Glucose Testing in Pregnancy

[KandyKinz]

Just wondering how many of you are planning or did the glucose testing in pregnancy???

I'm leaning towards not being tested as the research so far has not shown any improvement to outcomes after having a diagnosis of gestation diabetes and being treated in pregnancy. And while I would love to know whether I am at an increased risk of type 2 diabetes later in my life I feel that incorporating the testing into my pregnancy may just be opening up a can or worms and would be inviting many needless interventions into the mix like unnecessary c-sections....

 

[Rmar]

I'm leaning towards no but with most things, I would if I felt there was a need to. I would have to do a bit more research about the effects of GD especially in those that had hardly any symptoms of it. I really wouldn't want any uneccessary tests going on and it is hard to tell which ones I want and which ones I don't. Even with the first bloods taken by the doctor, he asked me if I would want him to test for STD's and I don't think it is necessary because I don't think that is a possibility but why not? It's not like I am worried about it and it would cause other interventions but it was one of the first choices I was faced with and I didn't even think about it beforehand so it took me off guard.

 

[stardust599]

They don't offer it at our hospital unless you're showing symptoms or in one of the high-risk groups for GD so won't be tested xx

 

[Sophist]

I think I'm in the "high risk" group to be tested, because even though I never had diabetes and have no family history of it, both my kids were big babies.

I'm sure my mw will offer the test, but so far with every test she's given me a choice. Some women I know have opted out, feeling that it was risky unhealthy for their babies to drink that much sugar all at once.

 

[KandyKinz]

So I know right now I'm in the "at risk" category... I'm now 26, I have a family history of diabetes, I also have a history of having big babies...

And I'm not at all concerned about the glucose drink.... It's about equivalent to eating 40 to 50 M&M's, so in reality it's not to bad but certainly not something I'd do everyday.

I'm more concerned about the cascade of interventions that tend to occur afterwards. There was one study where they took a large group of women who were diagnosed as having gestational diabetes and labeled half of the group as having it and they other half as having normal glucose levels so there care providers did not actually know that some of the women who were labeled as "normal" actually had GDM. Anyway's in the end the group labeled as having GDM were significantly more likely to be induced and require c-sections then the group labeled as normal. The worst part of it is.... The outcomes were no different in both groups... So the increase in inductions and c-sections did not actually help any. No change in stillbirth rates, no change in macrosomia,no change in incidences of neonatal glycemia. To me it's pretty concerning that all these interventions are occuring to so many women (in some populations up to 15% of women are diagnosed with GDM) and no benefit comes from it.

And personally I think there are very very few individuals these days who fall into the low risk category. I'd say over half of all pregnant women are either over the age of 25 (that's a risk factor), have a BMI over 27 (another risk factor) or not being caucasion.

And you can't go by symptoms at all in pregnancy... Symptoms include increased thirst, increased urination, dizziness.... Too bad those symptoms occur in most healthy pregnant women anyways! There's always spilling glucose in your urine or measuring big, but even so... if you have GDM what difference would finding out make????

 

[CupboardLove]

i went to the midwife the other day, and she said i was there to be booked in for a sugar test.

I didn't ask why, I just said ok. There is type 2 diabetes in my family, but i don't think that makes me high risk.

Not sure whether the test is a good idea now. I don't want anything to scupper my home birth plan.

If you do have GD what happens? Would regular insulin shots be needed, or just a careful watch over diet?

 

[KandyKinz]

i went to the midwife the other day, and she said i was there to be booked in for a sugar test.

I didn't ask why, I just said ok. There is type 2 diabetes in my family, but i don't think that makes me high risk.

Not sure whether the test is a good idea now. I don't want anything to scupper my home birth plan.

If you do have GD what happens? Would regular insulin shots be needed, or just a careful watch over diet?

Management really varies where you live, but for the most part it consists of seeing a dietician to improve eating habits, staying physically active and implenting an exercise program and monitoring your glucose levels throughout the day. You'd also get increased ultrasounds to monitor fetal well being and size towards the end of pregnancy. It is very very rare for a woman to require insulin for gestational diabetes, but it can potentially happen. It's thought that this much more likely to occur in a women who had pre-exisiting diabetes and was not aware of it before the pregnancy but there is no way to tell if that was actually the case. Anyways, if your glucose levels are so so bad that insulin is actually required then doing the glucose test and knowing about it is a good thing as that can improve outcomes. But as I mentioned before MOST women with GDM do not have glucose levels severe enough to warrant insulin.

