Would You Choose To Take the Gestational Diabetes Test, or Not?

[orange_mommy]

Today my midwife asked me if I want to get the gestational diabetes test.  One one hand, I am thinking well, I might as well get it and have more info to work with, and if I DO have it then it's probably a good thing to know.  On the other hand I'm thinking, if it comes out positive, then I am considered high risk and I think I have to be transferred to an OB, or at least be forced to have the baby in the hospital. :(  So when my midwife asked me, I asked if I could think about it until the end of the appointment (5 minutes later, lol) and then I felt like I had to make a decision and ended up saying yes.  I have my form, and I'm wondering if I made the wrong choice.  I'm thinking I may send them an e-mail and ask if I can change my mind and decline the test.  I just don't want to end up making a choice that will put me back into the medical system if it's something that could have a false positive, etc.  That would be horrible!

So here's my info:

32 years old, I have a 6-year-old son and had a healthy pregnancy with him.  My first GD test with him looked high, so they sent me in for the second one and it was normal.  I had a great grandpa and a few great aunts/uncles with type 2 diabetes, but no one in my family has type 1 diabetes.  I eat fairly well.  I would really rather avoid anything that would put me unneccesarily back into "the system" and away from my midwives and the possibility of either a home birth or a birth centre birth.  I had a rotten experience with doctors and nurses and the hospital with my son.

Anyhow, would you opt to take or decline the gestational diabetes test if you had the choice? (I'm in Canada, and I have heard that in some places it is non-optional.)  Are there huge risks for the baby if the mother has GD and doesn't know about it?  Are there any other signs that would be obvious if you had GD?  Would you know immediately after the baby was born if they showed symptoms of you having GD?  Would having a baby outside of a hospital setting be risky for a baby in that case?  I know that the first GD test can give a false positive... can the second GD test give a false positive as well?

Thanks in advance for your thoughts!

[Nicole730]

I declined to take one with my second pregnancy.  My midwife told me I could, but she didn't think it was necessary, so I felt comfortable not taking it.

[sewingsparklz]

Sounds like your situation is a little tough. I''ve always passed the first test (it's required by my ob), but I don't enjoy the test, so if I had a choice I'd say NO WAY!

But it sounds like you are a little borderline as far as risk goes...hmmm...I thought that something would show up in your urine later on in the pregnancy that would indicate to your midwife that you had GD. Could they just watch for that?

Or maybe, if you have to have the bloodwork done anyway in that point of the pregnancy, you might go ahead and do it (as long as you get to eat breakfast!).

That's all the opinion/advice I have. I don't know much about the risks to momma/baby if you have it and it goes untreated...

Hope someone else can help more!

[orange_mommy]

Originally Posted by sewingsparklz 

But it sounds like you are a little borderline as far as risk goes...hmmm...I thought that something would show up in your urine later on in the pregnancy that would indicate to your midwife that you had GD. Could they just watch for that?

They don't test urine at my appointments... apparently routine urine testing has been under scrutiny as far as relevant results, so they don't do it at all.  She definitely didn't push for me to get the test either... she said that basically the only thing I am required to do is have the baby.    I have been reading for the past hour on the net, but still wish I had more info to make my decision on.

[annaconda]

I have a choice at my OB, and I have some risk factors.  There is juvenile diabetes my mother's family - 2 people.  I'm 31, obese but healthy, and it's my first pregnancy.

I am declining the test.

I have had lots of testing done pre-pregnancy and I work hard on my eating habits.  Sure I have treats but I keep them to treats and try to eat relatively low-glycemic index style foods and I exercise very regularly.  Of course there are some days where white pasta just rocks my world but they're few and far between.

So, in the scientific research protocol, they didn't get people OUT of the screening sets who had diabetes pre-pregnancy.  So I know that I"m not diabetic to begin with.  This and many other things I've read kind of skew the research, and I don't particularly think the treatments and protocols are proven to affect changes.  I really don't want to be categorized or have my risk for c-section increased.  I'm adamant about that.

What I will be doing is monitoring my blood pressure regularly.  I have a very accurate BP test kit that I use for work and my BP is excellent normally and has continued to be through my first and beginning of second trimester.  In the third trimester I'll be monitoring my BP.  I'm quite attuned to my blood sugar swinging and avoid carbs in the morning to begin with, so I'm going to monitor my BP for changes every few days in the third trimester.

If there is an upward trend in BP, I'll consider talking to my OB about it.

That's what I'm doing.... but I wouldn't begin to say what another person should or shouldn't do.

[orange_mommy]

Thanks all!  Anna, does BP correspond with possible diabetes?

[noahs.mom06]

I would decline. I don't remember actually taking it my last pregnancy- I was seeing homebirth midwives and was planning to decline, but then we found out baby had a problem and switched to high-risk OB's... still don't think I took it. Won't take it this time either. I've had healthy pregnancies, although everyone in my family has diabetes and my sister had GD... I eat a much better diet than any of them do so I'm not worried about it.

[WifeofAnt]

Its standard here but I had a risk factor (PCOS) so I probably would have taken it anyway.  It was a big fat negative (I got a 75) so it was one less thing to worry about.

You don't have to be 'at risk' to get it though.  Perfectly healthy women making great lifestyle choices can and do still occasionally develop GD.

[~Adorkable~]

Wish there was a sticky thread on this, since this thread gets restarted at least once a week!

If you do a quick search you will find latterly dozens of threads asking this and pages of opinions on both sides, some very strong.

