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Gestational Diabetes Test: Should You or Shouldn't You?

Should you get the test?

I’m just past 28 weeks along now (29 on Friday) and I’m heading to my midwives’ appointment this week.  That got me to thinking: most women take their gestational diabetes test at this point in pregnancy.  Now, I won’t be.  But should you?  And if you need to take it but are uncomfortable about the traditional way, are there other options?

Let’s explore the gestational diabetes test!

A couple years ago, when I was pregnant with my son, ACOG came out with some new guidelines about the gestational diabetes test.  They stated that women in a certain category did not need to take the test (and this factored into my decision to skip it).  Their criteria are:

  • less than 25 years old
  • not a member of a racial or ethnic group with a high prevalence of diabetes (eg, Hispanic, African, Native American, South or East Asian, or Pacific Islands ancestry)
  • a body mass index (BMI) 25
  • no history of abnormal glucose tolerance
  • no previous history of adverse pregnancy outcomes usually associated with GDM
  • no known diabetes in first-degree relative

At the time, I was 24 and otherwise fit these guidelines perfectly.  So, although many practitioners continue to screen all women, ACOG feels that there is not necessarily a benefit to women in this circumstance.  Obviously if you have any risk factors or symptoms, you should be screened.  This includes if your practitioner does a urine test at each visit for glucose — if it shows up in your urine, you should get the test (I would, if this were the case).

Are There Alternatives?

Some women, for various reasons, are not comfortable with the standard test.  The 1-hour test requires you to drink a solution that is 50 mL of glucose.  It is often flavored and artificially colored, and some women say they don’t feel well after drinking this.  (Plus, frankly, it’s not especially natural, given the artificial flavors and colors, which some women do not like.) 

There are other options available:

  • 50 mL equivalent of 100% grape juice
  • 50g carb-heavy meal

Talk to your doctor or midwife if you would prefer to use one of these alternatives, and make sure that you get their approval and clear instructions on what to eat or drink in place of the glucose solution.  Bring this up at your 24-week appointment (or even 20-week appointment, depending on when you will do the test; most do it at 28 weeks but some do it sooner).

Some doctors or midwives will agree to do this test in another way entirely.  It is possible to buy home blood sugar monitors (the ones diabetics use) and actually test your blood sugar at certain times after meals for about a week.  Some midwives prefer this test because it gives a clearer, more accurate picture of what your glucose is actually doing in a real-life situation.  This test obviously requires a lot more from you, both time and money-wise, and repeatedly testing your own blood sugar may not be especially fun.  But, if your doctor or midwife agrees, it may be another option to the traditional test.

What If I Fail?

Some women do fail the 1-hour test.  (By the way, unless your practitioner advises otherwise, typically you are not required to fast prior to taking it.)  The next step is usually the 3-hour test, which does require fasting.  Typically it is done first thing in the morning, and you are required to drink a 100-mL glucose solution and have your blood drawn at 1, 2, and 3 hours after finishing it.  This gives a more accurate picture of how your body metabolizes the sugar, and if you fail this too, then you will be diagnosed with gestational diabetes.

What If I Don’t Take the Test?

If you don’t take the test (and there are no indications that you should), following a healthy diet is a smart idea.  Minimizing sugar and refined carbs is always good.  Consume plenty of fat and protein, which will help keep your blood sugar from spiking.  Diet is often the “treatment” for gestational diabetes, especially if not severe.  It’s also important to continue getting regular urine tests so that if glucose does show up in your urine, you can make a decision to take the test later if needed.

Did you or will you take the gestational diabetes test?

Top image by jessicafm

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