 

[aob1013]

I had it because finding out about serious health issues that could affect my baby is very important to me. Best to be safe than sorry.

 

[KandyKinz]

I had it because finding out about serious health issues that could affect my baby is very important to me. Best to be safe than sorry.

My only problem with it though is that the studies so far have not been able to demonstrate the interventions actually improve baby safety.

 

[KandyKinz]

If anyone can lead me to some studies showing otherwise I'd love to see them.

 

[Pixelle]

I personally don't need studies to tell me the outcome of potentially increased risks.

I had the GTT and was diagnosed with GDM. I had been feeling awful for weeks so it was actually a relief to find out why.

Yes, it's a pain in the bum going to the hospital every week to see consultant, dietician, obstetrician etc but I'd much rather be monitored and helped than just leaving everything to chance.

If my baby is going to be/potentially affected in any way whatsoever, I'd rather be informed.

I think it's pretty reckless to play with your health if you know you have GDM but do nothing about it. I know no one here has said they'd do that, but I know people who have.

With the right meds, exercise and diet, most of the time the baby is fine and normal delivery can take place....is what I've been told on several occasions.

Yes, there are sometimes complications, but that's true of a lot of pregnancies, GDM or not.

There is an actual risk to babies (stillborn...they don't know 100% why but it's thought to be to do with deteriorating placenta) being born after 40 weeks, where mothers have GDM. Hence why my particular hospital induces before 40 weeks, if baby hasn't come naturally.

There is also the serious risk of shoulders or abdomen getting stuck when in labour, if baby grows too big...and you wouldn't know baby is too big unless you've been diagnosed and sent for growth scans. Fundal height measurements don't cut it for this.

Went on a bit there, sorry!

ETA: I can't see why c-sections and/or induction are deemed unnecessary, if that's what is needed to be done to have a safe delivery. I don't think they do them for fun!

 

[KandyKinz]

I personally don't need studies to tell me the outcome of potentially increased risks.

I had the GTT and was diagnosed with GDM. I had been feeling awful for weeks so it was actually a relief to find out why.

Yes, it's a pain in the bum going to the hospital every week to see consultant, dietician, obstetrician etc but I'd much rather be monitored and helped than just leaving everything to chance.

If my baby is going to be/potentially affected in any way whatsoever, I'd rather be informed.

I think it's pretty reckless to play with your health if you know you have GDM but do nothing about it. I know no one here has said they'd do that, but I know people who have.

With the right meds, exercise and diet, most of the time the baby is fine and normal delivery can take place....is what I've been told on several occasions.

Yes, there are sometimes complications, but that's true of a lot of pregnancies, GDM or not.

There is an actual risk to babies (stillborn...they don't know 100% why but it's thought to be to do with deteriorating placenta) being born after 40 weeks, where mothers have GDM. Hence why my particular hospital induces before 40 weeks, if baby hasn't come naturally.

There is also the serious risk of shoulders or abdomen getting stuck when in labour, if baby grows too big...and you wouldn't know baby is too big unless you've been diagnosed and sent for growth scans. Fundal height measurements don't cut it for this.

Went on a bit there, sorry!

ETA: I can't see why c-sections and/or induction are deemed unnecessary, if that's what is needed to be done to have a safe delivery. I don't think they do them for fun!

