3 hr GDT at 38 weeks?

[momuveight2B]

My peri has finally given me the results of my one hour glocose tolerance test from 5/17. It was 166. His error that giving me my test results was overlooked all this time. I am almost 38 weeks and now they want me to do the 3 hour test to rule out GD. They dip urine at every visit and there has never been sugar or protien.

I don't know what to do. I don't want to risk the baby who by the way is estimated to be about six and half pounds now based on their very sophisticated US machines, since they are peris.

I don't think I can do this test because the glucola makes me very ill during the one hour test that can be done without fasting. I would have to fast ten hours before the test and they actually want me to drive seventy miles each way to a lab near their office to have it done. The lab there is known to have a wait of up to two hours to even be seen to start labwork.

They don't want me to use the lab at our local hospital because they say they can't get the results from them. None of our other doctors have ever had a problem with our lab here.

I don't think it is safe for me to fast and drive and then do the glucola and drive on that either.

Any help will be really appreciated.

[Birth&Bunnies]

Just say NO

(Also called the Glucose Tolerance Test)
Article by Henci Goer, Author of The Thinking Woman’s Guide to a Better Birth

THIS IS an portion of this article, it's longer than a post should be, so I can email you the rest if you like...

What are the problems with gestational diabetes testing?
A diagnostic test should be reproducible, meaning you get the same results when you repeat the test. Thresholds should be values at
which complications either first appear or incidence greatly increases; and normal ranges should apply to the population being tested.
The OGTT is none of the above.
Obstetricians adopted data from the original 1950s studies as the normative curve for all pregnant women, but they shouldn’t have.
For one thing, those researchers tested women without regard to length of gestation, whereas today, doctors typically test women at
the beginning of the third trimester. Glucose values rise linearly throughout pregnancy, but no corrections have been made for this
(15). For another, they studied a population that was sixty percent white and forty percent black. Hispanics, Native Americans and
Asian women average higher blood sugars than black or white women (10,57). This means values for that 1950s population have
been established as norms for all women, which in turn means that some women are being identified as diseased simply because of
race.
The OGTT also isn’t reliable. When pregnant women undergo two OGTTs a week or so apart, individual test results disagree twenty to
twenty-five percent of the time (5,23). A person’s blood sugar values after ingesting glucose (or food) vary widely depending on many
factors. For this reason, the OGTT has been abandoned as a diagnostic test for true diabetes in favor of high fasting glucose values,
which show much greater consistency, or values after eating of 200 mg/dl or more, which are rare (46,52). Moreover, pregnancy
compounds problems with reproducibility. Because glucose levels rise linearly throughout pregnancy, a woman could “pass” a test in
gestational week 24 and “fail” it in week 28 (55). These same reproducibility problems hold true for the glucose-screening test that
precedes the OGTT (47,55).
More importantly, no threshold has ever been demonstrated for onset or marked increase in fetal complications below levels diagnostic
of true diabetes. The original researchers chose their cutoffs for convenience in follow-up, but all studies since have used their
criteria or some modification thereof as a threshold for pathology in the current pregnancy. Numerous studies since have documented
that birth weights and other outcomes fail to correlate with the 1950s or anybody else’s thresholds. Today’s researchers acknowledge
that the risks of glucose intolerance almost certainly form a continuum and that screening and diagnostic thresholds are arbitrary
(7,29-30,48,51).
Several organizational bodies that have looked critically at the GD research have come out against GD testing. A Guide to Effective
Care in Pregnancy and Childbirth, the bible of evidence-based care, relegates screening for gestational diabetes to “Forms of Care
Unlikely to be Beneficial (12).” The American College of Obstetricians and Gynecologists says no data support the benefits of screening
(1). The U.S. Preventative Services Task Force and the Canadian Task Force on the Periodic Health Examination both conclude that
there is insufficient evidence to justify universal GD screening (4,11).

[the_lissa]

Don't do it.

[momileigh]

I don't know what possible good it would do now to do that test! Maybe if it had been done months ago, it might have had some modicum of value as far as a special diet or something, but now, what? Just a reason to label you high-risk? (Not sure if you already are, since you are seeing a peri.) Consider this another vote for "just say no."

I remember when I refused the 1-hour during my first pregnancy. I numerated the reasons why I was unconcerned, highlighting my low-risk status and lack of any symptoms, and my family doctor replied, "But what if you have it, and it is 'silent'?" (Is it just me or is that funny?)

[Reha]

Originally Posted by momileigh

I don't know what possible good it would do now to do that test! Maybe if it had been done months ago, it might have had some modicum of value as far as a special diet or something, but now, what?

I agree with the 'just say no' stance here. But, also wanted to point out that dietary modifications have no effect on the mortality or morbidity of babies and mothers in women labeled as 'gestational diabetic', even if started early on.

