How necessary is the glucose test? - Mothering Forums

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#1 of 49 Old 11-06-2010, 04:10 PM - Thread Starter
 
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I hated the glucose test when I was pregnant the first time. Not only did it make me feel sick all night, baby was bouncing all over his womb. I also have aversions to sweets during pregnancy, and just choking down the juice was torture.

So, my question is, if a woman were prone to gestational diabetes, wouldn't she have other symptoms? How terrible would it be to decline the glucose test and risk not knowing one had GD?

Anyone out there glad they had the test because it revealed GD?

THANKS!

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#2 of 49 Old 11-06-2010, 04:33 PM
 
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I had the test with my first and I failed it. I had to go for the 3 hour GTT and that revealed that my sugars were actually on the low side.

IMHO, having worked in Ob/Gyn, seeing so many women "fail" the 1 hour and then pass the 3 hour with flying colors, unless you have pre-determined risk factors for diabetes I do not see a reason to have the 1 hour GTT performed. Blanket testing for every pregnant woman is just absurd. Why should every single woman be tested for something if they are not symptomatic, have no family history and are otherwise healthy?

This was taken from the VERY mainstream WebMD site:
Pregnancy and Gestational Diabetes Screening
All pregnant patients should be screened for gestational diabetes during their pregnancy. Screening may be done via patient history, clinical risk factors, or laboratory screening (the oral glucose tolerance test.

Needless to say, I did not test with pregnancy #2 and will not this time around either. If you have high risk factors, go for it.

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#3 of 49 Old 11-06-2010, 04:34 PM
 
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I skipped it after my first pregnancy 17 years ago.

Annabelle Catholic wife to Jeff '92 and mom to Makaley 19 Arden 19 Anniston 17 Taegan 14 Balen 12 Kellen 10 Ellery 8 Innish 6 Eiley 4 Finnian 3 Esca 2 our 8th uc.jpghomeschool.gifwaterbirth.jpgIHhbac.gifbftoddler.gifvbac.gifand expecting sweet pea January 2014.

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#4 of 49 Old 11-06-2010, 04:36 PM
 
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I didn't do it my last 2 pregnancies. My first 3 I passed the 1 hr but felt awful afterward... there are alternatives to drinking the glucola though if your doctor is interested in alternative ideas.

Nic, loving mama to 5 with a SURPRISE 6th on the way.

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#5 of 49 Old 11-06-2010, 04:37 PM
 
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I was on the fence whether or not to take it. Problem is that there may be no other symptoms than a baby that weighs (too) much, so it is good to know whether being pregnant made you worse at processing glucose.

I decided to get a home glucose test. That way, I don't have to down an artificially large amount of glucose and I get the real life view on my glucose situation. I measured a few times in the morning (sober), a few times one hour after a normal meal and a few times one hour after a sweet attack (high-glucose meal or having eaten too many chocolates). It gave me a good view on my glucose tolerance (OK) and it also confirmed that eating high-glucose meals isn't healthy (as gd is not black-and-white: a lot of glucose is bad for you / the baby even if on the high end of normal and not the result of gd).

I looked online for the normal ranges in these situations; don't have the website (my dh looked for them), but it's pretty uncontroversial.
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#6 of 49 Old 11-06-2010, 05:14 PM
 
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I had the standard fast & glucose drink test during my first pregnancy and I haven't had it since. I don't have a high opinion of that testing method; it's completely unnatural and I don't feel like a pregnant woman should fast and then overload her body with sugar, it's bound to cause serious discomfort at best. There are some people who go so far as to say Gestational Diabetes doesn't even exist, and I'm not totally convinced that they're wrong.

In my first pregnancy, I did the regular test, failed, and had to go back for the three-hour test. I passed with flying colors.

I didn't have any test at all during my second pregnancy.

During my third, I fasted for an hour and then had a candy bar before having blood drawn.

During my fourth, fifth, and sixth (this pregnancy), I ate normally and then told my midwife exactly what I'd eaten. She did a finger prick. Results were normal.

If I ever end up with a health care provider who is not willing to do a modified test, I will waive it altogether. The only reason I take it in the first place is because there are so many diabetics in my family; if my risk were lower I wouldn't do it.