I certainly don't want to trivialize your experience and I do acknowledge that there are in fact several risks associated with GDM.... My problem with it is that treating it has not been shown to better outcomes... So yes stillbirth is more common [and from all the data I read the elevation of stillbirth rate rises quite significantly for mom's with GDM after 34 weeks (not 40) and that risk does rise over time, but most studies have not been able to demonstrate that treating GDM reduces stillbirth rates Same goes with shoulder dystocia.... and while size of the baby does increase the risk of dystocia it certainly is not the only factor. Many women can push out 11lbs babes with no problem at all and wee little 7lbs ones can get stuck if their head flexion is wrong. (So yes, bad outcomes occur whether a woman has GDM or not) And ultrasound is of absolutely no use when it comes to predicting size and is only considered to be accurate to +/- 2 lbs... So a babe estimated to be 9lbs could easily be anywhere between 7 to 11lbs... Because of that inconsistency in accuracy it has not been advised to induced based on suspected macrosomia and this has led to alot of controversy amongst obstetricians. Especially because induction and c-section are not without risks as well. And while I doubt c-sections are done for fun... they are frequently done unnecessarily and have witnessed and been apart of some unnecessary c-sections done for obstetrical convenience. It's also important to note that OB's get paid substantially more for performing cesareans then to attend a vaginal birth.

And while I admit the intention of glucose screening in pregnancy is good the current structure of management to improve outcomes simply is not. For every study that I find that suggests it does improve outcome I find 2 more that dispute that and most that do suggest improved outcomes are based on the minority who require insulin. Even the latest cochrane review has failed to confirm whether glucose screening and treatment is beneficial or not.

And to add more to the dilemma, the governing agencies (such as the SOGC in Canada) which dictate to obstetricians as to whether or not universal screening, risk factor screening or no screening should be implemented have concluded that the research is still unclear and that the decision is best left to individual preference... WTF?!?! So if I were under obstetrical care in my current town it would be considered a routine screen.... but if I lived 4 hours away I would not be offered the screen at all.... But both practices are considered fine???

I do however think that part of the GDM "management" should be implented amongst all pregnant women. Healthy lifestyles, specifically healthy eating and exercise is not addressed enough in my opinion and it's also my opinion that all women should be paying just as close attention to their diets as someone with GDM. And although I can't speak for other countries, the midwifery and medical training here in canada does not adequately incorporate diet and nutrition into their education program and as a result the care providers are generally ill equipped to counsel women in this regard unless they themselves have a personal interest in the subject or specialize in GDM management. And unfortunatly not everyone has access or can afford to have their own personal dietician. It's sad and the reality of it is all pregnant women can benefit from that additional support.... without the addition of the unnecessary interventions accompanied with a diagnosis of GDM.

 

[Farie]

I am having the basic test next week, I'm low risk but I'd much rather know - if I'm informed I can make informed decisions and keep an eye out should something be a little 'off' - if I do have anything it doesn't mean an automatic c-section at 38 weeks, it just means they will keep a closer eye and me and bub - which I think can only be a good thing.

Just my opinion

 

[KandyKinz]

Having GDM certainly doesn't mean you're gauranteed at c-section at 38 weeks.... but it does increase your chances... For instance many doctors will recommend induction at 37-40 weeks (like Pixelle's above) and depending on the study you look at up to 25 to50% of first time mom's who are induced will require a c-section depending on what gestational age they are induced at.

 

[Pixelle]

I understand what you're saying but since I do have GDM, I have been told the risks and potential complications and definitely feel much safer knowing there are procedures in place to deal with whatever comes along.

No amount of studies or research would stop me from taking advice from my medical team. They know what is best for me and my baby and if it turns out I have to have a C-section or induction, so be it.
My hospital have assured me that there is no way they'd induce or c-section unless absolutely necessary. I do understand other countries and hospitals are different.

Managing GDM is certainly not easy, and of course, as with all pregnancies, bad things can happen. You say the studies you've looked at show that managing GDM hasn't decreased still birth rates etc....the info I've been given by the hospital is different and suggests that intervention before 40 weeks has a much higher 'successful' labour rate. I realise they wouldn't tell me otherwise as it would worry people more, but they're not going to lie about it.

I still think that if you refuse a GTT and it turns out you have GDM, you're putting yourself and your baby at increased risk.
GDM does need to be managed and mothers need to know the risks and need to be helped to come to terms with these risks....but it's not all bad news. A healthy diet and lifestyle is better for mother anyway and can help the mother in the future...e,g not getting Type 2 Diabetes (once you've had GDM, you're more likely to develop Type 2 within 10 years).
Yes, women have 11lb + babies all the time. Big babies, babies getting stuck and stillbirth are not the only risks associated with GDM, they are just the most serious and likely to threaten life.

I don't think this is a subject we'll agree on though!

