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Anyone know what happens if I just dont do the GD screen? My (backup) OB expects it done, but my MW (primary) couldnt care less. I had a 28 week appt today w/ OB and she gave me the paper work and basically said go to the lab and get it done within 2 weeks, but what if I just didnt go? This is technically my last visit with her in order for her to be considered a back up so I probably wont be seeing her again. (Although she wants me to come in at 36 weeks which I have no real intention of doing).

I don't want to offend her as she is kinda going out of her way to be a "back up OB" to my HB MW (don't see too many drs willing to do this), but I really dont feel like jumping thru the hoops of the GD screen, namely doing the actual test if the screen comes back high.
 

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You just don't have it done :)

I was given a lab slip when I went to my 12 week visit and I wanted only some of the labs done. At my 20 week (and last appointment) the nurse said "We don't have XYZ." and I said "Yes, I know." That was the end of it.

So if you don't want to do it, don't go.
 

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The only down side would be if (for whatever reason) you ended up having the babe in the hospital.

Many hospitals have a routine protocol that a "big baby" (I don't recall the weight off the top of my head, but I want to say more than 8.5 pounds?) be blood tested and observed to make sure they're handling their blood sugar levels apart from mom. It's a series of 3-4 heel sticks over the course of several hours and they may try to feed the babe glucose solution or formula if the blood test shows anything odd. You can obviously decline the test (just read up on the visible signs of infant glucose imbalance) and sign the AMA paperwork, but it's one of those things that IF you've transfered you might not be consulted on (I know with our first babe they didn't "ask" or get prior consent, they sort of just told us as they were doing it and since I was post op and groggy and DH was scared silly by the sudden change in our birth neither of us was really up to "fighting" hospital protocol... it was a bad scene all round and a nurse telling us that dd1 "needs a little glucose now" just didn't register for a while, though we did ask for a dropper rather than a bottle). I don't know how your backup OB/backup hospital would handle it but I've learned that at the hospitals in my region it's easier for a mom with a good GTT result to waive the blood draws/glucose dose than it is for a mom who doesn't have a GTT on record or who had a poor GTT result.

Personally I think GTT is a waste of time and energy in most cases... it's just not a well controlled or well applied test, the testing protocols vary too much for reliable results, and unless there are other factors at play I just don't see the point. BUT I get the test done every time since my smallest babe was 9lbs and having the GTT on record ultimately makes my life easier and my babe's first day more comfortable.
 

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Another factor, according to my midwives (who certainly are open to people declining all testing-- I've declined most) is that if you do end up in the hospital in labor without a GD screen on your record, you MAY automatically be treated as though you do have GD-- some hospitals have different labor protocols for women laboring with GD, due to the "dangers" associated with birthing big babies, and may want allow you less time for various phases of labor before beginning interventions, etc. I'm just throwing that out there as something I've been told-- the midwives assured me that the hospital I would transfer to is NOT one that calls you GD unless proven otherwise, which was reassuring. I wonder if that's something your midwife or the OB would be able to tell you about the hospital where you could transfer?
 

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Well, you could have gestational diabetes and go without treatment or monitoring because you don't know that anything is wrong, and then have complications that harm you or your baby.

If you're not going to have the glucose tolerance test, would you be open to monitoring your blood sugar with a meter at home? To me, taking the GTT was much easier, but either way I wanted to be screened.
 

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I refused the GD screen with my fourth mainly because I had never been borderline with my first 3 pregnancies. I did, however, consent to my midwife doing a finger prick at my appointment and we checked with an at home monitor. With this babe, I'm refusing again and instead just doing a fasting draw in the am. In this state they do routine HIV testing in first and third trimesters and if you don't consent to it they require that your baby be tested! So, point being, I have to go anyway for that test so a little extra for the GD screen shouldn't be too bad.
 

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Quote:
Originally Posted by kathrineg View Post

Well, you could have gestational diabetes and go without treatment or monitoring because you don't know that anything is wrong, and then have complications that harm you or your baby.
Yeah, and she could go in for the test and then have to go back for a 3 hour test and then figure out nothing is wrong anyway and Mama was stressed out for nothing.
 