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#7 of 49 Old 11-06-2010, 05:30 PM
 
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I have gestational diabetes with this pregnancy and both of my other pregnancies. I have no risk factors. I control it very well by eating very healthfully and monitoring my blood glucose with a meter. This time, as soon as I had my first OB visit, I asked to skip the glucose tolerance test and just get a meter. He agreed. I don't know why anybody couldn't just do a few standard blood glucose tests (fasting first thing in the AM, and one and two hours after eating a normal meal- called post-prandial blood glucose tests). If the values are normal, according to your physician's guidelines, then I'd say you probably have nothing to worry about. If they're questionable, a test called A1C can give you a six-month average of your blood glucose. I agree that inundating your body (and baby's body!) with unnecessary sugar doesn't make much sense.

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#8 of 49 Old 11-06-2010, 05:30 PM
 
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I would also ask if they may be open to alternative methods. My MW just has me eat a large breakfast and then does the blood draw an hour after that. She feels that the glucola just overloads your body in an unnatural way and is not accurate as far as determining GD.

If you have no past history or family history I wouldn't feel bad declining it.

S, mama to L(DD)-12/04, K(DS1)-12/06, C(DS2)-03/09 & B(DS3)-05/11

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#9 of 49 Old 11-06-2010, 05:32 PM
 
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I didn't take the test and this is my first pregnancy.
thought it was strange to screen everyone for it... it's not something my mother or any my sister-in-laws ever had done, and I don't have any family history with GD or any type of diabetes.
my midwife didn't care either way, and when I asked her about it, I could kind of tell she thought it was unnecessary. But I decline most tests.

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#10 of 49 Old 11-06-2010, 05:34 PM
 
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The three-hour test made me sick, sick, sick. It was sheer torture. I am never doing that again.

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#11 of 49 Old 11-06-2010, 11:16 PM
 
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Like a couple of PPs, my midwives had me eat a normal breakfast and tested my blood sugar with a glucometer an hour after I finished eating. The glucola is kind of an insane practice - why would you overload your system with sugar and use those results to determine how your body processes sugar in your daily life? Hopefully you aren't consuming 100g of sugar on an empty stomach regularly. It makes so many women sick and dizzy, there's no way it's good for mama or baby.

If you're concerned I would ask for the "real-life" test with a glucometer, otherwise I'd be tempted to skip it, especially if you have no family history of diabetes.



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#12 of 49 Old 11-07-2010, 01:33 AM
 
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If you have any risk factors then I would ask for the 3 hour test. I wouldn't ever bother with the 1 hour test, it is a screening tool it isn't diagnostic. In fact the hospital where I had my antenatal care doesn't do it at all. If someone has risk factors then they offer the 3 hour diagnostic test.

If you do have risk factors then it is worth doing IMO

- as a PP mentioned, sometimes the woman will not experience symptoms
- macrosomia is not the only potential problem uncontrolled GD can cause for the babe
- GD increases a woman's risk for DM Type II. I, *personally*, would want to know if my risk was increased so I could modify my lifestyle risk factors accordingly and be aware of early symptoms of DMII so I could start treatment immediately.
- home glucose monitoring is not a reliable way of diagnosing GD. As unpleasant as many people find it, the 3 hr test is the best diagnostic we have at the present time.

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#13 of 49 Old 11-07-2010, 06:52 AM
 
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I've done the test five times now (six, if you count the only 3-hour I've done). The last 3 times, I've used a 50g glucose healthy breakfast.

If my hcp "required" me to use the glucola drink, I think my view might change. I distinctly remember feeling awful after those, and I'm not sure I'd believe it was worth the effort.

Personally, I want to check on how my sugar is doing, and getting one blood draw appeals to me more than getting my own glucose monitor. But getting my own glucose monitor appeals to me more than doing a 3-hour glucose test, if it were to have come to that this time. Everyone has their own individual limits.

I think the fact that my first two babies were such different sizes (7lb9oz then 9lb2oz) plays into it. I have no reason to think any of my pregnancies is going to be the same as the previous, so it makes me feel better to "check in" on them.