Maybe in Canada things are different, I don't know. But my hospital has been excellent with me. Even before I was diagnosed with GDM, lifestyle, exercise and dietary advice was given and there is a lot of support available.

 

[megs79]

Hi there - this one's obviously a v personal decision and I totally respect why someone would want to go with it and be 'better safe than sorry'.

Personally, I decided not to have it. I was told I needed it because I might have polycystic ovaries (not a firm diagnosis though). I know 2 people who tested positive for GD and were booked in for c sections due to being told they would have very large babies (both wanted natural births, one was keen to have a home birth). One baby weighed 6 lbs, the other 8, so not large babies at all.

My problem is that (from the research I've done) the results seem very inaccurate and often make your pregnancy a complicated one when it needn't have been. I discussed it at length with my midwife, who luckily is v supportive. She said that we can keep an eye on how big I'm measuring and then if there are warning signs we can decide what to do from there.

Am 31 weeks now, and measuring 30 weeks. All blood test etc. fine. My mum had 3 of her 4 children at home without any complications, even though doctors tried to discourage her all the way through. I totally understand that people want their baby to be as safe as poss but it's my opinion that constant monitoring and testing can actually be counter-productive.

I thought a quote from Ina May's Guide to Childbirth might be helpful. It's firmly against testing so could be seen as biased but there's so much out there to encourage us to have all these tests that it's useful to read a counter argument (and it's one I agree with personally! Also, it's based on a lot of research and investigation)

"Many doctors recommend this test for all pregnant women, to be performed between 24 and 28 weeks of gestation. The test, unfortunately, is not very reliable. Between 50 and 70% of women, if retested, will have a different result they got from the first test.

The best evidence we have says there is no treatment for GD, either with diet or with insulin, that improves the outcome for mothers or their babies. In short, the anxiety that is often produced by this test simply isn't worth the information gained from it.

... My partners and I use a little device called a glucometer to help identify women who can benefit from dietary changes if we find their blood levels are varying too widely...."

(she goes on to discuss this but I don't think i can type any more!!)

- Hope this is of some help and offers some counter thoughts. x x x

 

[lisaf]

I found this topic interesting. I've had a GTT while not pregnant to see if I had insulin resistance as part of my PCOS testing. (My levels were fine)

I've heard so many pregnant women have to take the GTT multiple times either because their doctors think they are in an at-risk category, or because they tested high on a fasting test. The fasting guidelines for pregnant women seem to vary too which is frustrating.

I'm sure I will do the test if asked, because I really want to know if I do have it so I can be stricter with myself about ignoring my sweet tooth or making sure I get off my lazy butt.
Yes, I should be doing that stuff anyway, but I'm realistic about my own motivation.
I've been trying to be good because I'm hoping I can get away without any GD and the more restricted diet, but I'm not a perfect angel.

My friend was diagnosed with insulin resistance and they put her on the diet and I can't imagine having to do that! lol! No dairy, fruit or carbs for breakfast? Yikes!

I can imagine getting fed up if my docs send me to do the test more than 2 times.

 

[megs79]

Hi Lisa - think I've seen you on the Clomid thread - congrats!!!!

That sounds like the breakfast time from hell your friend has to have! Interesting about having it as part of PCOS testing too. Yes, it's the reliability of the test itself that worries me most but see your point about it encouraging good habits, which can never be bad!

x

 

[PrincessJenna]

My mw booked me in for a glucose test as my BMI was high, also my dad is diabetic

 

[Aunty E]

What kind of diet do you have? If your diet is nicely balanced, and you don't feel any symptoms of GD, then maybe you could not have it. I was actually worried I might have GD (I am high risk, but didn't have it last time and had a dinky baby) but my MW decided not to to the GD test, so my lovely lovely friend checked my blood sugar for me an hour after eating and it was fine, so I was really pleased. Might check again and see how I'm doing in a month or so, because I do worry about the consequences of untreated GD. Aside from the difficulties with bubs, which you've obviously researched, I am also concerned about the consequences for my long term health as a result of uncontrolled blood sugar levels. I like my circulation just how it is thanks, and I suspect, although don't know, that uncontrolled GD might increase your chances of type 2 diabetes later more than controlled GD. Just a thought to add to the mix.