It guess it comes down to what you will do with the data and maybe what kind of test is asking to be done, some are harder than others.

It seems to me that the info is good to have, because yes there are risks and they are good to understand. You may ask your midwife what she would do with the outcome, would it actually risk you out or would it take you having one of the complications that can possibly arise from GD in order to risk out? (like high BP)

Also remember that fasting one hour is a screening test to see who should take the full one, it is designed to catch a large group, most of which will pass the full diagnostic version with flying colors.

[myk]

i definitely did it, i am at high risk of GD (obese, aboriginal, family history of type 2 and GD on both sides). i passed with both pregnancies, surprisingly enough :) if you're really not comfortable taking the test, i would err on the side of caution and eat as if you had GD - low glycemic, controlled carbs, balanced protein, etc.. :) untreated GD can cause polyhydramnios, hypoglycemia in the newborn, etc.. definitely something you want to avoid.

[RedPony]

I had no risk factors and declined the GD test for all three of my pregnancies.  My diet was excellent and my midwife spot on about watching for any deviations from normal (as was I) so I felt super comfortable doing it. 

[annaconda]

Really out of control blood sugar can lead to high or elevated bp but its not like they use bp to screen for gestational diabetes.

[NicaG]

Originally Posted by myk 

i definitely did it, i am at high risk of GD (obese, aboriginal, family history of type 2 and GD on both sides). i passed with both pregnancies, surprisingly enough :) if you're really not comfortable taking the test, i would err on the side of caution and eat as if you had GD - low glycemic, controlled carbs, balanced protein, etc.. :) untreated GD can cause polyhydramnios, hypoglycemia in the newborn, etc.. definitely something you want to avoid.

Also increased risk of stillbirth.  If you have risk factors, it's probably a good idea to take the test.  I had basically no risk factors and ended up raging gd both pregnancies, it was a complete surprise because at the time of my first pregnancy I was running 3+ miles a day (even throughout the pregnancy), eating well, normal weight, etc. but my gd was extremely difficult to control, couldn't be controlled with diet and exercise, ended up on insulin.  Still, I'm glad I knew I had it, even though it meant "high risk pregnancy"--I think the risks to me and my dc from untreated gd would have been great.
 

[jksmith]

All tests/ procedures are your choice! So don't let anyone make you think you have no choice.

In Ontario, (not sure about other provinces) gestational diabetes can be handled by your midwife as long as it is diet controlled. If you start needing insulin they have to transfer to an OB.

But if you did have it, it would be better to know now and be able to handle it that end up with an operative delivery or a baby in the NICU later. Think of it as one smaller, safer intervention to prevent bigger, more serious ones.... that's why I chose the test anyway..

I also read that cinnamon and apple cider vinegar are metabolism boosters so I drank cinnamon tea everyday after my first GD test was positive and then my second one was fine. I also think it gave me more energy overall.

[gummibears]

I take all of those tests just to err on the side of caution so long as there are no risks to me or baby through doing so. I took it with son, and I suspect I'll be taking it again this time.

[Ravin]

I decided to refuse it this time around. There's no diabetes in my family, or history of GD, and I had no such problems with DD, so I figured why bother?

[mylilmonkeys]

I have declined with all but my first pregnancy, even after having several babies whose birth weights put me in the GD "risk" category.  They were healthy and none of them showed signs of hypoglycemia at birth.  My last two babies have been under that threshold, anyway.

GD is complicated.  There is evidence that it can be a huge risk to both mom and baby.  But the 'research' used to arrive at lower limits are highly suspect.  It is absolutely normal for pregnant women to become somewhat insulin resistant during pregnancy.  This is a normal, natural metabolic state which allows more sugar to circulate in the blood stream to aid baby-building.  Of course, the modern American diet is so high in sugars (high fructose corn syrup in everything...) that this natural state can become problematic.  However, there is no good research that establishes at which blood glucose level this might happen.  In the absence of a GD test, it would be wise to try to stick to a GD diet as possible, low or no simple carbs; no fruit juice, eat the whole fruit; good quality proteins; complex carbs; lots of veggies of all colors.  Really, keep a well-balanced healthy diet.

PP have mentioned some of the other signs and risks of uncontrolled GD: polyhydramnios, spilling sugar in urine, high blood pressure, macrosomic baby (very large baby, increasing risk of shoulder dystocia), pre-eclampsia, preterm labor and stillbirth.  There are risks to being labeled GD, too, which mostly are due to caregivers fears, leading to early induction of labor and increased cesarean risk.  

Since your caregiver does not do a urine screen, it may be better to go with the test, since the other early screen is sugar in the urine.  By the time other symptoms show up, it may be hard to control your sugars through diet.  There may be options other than the GTT syrup test.  Some midwives have formulated a "jelly bean" test.  Others follow a protocol using a specific breakfast menu, with a known calorie/glucose content.  Some will even just send you home with a monitor to check blood glucose levels at specific times of day.  You may want to call and ask if you could use any of these other methods, especially more nutritionally sound ones.  

Here is an excellent page which details all the complexity of the GD issue, including relevant quotes of people who have studied the research and pointed out serious flaws.  http://www.plus-size-pregnancy.org/Prenatal%20Testing/prenataltest-gdscreensummary.htm

And a few references to alternative tests: http://www.gentlebirth.org/archives/gestdiab.html#Jelly

[BusyMumof5]

I was tested in my last pregnancy (Twins) and I really wish I wasn't.. I am a needle phobic and they stabbed me 5 x and made me black and blue - and the fainting at the sight of a needle is NOT good. lol x