Also, I don't do any blood draws before that (unless otherwise indicated). So this trip to the lab was for more than just glucose testing.

The fact that I could get it done at 7am, not have to go hungry, not have to drink the icky stuff, and only have to deal with 1 needle the whole time really makes it no big deal in my book, and gives me some peace of mind.

If circumstances were different, I'd have to reweigh all the factors, and might come to a different conclusion.

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#14 of 49 Old 11-07-2010, 12:01 PM
 
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Originally Posted by katelove View Post
- home glucose monitoring is not a reliable way of diagnosing GD. As unpleasant as many people find it, the 3 hr test is the best diagnostic we have at the present time.
Please explain why home monitoring is not reliable and why the 3 hour test is. This is the first time I have ever heard anyone say this.

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#15 of 49 Old 11-07-2010, 12:14 PM
 
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Originally Posted by msmiranda View Post
Please explain why home monitoring is not reliable and why the 3 hour test is. This is the first time I have ever heard anyone say this.
I'd be keen to hear why as well. After all, diabetics depend for their life on that test. I'd say that a one-off test would not give the full picture either (?).
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#16 of 49 Old 11-07-2010, 01:53 PM
 
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I really suggest reading up on GD. And apparently there are several people on this thread even that could use some boning up on the subject. Henci Goer has some great online articles on the subject.

I didn't do the test. I refused with both pregnancies. The first time, they tried to scare me into doing it, using "big baby". The 2nd time, I chose my care provider a bit more carefully and made it clear during the initial interview that I wouldn't be doing it. Since she was of the same mindset (and taken some of the same classes) as me, it wasn't an issue at all.

GD is a completely unstudied diagnosis. There is no evidence of it's existence. And being labeled GD does nothing to improve outcomes, but it can definitely lead to more interventions. Make your choices fully informed.

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#17 of 49 Old 11-07-2010, 02:12 PM
 
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This is very interesting as it's something I was planning to decline, but still researching.
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#18 of 49 Old 11-07-2010, 04:38 PM
 
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http://www.gentlebirth.org/archives/gdhgoer.html

Here is the article by by Henci Goer.

Annabelle Catholic wife to Jeff '92 and mom to Makaley 19 Arden 19 Anniston 17 Taegan 14 Balen 12 Kellen 10 Ellery 8 Innish 6 Eiley 4 Finnian 3 Esca 2 our 8th uc.jpghomeschool.gifwaterbirth.jpgIHhbac.gifbftoddler.gifvbac.gifand expecting sweet pea January 2014.

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#19 of 49 Old 11-07-2010, 06:51 PM
 
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I took the standard overly sugary soda when I was pregnant with my 10yo and "passed."

With my 7yo, I did the test, but used 1/2 banana and a pint of orange juice, "passed" again.

I chose not to do the test with my 3rd and 4th children. It wasn't something that I was concerned about and I was more comfortable declining things.

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#20 of 49 Old 11-07-2010, 08:23 PM
 
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Quote:
Originally Posted by msmiranda View Post
Please explain why home monitoring is not reliable and why the 3 hour test is. This is the first time I have ever heard anyone say this.
Quote:
Originally Posted by EllisH View Post
I'd be keen to hear why as well. After all, diabetics depend for their life on that test. I'd say that a one-off test would not give the full picture either (?).
Home monitoring is not as sensitive as the 3hr GTT. The home monitors are intended to be an adjunct to treatment not a diagnostic tool.

In the presence of GD a woman's BGL will rise higher and drop more slowly following a glucose challenge than in a woman who does not have GD. That's why 3-5 blood tests are done during the test. And lab machines not bedside (or home) monitors are used to analyse the samples. The large glucose load combined with more sensitive testing tools allows this to be seen clearly. Eating normal food and testing randomly is less likely to produce changes which will be identifiable by a home monitor as pathological.

The GTT is not 100% sensitive either, meaning that it will fail to diagnose a percentage of women who do it. However random home monitoring is *less* sensitive, meaning that it will fail to identify even more women.

