Glucose Test - New Standards since Jan.?

[Carrissa]

Went to the midwife today and the glucose test was brought up - I'm 13 weeks. She said that I would have to have the glucose test done TWICE this pregnancy - once I think at 20 weeks and another at 35 weeks? Can't remember the exact weeks. She said they changed the standard in Jan. and it's no longer just a 1 hour first either. She said that you fast, they take your blood, you drink the stuff, then blood test at 1 hour and then another at 2 hours for both tests. She said this would apply to me because of my BMI and then she looked at me like she was sorry. This is the first time I have met her (second time being at this office). I want to know if anyone else has heard of this as this is the first time I have and I got more than a little upset as she has no idea what my BMI is.  I'm a little overweight, but I'm wondering what the heck your BMI has to be to be treated like this. It sounds ridiculous to me. Thanks!

[lifeguard]

bmi is used because being heavier is a risk factor (among others) for gestational diabetes. Having had 2 gd pregnancies & read everything I see on the subject I can tell you it comes down to this: there is no one standard of care, each care provider/organization uses it's own standard when approaching it. If you really don't like it I would consider looking for a different midwife.

[Carrissa]

I also have had two gd pregnancies, but she didn't know that as she is a new midwife for me. I want to see whatever she is talking about in Jan. that changed how to do this so there is no more 1 hour test. I found the IADPSG panel that suggested new guidelines, but nowhere in there did it say anything about doing this twice for people with high BMI. Does anyone have this information?

[WaitingForKiddos]

What if you just say 'no thanks' ?

[Carrissa]

Yes, definitely will do that, but would like to see the new guidelines she is talking about. 

[parsley]

At my first appt with my midwife practice I was told that they have started offering a GD test at 10-14 weeks to all women who have a BMI over x?  (I forget the actual number).  I declined, explaining that I know I'm not a diabetic and didn't have GD with my first pregnancy.  The midwife was totally fine with my response and nothing else was ever said. 

I will agree to do the 1 hour test in a few weeks time (I'm 21 weeks now). 

With my first, it was a different practice and different state and city, but no one suggested doing an early GD test. 

[emmaegbert]

bmi is just weight and height so if that was in your chart, she can easily see what it is.

I had a previous GD pregnancy and was able to skip the test, just went straight to monitoring. we all agreed it was more important to know what my actual blood sugar is doing, not what happens when I fast and then drink a glucose syrup, which is something that literally I would never do in real life. Its important to me for my own health and that of my baby to have stable, normal blood sugar so I am very happy to have the opportunity to take control over this from the get go and I decided to just be proactive this time and chose my health care practitioners b/c they we were on the same page about it all. I had been able to achieve satisfactory control through just diet in my previous pregnancy, so we assumed that I would be again (I have been).

I agree with Lifeguard, seems like different practices have really different protocols. If they work through a particular hospital or OB practice, the MWs may not have much leeway.

FWIW, I think that all women are recommended to be screened, regardless of BMI. Thin people can develop GD (and type II) and it can be missed b/c there are so many assumptions around the link between being overweight and diabetes.

[Thesan83]

The practice I go to no longer does the 1 hour screen and opts for giving everyone a 75g, 2 hour test instead. (This also replaces the 3 hour test: fail the initial 2 hour and you get referred to a GD clinic rather than go back in for an even longer test.)

I thought it was odd when they first told me about it, since I'd never heard of anyone doing something other than a 1 hour screen followed by a 3 hour diagnostic test. I did find some information suggesting that shifting to a 2 hour test is becoming more common in the United States and that it is standard in Europe and Canada. I didn't find anything that suggests it should be done more than once based on BMI alone, although it makes sense to screen early based on that since being overweight is a risk factor.

20 weeks doesn't strike me as super early to do the test. But I would be concerned about missing GD that might develop around 24-26 weeks and not detecting it until 35 when there's not much left that you can do about it. In any case, if your MW was aware of your previous GD in pregnancy, she'd probably want to screen you even earlier so that they could catch it as early as possible.

[lifeguard]

fwiw - with previous gd pregnancies I would go into this assuming it will be again & get on track with diet & tracking from the get go regardless of testing policies or timing.

[Sweet.Bee]

Quote:

Originally Posted by Thesan83 

I did find some information suggesting that shifting to a 2 hour test is becoming more common in the United States and that it is standard in Europe and Canada.

I can confirm that the longer test seems pretty standard in Europe right now. I'm going straight to the fasting test (next week's appointment at 27 weeks). I am thin and did not have GD during my last pregnancy. Also no sugar in my urine yet, though I did have it often enough last pregnancy that I had to repeat the test after passing the 1st. This was ~2 years ago (in a different European country), and I also jumped right to the longer test then.