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I turned it down too, even with a high risk pregnancy. I RARELY eat sugar, a whole food vegan and get ill when I eat or drink sugar. I can barely drink 1/4 of a cup of REAL soda, like sprite or coke without feeling like Im going to puke. Instead we did a 1 hour glucose test, so I ate a normal meal, ate something that I normally would consider a "treat" (so delicious coconut milk mini ice cream bar sweetened only with agave and dairy free! LOVE THEM!) and then they did a random glucose screen in an hour. They also did a HGA1c screening which is some sort of test that will test them if I have had diabetic conditions in the last few months. I came back negative on both. http://en.wikipedia.org/wiki/Glycated_hemoglobin It seemed to be a good compromise between not doing it and doing the full 3 hour fasting and glucose drink thing.
 

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One thing to keep in mind with this discussion... the term "glucose test" actually covers a LOT of different tests. So it's easy to have a conversation where everyone thinks they understand everyone else, but they are actually talking about different tests! LOL

The three most common types are:

A one hour GTT: mama drinks a specific glucola beverage (so a clinically controlled amount of glucose) and has a blood draw in one hour. Variations include asking mama to fast prior to the test (usually overnight), asking mama to eat a no-carb meal prior to the beverage but not fast, asking mama to eat normally prior to the beverage, asking mama to move about normally during the testing hour, asking mama to sit in a chair and NOT move during the testing hour. One reason I feel this particular test is kind of silly is due to this variation... different providers and labs have moms do different things, but they all use the same diagnostic chart.

"Relaxed" glucose screening (this variation has a whole bunch of names sinceit's often specific to an individual provider): more commonly seen in midwife practices, this variation asks moms to eat a regular meal (or a meal that includes specific food items, like toast with cheese) or a specific candy (often a pre-determined number of jelly beans) and then do a blood draw after an hour. This is either more reliable (since mom is eating/moving more naturally) or less reliable (since it is less controlled and what is normal for one mom may not be normal for other women in that practice so it doesn't actually tell you much).

Three hour GTT: Usually happens if mom "fails" the one hour test or if she has other risk factors. Mom drinks the controlled glucose solution, then has sequential blood draws over several hours. Some practices put mom on a controlled low-carb diet for several days prior to the challenge, others don't. But almost all practices require fasting prior to the glucose challenge (unlike with the one hour test).

There are other variations, but those are the most common...
 

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Like the OP, my midwife didn't give a hoot about it. I'm 38 and overweight and I know if I'd seen an OB they would have insisted on it, but I've showed no signs of GD, I eat well even though I do occasionally eat sugary foods, and she pricked my finger last month to check my blood sugar (hematocrit/hemoglobin), which was fine. I feel so blessed to have sailed through so far without much testing at all. I pee in a cup every month (now every two weeks) and I've had blood taken twice (HIV screen, blood typing, hcg levels, Rh neg antibodies, etc), I get weighed and measured and checked for swelling (none so far) and that's about it. Oh, and I had one ultrasound at 16 weeks. Yep... I love my midwifery care. I have learned not to trust doctors very much at all and I rarely, if ever, let them dictate my behavior in any way. Pish! If you and your midwife don't care... trust your instincts.
 

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I declined it because I'm showing no symptoms, have no risk factors, and am concerned about the repercussions of a positive result. The cascade of interventions that are likely to follow unless you have very supportive care and you are are willing to insist on an evidence based care approach is not worth the associated risks of a GD diagnosis for me at this point. I trust myself and my midwifery team to monitor my health regardless of what tests I do and do not do. Also, unless you've been tested regularly before and during pregnancy, I'd be cautious of the results, too, and we know that with so many variations in testing method and results, the test is not the most effective measure of health for you or your baby. I know that every country, state/province can be slightly different, but here I would simply decline any testing on my baby that didn't seem warranted (just like so many other birth procedures like eye drops, suctioning, etc.) such as the one above in regards to a baby over 8 lbs. 5 oz, but you may want to review your area's regulations and have a copy of that with your birth bag in case of a transfer or take it into consideration when deciding what to do.

I will say that anecdotally, more and more friends and acquaintances are being diagnosed with GD (5 within two months of my EDD) and are being put on strict diets, facing the risks associated with induction/augmentation of labour (to avoid the big baby concern) and are finding themselves miserable throughout pregnancy, quicker to consent to an induction for no reason other than GD at 37 or 38 weeks as they've already given up so much control over the situation and have now settled for fear based care instead of evidence based practice (and the shift in attitudes of all parties that come with it), and are winding up with smaller fidgety babies with a greater incidence of jaundice and all the other risks associated with doctor dictated delivery. It's a very slippery slope IMHO... Anyone have an statistics on it, I have nothing near by at the moment?
 