If a woman desperately didn't want to do the GTT then, I guess, the home monitoring would be better than nothing but she should be advised of the decreased sensitivity and the implications of that. Personally I don't see the point of a testing regime which requires more effort for less result. However, as with all things, it's a matter of weighing the pros and cons. We just need to move away from the idea that we're comparing apples with apples when choosing which test to go for.

ETA - My DH read this post and he added that the lab test of blood is much better at giving a *true* BGL. The home monitors are influenced by a variety of components within the blood and were designed more to show trends over time rather than one off levels.

In terms of treatment for pepole with diabetes they also have the advantage of being cheap (relatively), portable and easy to use. All these things are factored in when considering anything ffor long-term home use. Often, a degree of reliability or sensitivity is sacrificed for the other factors I mentioned.

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#21 of 49 Old 11-07-2010, 10:27 PM
 
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I had GD with my first pregnancy and was diagnosed early with this pregnancy as well. Other than being slightly overweight (I wear a size 12), I have no other risk factors. My mother had normal size babies and was never tested for GD. Me and Sibs were 6-7 lbs each, however her pregnancies were very different than mine (for one, she smoked through her pregnancies). I also had no symptoms of GD and was shocked when my 1hr result was 197.

I have never doubted the diagnosis -- once I started monitoring my sugars, I could see clearly how certain foods (even healthy foods, like oatmeal with fruit for breakfast) send my blood sugar into a dangerous range. It was a lot of work and a lot of diet control to manage my sugar during the last pregnancy-- ending with a full term 8.13 baby. I thankfully delivered in a very baby-friendly hospital whose protocol for managing that was to check baby's sugar (right before nursing) until it was greater than 50 three times in a row. There was no alarm that it was low, because baby was just about to eat. It took 5-6 checks before that was true, but no other interventions were offered/suggested.

I contrast this experience with a friends, also low risk for GD who controlled her sugars poorly, had a large baby born by c/s at 36 weeks who spent 4 weeks in the NICU. She never breast fed after the first few days (partly because of lack of motivation, partly because she didn't have a home pump and didn't want to be at the hospital every 3 hours). I see her obese 11 year child (which is not solely related to the GD, but I certainly believe that is a contributing factor), and wonder what the future holds for his health and am sad he got a poor start in life.

I must be the only one on MDC who likes candy and sweets(maybe that is my risk factor for GD?) A box of Hot Tamales, a Starbucks pumpkin spice latte (oh how I miss you!) are tremendous, yummy glucose loads, equivalent to the dreaded glucola. If I didn't have GD I would be eating crap like that on a regular basis -- and I think that would be detrimental to my child.

I did once check my BG between pregnancies after eating a tremendous amount of candy. It was 92. My HbA1c at my first prenatal visit was 5.2% (excellent). My blood sugar one hour after eating 1/2 cup steel cut oats with 1 cup whole milk (for the fat and protein to slow absorbsion of glucose) the other day was 184. My glucose metabolism is different during pregnancy. I don't know why people are so resistant to that idea -- a lot of hormonally controlled things are different for me during pregnancy. My sex drive, my acne, my sense of smell, my sleep cycle, my thermoregulation and more . Just like some people have a great sex drive and awesome skin, some people don't.

I accept that it is safer for me and my babies to carefully monitor my blood sugar at least 4 x per day. If I didn't believe that I had GD I would not carry my monitor with me, interrupt my work, socialization, etc to continue to check my BG -- and that is why "checking things a few times at home instead of doing the glucola" is a terrible idea in my opinion. I need the constant feedback from the meter to help me shape my food choices. Fruit in morning after breakfast = out of control sugar, fruit after lunch = no big deal.

I am extremely suspicious of people on this thread who say things like "GD is a completely unstudied diagnosis." I don't know what they mean by this. There are thousands of pages of studies and millions of dollars of research that have been poured into this. Is it the research I would do? Not always. But it is heavily-studied, if not well-studied.
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#22 of 49 Old 11-07-2010, 11:24 PM
 
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http://www.gentlebirth.org/archives/gdhgoer.html

Here is the article by by Henci Goer.
This article is 14 years old. And some of the papers she quotes are now 30 years old. There has been a bit more work done since then.