[momileigh]

Originally Posted by Lennon

I agree with the 'just say no' stance here. But, also wanted to point out that dietary modifications have no effect on the mortality or morbidity of babies and mothers in women labeled as 'gestational diabetic', even if started early on.

I'm not a "researchist" and I'm not sure how to parse out all the scientific qualifiers in that statement. But I do know that:

1. Diet makes a huge difference in birth outcomes in the general population
2. If you've already got some insulin/sugar issue, pregnancy-induced or not, eating a SAD is going to increase your chances of prenatal or intrapartum transfer from the MMC (where I am a student) to the hospital.

Although I think the glucola treatment is ridiculous, I do think if your blood sugar is out of whack it is often due to dietary issues, which obviously can be fixed dietarily.

[momuveight2B]

Thank you. I am high risk because of advanced maternal age of 43. I have a good pregnancy and birth history. I am not having any problems with this pregnancy until this week but apparently since the test was done on 5/17 it is not a new problem.

I have gained sixteen pounds during this pregnancy, most in the last trimester. I think I have done reasonably well following a good diet. My biggest problem is my aversion to meat and eggs. I do try to eat them though most days.

I do plan to buy a monitor today so that I can keep track of my blood sugar and will continue to follow a good diet and exercise. I have been swimming most days of this pregnancy. The rest of the time I am taking care of my family. I don't get much time to take it easy.

[Reha]

Originally Posted by momileigh

I'm not a "researchist" and I'm not sure how to parse out all the scientific qualifiers in that statement. But I do know that:

1. Diet makes a huge difference in birth outcomes in the general population
2. If you've already got some insulin/sugar issue, pregnancy-induced or not, eating a SAD is going to increase your chances of prenatal or intrapartum transfer from the MMC (where I am a student) to the hospital.

Although I think the glucola treatment is ridiculous, I do think if your blood sugar is out of whack it is often due to dietary issues, which obviously can be fixed dietarily.

I am referring to a starvation diet: lower calorie, low carbohydrate (which is the typical diet prescribed for GD to pregnant women), not a healthy diet in general. Also, if a woman "feels" unwell due to blood sugar problems, then of course taking steps dietarily to fix those is important (eating some protein with each meal, eating frequently, etc.).

If you refer to the Henci Goer article reference above and her others on GD, she has a whole lot to say about how the typical GD diet is not only useless, but can be dangerous.

[Birth&Bunnies]

Originally Posted by Lennon

I agree with the 'just say no' stance here. But, also wanted to point out that dietary modifications have no effect on the mortality or morbidity of babies and mothers in women labeled as 'gestational diabetic', even if started early on.

Per Pam's article, the statistics and research were very flawed

They selected women for glucose testing based on such risk factors as prior stillbirth, current hypertension, or extreme
overweight, indications that alone could explain poorer outcomes (12). They failed to account for compounding factors, such as that
glucose intolerance associates with increasing maternal weight and age, which themselves strongly predict large babies and maternal
hypertension. Finally, they used management protocols that increased risks such as starvation diets, early induction and withholding
nourishment from the newborn (18). Despite these flaws, researchers concluded that mildly deviant glucose values in pregnancy
caused serious harm.
We now know that GD doesn’t increase the risk of stillbirth or congenital malformations (4). A couple of modern studies have concluded
otherwise, but they didn’t take into account that women with high blood sugar are more likely to have other risk factors for poor
outcome, or that some women had undiagnosed diabetes prior to pregnancy.

[Reha]

Originally Posted by momuveight2B

Thank you. I am high risk because of advanced maternal age of 43. I have a good pregnancy and birth history. I am not having any problems with this pregnancy until this week but apparently since the test was done on 5/17 it is not a new problem.

I have gained sixteen pounds during this pregnancy, most in the last trimester. I think I have done reasonably well following a good diet. My biggest problem is my aversion to meat and eggs. I do try to eat them though most days.

I do plan to buy a monitor today so that I can keep track of my blood sugar and will continue to follow a good diet and exercise. I have been swimming most days of this pregnancy. The rest of the time I am taking care of my family. I don't get much time to take it easy.

As a midwife, I don't consider you to be high risk due to 'advanced maternal age'. Also, it is more than possible to have a healthy pregnancy without meat or eggs. There are lots of other great sources of protein (beans, dairy, chicken, whole grains, etc.)

[momileigh]

Originally Posted by Lennon

I am referring to a starvation diet: lower calorie, low carbohydrate (which is the typical diet prescribed for GD to pregnant women), not a healthy diet in general

If you refer to the Henci Goer article reference above and her others on GD, she has a whole lot to say about how the typical GD diet is not only useless, but can be dangerous.

Well we certainly don't use that kind of diet. We use a really strict but healthy diet low in sugars and carbs and very high in protein and vegetables with 6 meals a day required. It is very helpful IME but only if it is started before 38 weeks of course.

