) well during pregnancy… but I personally don’t like the method used at this time.

Gestational Diabetes

What is gestational diabetes exactly? It’s actually normal for a pregnant woman to be slightly more insulin resistant and have slightly higher blood sugars levels. These mechanisms are in place to ensure a steady supply of glucose / energy for the growing baby. However, for some women the insulin resistance and blood sugar levels can reach a point where they become deleterious for both the mother and the baby.

You are at increased risk of developing gestational diabetes if you meet some of these criteria:

  • being overweight or obese prior to becoming pregnant
  • belonging to one of the following ethnic group: Hispanic, Black, Native American or Asian
  • having pre-diabetes / insulin resistance prior to your pregnancy
  • having a family history of diabetes (especially parents/siblings)
  • having previously given birth to a baby over 9 lbs (4 kg)
  • having had gestational diabetes during a previous pregnancy
  • having too much amniotic fluid (polyhydroaminos)
  • having PCOS (polycystic ovarian syndrome)

Why does it matter? Well, developing diabetes during your pregnancy put both you and the baby at risk of developing type 2 diabetes later in life. In addition, your baby is more likely to weight more than 9 lbs (4 kg), to have respiratory distress syndrome and hypoglycemia (low blood sugar).

The test (OGTT or Oral Glucose Tolerance Test)

The current way to screen for gestational diabetes is with the OGTT. With this test, you are given a orange drink called Glucola containing 50-75 g of sugar in the form of glucose. That’s the equivalent of over 12-19 teaspoons of sugar at once. Your blood sugar levels are measured before, after 1 hour and again after 2 hours. If your blood sugar levels go above a certain number (see table below), you will be diagnosed with gestational diabetes.

Pregnant women are "encouraged" to drink this Glucola solution containing 50 g of sugar along with many other chemicals between their 24th and 28th week of pregnancy.

Pregnant women are “encouraged” to drink this Glucola solution containing 50 g of sugar along with many other chemicals between their 24th and 28th week of pregnancy.

Is it a good idea to take that much sugar at once when you’re pregnant?

I personally tend to think that it’s not such a good idea. Especially if you’re eating an overall low-sugar diet, which can make it more difficult for your body to deal with all of that extra sugar and can cause your blood sugar levels to stay elevated for longer following the test, even if you don’t have gestational diabetes. You should also be aware that the risks of having a false positive result (being falsely diagnosed with gestational diabetes) are increased if you consume fewer than 100-130 g of carbohydrates a day.

In addition, Aviva Romm, one of my favorite gurus in the field of natural birth, recently wrote a great article “Gestational Diabetes: Please don’t drink the Glucola without reading the label” further detailing other potential dangers of drinking the Glucola.

Dr. Romm explains that one of the ingredients used in this chemical-laden beverage is BVO or brominated vegetable oil. Doesn’t it sound appetizing?

According to the Center for Science in the Public Interest, “safety questions have been hanging over BVO since 1970, when the FDA removed BVO from its ‘Generally Recognized as Safe’ list of food ingredients.” At that time, the FDA granted BVO ‘interim status’ as a food additive which allowed its use in soft drinks, but it was and remains banned from European and Japanese soft drinks. BVO is patented in the U.S. and overseas as a flame retardant.

Yet it is in EasyDex, a medical testing “drink” consumed by presumably hundreds of thousands of pregnant woman in the US!!! – From Aviva Romm’s article

Here’s a great graphic from Vani Hari (aka The Food Babe):

Glucola

Yummy, right? 😉

So what’s wrong with BVO (brominated vegetable oil) exactly?

BVO contains bromine, which is known to interfere with thyroid function. Even more frightening, it is found in the brominated flame retardants that are used in upholstered furniture and children’s products, which I wrote about in a previous blog.

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.

Charles Vorhees, a toxicologist at Cincinnati Children’s Hospital Medical Center, toldScientific American that “compounds like these that are in widespread use probably should be reexamined periodically with newer technologies to ensure that there aren’t effects that would have been missed by prior methods…I think BVO is the kind of compound that probably warrants some reexamination.” – From Aviva Romm’s article

Although your doctor or midwife may not be aware of the alternatives, there are other ways to see how your body handle carbohydrates without taking unnecessary risks for the health of you and your baby.

Do your own gestational diabetes screening test at home

You can request to do your own OGTT at home. All you need is to get your hands on a glucometer. Most drugstore will give you a glucometer for free… if you buy 100 strips. The hic is that each strip is about $0.75-1.00, making it a considerable investment. However, I think it can be a worthwhile investment in your health, especially if you have many risk factors for gestational diabetes and/or are worried about your blood glucose levels.