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#23 of 49 Old 11-08-2010, 12:36 AM
 
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I've had gd with two pregnancies and assume I will have it with #3.

I had no risk factors with my first pregnancy (well, I was over 30, 32 to be exact, but that's it). At the time I was running 3-6 miles most days, was at a healthy weight, etc. There are no symptoms for gd. The diagnosis took me completely by surprise.

When people (on MDC) say there is no such thing as gd, I'm puzzled and annoyed. I understand that some women are probably borderline and can control their blood sugar levels with diet and exercise. Fine. But in my case, even small amounts of carbohydrates sent my blood sugar to extremely high levels. I needed insulin to control my blood sugar levels (in spite of excercising regularly and following the low-carb diet). Even with insulin my dd was close to 9lbs.

I never see anyone who was diagnosed and treated for gd recommending Henci Goer. Also, if Henci Goer's theories are gospel truth, why are there no other sources that show scientific evidence supporting her theories?

To the OP: if you did not have gd with your first pregnancy and didn't have a 9+lb baby, you're probably fine.

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#24 of 49 Old 11-08-2010, 01:42 AM
 
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One of my best reasons for advocating for testing for GD (not necessarily the way that it is currently done in an office setting) is because out of control blood sugar can cause high blood pressure.

With my 2nd my blood pressure started climbing at about 24 weeks...by 30 weeks it was 140/90 and my midwife was getting concerned. 30 weeks is also the same time that I was diagnosed with GD...I failed the test, literally, by just 1 point. A different day would have yielded different results...and I very well could have passed. However, I'm SO thankful for the diagnosis. After just 2 weeks of modifying my diet and exercise my blood pressure had dropped to a consistent 110/70 and it stayed that way for the rest of my pregnancy. I did have to take a small amount of glyburide to keep my fasting levels down, but other than that it was totally manageable and I felt 300 times better once I started the diet. And let me say too...my diet before the diagnosis wasn't bad...I had my occasional splurges, but overall it would've been considered healthy.

I had horribly high BP at the end of my first pregnancy and in retrospect I'm sure that it would have been MUCH better had I been following a better diet. (My diet at that point was pretty crappy.) I failed my 1-hr, but passed my 3-hr at 24 weeks with that one...but I'm sure that testing at a later date would have given a much different result being as how my baby did have several "symptoms" of a GD baby (difficulty breathing, low blood sugar, CRAZY jaundice...).

I do understand that the test isn't fun and I think the 1-hr test is pretty much worthless, but I do believe that GD DOES exist and that treating it has many benefits for both mom and baby.
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#25 of 49 Old 11-08-2010, 02:36 AM
 
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ive never taken one
Posted via Mobile Device

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#26 of 49 Old 11-08-2010, 04:30 AM
 
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Originally Posted by katelove View Post
Home monitoring is not as sensitive as the 3hr GTT. The home monitors are intended to be an adjunct to treatment not a diagnostic tool.

In the presence of GD a woman's BGL will rise higher and drop more slowly following a glucose challenge than in a woman who does not have GD. That's why 3-5 blood tests are done during the test. And lab machines not bedside (or home) monitors are used to analyse the samples. The large glucose load combined with more sensitive testing tools allows this to be seen clearly. Eating normal food and testing randomly is less likely to produce changes which will be identifiable by a home monitor as pathological.

The GTT is not 100% sensitive either, meaning that it will fail to diagnose a percentage of women who do it. However random home monitoring is *less* sensitive, meaning that it will fail to identify even more women.

If a woman desperately didn't want to do the GTT then, I guess, the home monitoring would be better than nothing but she should be advised of the decreased sensitivity and the implications of that. Personally I don't see the point of a testing regime which requires more effort for less result. However, as with all things, it's a matter of weighing the pros and cons. We just need to move away from the idea that we're comparing apples with apples when choosing which test to go for.

ETA - My DH read this post and he added that the lab test of blood is much better at giving a *true* BGL. The home monitors are influenced by a variety of components within the blood and were designed more to show trends over time rather than one off levels.