[Reha]

In what way do you find it helpful? Of course a healthy diet is very important for everyone, especially pregnant women.

But have you read this before?:
http://parenting.ivillage.com/pregna...9z3m-9,00.html
excerpt:
"GD treatment per se has never been shown to have benefits. In fact, it is virtually untested."

and

"The standard GD diet is a healthy diet. However, while it reduces blood glucose to normal range in most women, it has little or no effect on birth weight (54). Many women, though, are prescribed limited calorie diets. Reducing calorie intake by more than one-third causes the body to switch to a starvation metabolism (ketosis) that produces byproducts known to be harmful to the baby (31). Limiting food intake can also lead to malnutrition (27). "

(but by Henci Goer)

Sorry to derail this thread a bit. But, the non-evidence based practices surrounding GD really gets me all worked up. :

[momuveight2B]

Well I bought a glocouse moniter and test strips for testing my urine at home. The urine test is negative just like at the peri's office. I can't get a reading on the blood because my fingers will not bleed enough. I tried six hard stabs and gave up in frustration. It is not enough blood to get the test strip to pick it up in time.

What really makes me mad is I was having a perfectly happy pregnancy and felt fine until they told me this and ever since I have been very stressed and thinking the worst with every twinge.

[momileigh]

1st, to Lennon: When we have done reviews of our intrapartum transfers, we have found that the two biggest risk factors for transfer are gaining a lot of weight and late transfer into our care (after about 32 weeks). The weight issue is clearly dietary, and it only makes sense that the late transfer is also a dietary issue as well. We do a lot more nutritional counseling than the vast majority of ob's, and other than that, what would it be? Do our urine dipsticks give better results than the ob's? No. It is the, primarily nutritional, counseling they get. What does this have to do w/ GD? Because if someone is identified as GD or borderline GD, we stress the importance of a strict, healthy diet. (NOT calorie restricted.) This would be good for anyone, but for someone who has trouble controling blood sugar, it is especially good for them. It can help them not gain too much weight, and avoid fat distocia, even if it somehow doesn't affect the baby's size. (I have my doubts about that just based on what I've seen... the studies you're citing seem to be based on very specific medical tests and diets that don't necessarily apply to midwifery clientele.)

2nd, to the OP: Please don't let this stress you out! I am sad that you are seeing providers that tell you that you are high risk, and then make you feel like you are. I agree w/ the midwife who says you are not high risk just because of your age, and the 1-hr glucola test is so useless that most midwives don't even use it at all. If it weren't in the law, I don't think I would do such tests in my own practice. If you've been having a happy, healthy pregnancy, trust that it will continue that way. You're already at the end, and no blood test is going to change anything at this point, so try to enjoy the last few days of your pregnancy and trust that all will be well with you... and try to stand up for yourself with these providers as best you can.

[BinahYeteirah]

bs"d

momuveight2B, all debate about this test aside, you are 38 weeks already! You've only gained 16 pounds. I wouldn't be concerned if I were you. Enjoy the end of your pregnancy!

[Maggi315]

What's the point? I do believe that gestational diabetes is very real, I had a very obvious classic case of it and decided to take insulin. Insulin offers much better control, has better outcomes, better baby weights, and does not cross the placenta.

However, with 2 weeks, maybe 1 day left, what's the point? you should just eat the food based on a GD diet, it's really not going to make that much difference.

What the doc is going to want to do, is start down the intervention path if your results are high. Too bad, he made the error, you can just refuse the extra testing, I would definitely do that!

[Maggi315]

and poo-poo to your advanced maternal age, what a bunch of crap!!! Many, many women in my population are "advanced" and do just fine if not better than the younger first timers!!!

Just skip your doc visits, hide out, enjoy the rest of your pregnancy and don't let them scare or bully you into things you don't need or want!!! Gawd, that just makes me :

[pamamidwife]

even though the GTT and "gestational diabetes" are a load of hooey, what in the world is going to change your pregnancy out come this close to term? what will they do? induce you so your baby doesn't gain an extra 1/2 lb in the two weeks before your due date?

ugh, the mind numbing protocols like this just make me wonder what we're doing to women and babies - is this really about true informed choice or just fear? I vote for the latter.

[natbab]

depending on who are you, you may not "believe" in Gestational Diab.
(I don't either, in all cases)
But the caregivers obviously do. I'm sorry for the upcoming frustration and confrontation - not fun.

Her most difficult option (in light of the above) is to refuse any treatment and say "I'm doing this my way."

I know a woman who said to her OB "I'm opposed to following your advice for this, this, and this reason. If I follow your advice and something happens, I will hold you legally accountable. If something goes wrong and I have followed my own advice, you can hold me accountable. Have we got a deal?" Needless to say, he agreed and she was fine.

Good Luck!

Blessings,
Chris Anne Johnson