Having PCOS myself and having had blood sugar levels within the prediabetes range in the past, I have been testing my blood sugar levels a few times a month (before and after eating) and have been really pleased to find out that my blood sugar levels are well within the normal limits. 🙂 I feel empowered because I can test whenever I want and the results really show how the foods I eat impact my blood sugar levels. I don’t intend to eat 50 or 75 of sugar at once and am therefore not interested in finding out whether my body could handle it or not… that just doesn’t seem relevant to me! – Aglaée Jacob, MS, RD

For the OGTT test itself, you only need 3 strips but you can repeat these instructions at different meals throughout your pregnancy to see how your blood sugar levels are controlled. Make sure you also get a lancet with the appropriate needle to get started. Ready?

Checking your blood sugar levels at home is not that hard!

Checking your blood sugar levels at home is not that hard!

Here are the different steps:

  • Step 1: Insert the strip in the glucometer. This will turn it on automatically. The code appearing on the blood glucose meter should match the code on your bottle of strips.
  • Step 2: Prick your finger (the sides hurt less than the pads). If you’re afraid of needles, you can have someone else help you. Or try coughing at the same time, I swear you won’t feel it (or barely!). Try to do this step as quickly as possible before the meter turns off. If it turns off, take the strip out and re-insert it to re-activate it.
  • Step 3: Apply your drop of blood at the very end of the strip so it can be absorbed.
  • Step 4: Apply pressure on your finger with a piece of facial tissue and wait for your result!

Repeat these steps at these 3 times and note down the results:

  • right BEFORE your meal (ideally breakfast)
  • 60 minutes (1 hour) after your test meal (see below)
  • 120 minutes (2 hours) after your test meal (see below)

Compare your results to this table:

Gestational Diabetes
(GD) diagnosis
American values(75 g glucose) International values(75 g glucose) International values(50 g glucose)
Fasting 95 mg/dL 5.3 mmol/L
After one hour 180 mg/dL 10.6 mmol/L 7.8-11.0 mmol/L =retest> 11.1 mmol/L = GD
After two hours 155 mg/dL 9.0 mmol/L

Discuss your results with your health care provider for help interpreting them.

What should your test meal be like?

Your test meal should include 50 g of carbohydrates from REAL food, along with protein, healthy fats and vegetables

Your test meal should include 50 g of carbohydrates from REAL food, along with protein, healthy fats and vegetables

Unless you regularly eat sugar on its own, it’s more logical (and physiological) to test how your body reacts to carbohydrates as part of a balanced meal. You should include a normal serving of protein, non-starchy vegetables and healthy fats. And you can get either 50 g or 75 g of healthy carbohydrates from the foods and servings in the following table.

50 g of carbs 75 g of carbs
Sweet potato 1 cup mashed
Or 2 medium baked
1 ½ cup mashed
Or 3 medium baked
White potato 1 ½ cup mashed
Or 2 medium baked
2 ¼ cups mashed
Or 3 medium baked
White rice 1 and 1/3 cup cooked 1 and 2/3 cup cooked

There you go, as simple as that!

Even more options

Some doctors may also be willing to simply test your postprandial glycemia, a term that simply means your blood sugar levels after eating. How does that work? You could eat your usual breakfast at home and then go to the lab to have your blood sugars checked 1 and 2 hours afterwards. Another option if the previous two don’t work with your doc is to ask to monitor your blood sugar levels at home for a week. That’s an even better way to get a picture of what’s happening with your blood sugar regulation in a real life situation. Know your options and don’t be afraid to discuss them with your health team.

What happens if you have gestational diabetes?

If you have abnormal blood sugar results with this experiment, make sure you share these with a health care professional for help interpreting the results and finding the best strategy to deal with the problem. For most people, simple dietary changes and exercise are all that is needed to regularize and stabilize blood sugar levels and keep mom and baby healthy. Check out the services I offer as a registered dietitian nutritionist (RD or RDN) here if you want to work with me.

Here are the ideal target for your blood sugar levels if you are diagnosed with gestational diabetes:

GD target American values International values
Fasting  Below 95 mg/dL Below 5.3 mmol/L
After one hour  Below 140 mg/dL Below 7.8 mmol/L
After two hours Below 120 mg/dL Below 6.7 mmol/L

Bottom line

I believe most doctors aren’t giving all the information to pregnant women and I can say that it has been my experience so far, even with a midwife. I hope this post helps pregnant women realize that there are other options and that we don’t have to accept all the tests doctors are pushing our way. Take the time to read up on the tests offered to you so you can make an informed and educated decision. It’s your body and your baby. You will be the one living with the consequences, not the doctor or midwife, and you should be comfortable with your decision.

Work 1:1 with Aglaée Jacob, MS, RD and author of Digestive Health with REAL Food (the book & the cookbook)

Work 1:1 with Aglaée Jacob, MS, RD and author of Digestive Health with REAL Food (the book & the cookbook)

Share your opinion and experience

Did you take the OGTT test during your pregnancy? Did you develop gestational diabetes? Share your story! 🙂

 

Read more of my pregnancy-related posts here.