In terms of treatment for pepole with diabetes they also have the advantage of being cheap (relatively), portable and easy to use. All these things are factored in when considering anything ffor long-term home use. Often, a degree of reliability or sensitivity is sacrificed for the other factors I mentioned.
Thanks for the explanation, katelove!
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#27 of 49 Old 11-08-2010, 07:22 AM
 
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Thanks for the explanation, katelove!
My pleasure

Mother of two spectacular girls, born mid-2010 and late 2012  mdcblog5.gif

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#28 of 49 Old 11-08-2010, 10:31 AM
 
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Hmmm ... interesting responses. If I may project my own feelings about GD onto others on MDC, I think that the reason many of us sound skeptical of GD is because it is used as an excuse to push unnecessary interventions on women who don't need them.

My story is that I barely passed the 3-hour with my first, but I now believe that I did develop GD during that pregnancy. I was eating a ton of desserts and drinking chocolate milk, etc. (shudder) and during the last week my blood pressure went up a bit (into the 130s/80s range) and risked me out of the birth center. Had I known then what I know now, I would have been on the GD diet and probably would have had my birth center birth.

With my second pregnancy, I declined the GTT and did home monitoring, and the reason I did that is because I didn't want the GD label. I modified my diet, exercised regularly, and kept my blood sugar under control for the remainder of the pregnancy. I gained less weight (25 lbs v. 35 in my first pregnancy) and did not have the blood pressure spike toward the end. I had my baby at home with a midwife, again because I did not trust that an OB would have our best interests at heart and treat me like an individual who (a) has small babies, even with GD and (b) worked her ass off to keep her numbers perfect from 24 weeks on. I did not want to be pushed into induction or to have a big red "C" on my forehead. I also did not want my baby to be stuck a dozen times for nonexistent low blood sugar or to have supplementation pushed on us by paranoid nurses. I went into labor at 38w6d and had a 6 lb. 14 oz. perfect baby boy after less than 7 hours.

If doctors didn't freak out about GD to the extent they do, or could somehow distinguish between patients who truly have a problem and those who just need to stop eating so many carbs during pregnancy, I would be a lot more inclined to go along with their testing regime. In fact, I could say the same thing about a lot of things -- postdates, blood pressure, body weight, and so on. I take GD seriously, but I'm not about to put myself or my baby at risk for unnecessary interventions because of someone else's paranoia. I don't remember the stats about what the GD label does to your chances of interventions, esp c-section, but as I recall it was pretty significant. Maybe it's the case that those numbers correlate with non-compliance, but I wasn't going to take the chance.

SAHM to Bird (6/07) and Bear (7/09), and now enjoying our newest additionbabyboy.gif, born June 1, 2011!  bfinfant.giffamilybed1.gifsigncirc1.gifcd.gif

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#29 of 49 Old 11-08-2010, 10:03 PM
 
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One of my best reasons for advocating for testing for GD (not necessarily the way that it is currently done in an office setting) is because out of control blood sugar can cause high blood pressure.
This is interesting. I didn't do testing with my 1st, and I had a 7.5lb baby BUT my BP climbed pretty darn high. I would eat protein and that seemed to lower it, but it would go right back up. I was eating a ton of ice cream and vanilla milkshakes at the end of my pregnancy, and now I'm wondering about the supposed correlation you mentioned. I'm open to doing a more "normal" test where I can eat some food instead of drinking crap.

And for the person who said they must be the only mama on MDC who eats sweets, no you are not! Sometimes I see that trend as well, but I have been on a home made cinnamon roll binge the past few days! I have actually been noticing that I need to slow down on the sweets. I don't usually crave them, but this pregnancy I do.

aka ~lioneyes~ :: In love with DH :: DD 5 :: new sweet baby girl 3/14/2011~ both born at home in water
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#30 of 49 Old 11-13-2010, 11:53 AM - Thread Starter
 
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 What a fantastic dialogue here. You have all given me much to consider, and I think I will weigh my options with my OB before I decide what to do. Thank you, Thank you for all the input!


Married to Tony 6/07. Mommy to Jude 4/08 and Gemma 4/11.
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