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Quote:
Originally Posted by jaclyn7 View Post

I will say that anecdotally, more and more friends and acquaintances are being diagnosed with GD (5 within two months of my EDD) and are being put on strict diets, facing the risks associated with induction/augmentation of labour (to avoid the big baby concern) and are finding themselves miserable throughout pregnancy, quicker to consent to an induction for no reason other than GD at 37 or 38 weeks as they've already given up so much control over the situation and have now settled for fear based care instead of evidence based practice (and the shift in attitudes of all parties that come with it), and are winding up with smaller fidgety babies with a greater incidence of jaundice and all the other risks associated with doctor dictated delivery. It's a very slippery slope IMHO... Anyone have an statistics on it, I have nothing near by at the moment?
I don't have stats on this. However, problems regulating blood sugar can make babies fidgety, and GD is associated with higher incidence of jaundice. It's possible that at least some of the problems you are seeing as a result of medical intervention are actually problems caused by GD rather than by medical intervention.
 

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Originally Posted by activealli View Post

I turned it down too, even with a high risk pregnancy. I RARELY eat sugar, a whole food vegan and get ill when I eat or drink sugar. I can barely drink 1/4 of a cup of REAL soda, like sprite or coke without feeling like Im going to puke. Instead we did a 1 hour glucose test, so I ate a normal meal, ate something that I normally would consider a "treat" (so delicious coconut milk mini ice cream bar sweetened only with agave and dairy free! LOVE THEM!) and then they did a random glucose screen in an hour. They also did a HGA1c screening which is some sort of test that will test them if I have had diabetic conditions in the last few months. I came back negative on both. http://en.wikipedia.org/wiki/Glycated_hemoglobin It seemed to be a good compromise between not doing it and doing the full 3 hour fasting and glucose drink thing.
DDCC.

The HbA1C is next to useless if you have GDM. It's terrific if you have regular diabetes. It's correlated to your BGL over the past 120 days. If you have GDM, your A1C may be perfectly normal because it takes time for GDM to develop. You definitely didn't have it at 2 months, and your BGL has been gradually rising over that time. If you took an A1C at 9 months, sure, you'd find out if you had GDM, but it wouldn't do you much good. At 6 months, you probably haven't been pumping out enough glucose for long enough to cause a significant rise in A1C.

As for fasting prior to your glucola: If they want to get a fasting BGL, which is normally done with the longer tests (I was not in the US for my 1st and went straight to a 2hr 75gm fasting GTT as I am high risk for GDM) you need to fast. It also improves the accuracy of the test. The 1hr is not very accurate and providers know it--but it is easier for everyone than making them do the longer, fasting test. That's why the 1hr is called a screen.

More and more women are getting diagnosed with GDM not just because of tighter screening but because more and more women at risk of GDM are becoming pregnant. This is also why practices are instituting baseline screens for high risk women to exclude preexisting T2 or impaired glucose tolerance.
 

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I know this is a touchy subject on MDC, but here is my opinion and my experience:

My body has mild problems with glucose in pregnancy, and I eat a whole foods, low low sugar, low carb diet and have for years. If I wasn't monitoring my blood glucose with my glucometer that I got during my 1st pg, and/or consenting to the 1-hour GTT and then 3-hour GTT when appropriate, I would not know this about my body. I know the test is a pain (believe me I know! I have now done 4 1-hours and 3 3-hours in the last 6 years!), but for me it's an important piece of information to have.

I have been able to manage my blood sugar through diet and especially exercise, but it has been a huge learning experience for me. I for one am glad I've had the monitoring/testing.
 

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Quote:
Originally Posted by stik View Post

I don't have stats on this. However, problems regulating blood sugar can make babies fidgety, and GD is associated with higher incidence of jaundice. It's possible that at least some of the problems you are seeing as a result of medical intervention are actually problems caused by GD rather than by medical intervention.
It very well could be (although we do know for a fact that induction is another factor with these issues, too, along with a baby being of small size from the diet restrictions and the early eviction imposed) and given that there were no other indicators for further intervention other than the original GD diagnosis (in those cases I was referring, as I believe is the case more often than not with many pregnancy & birth interventions) I question the whole process. Isn't the prevention of those issues one of the main reasons so many push for testing and the associated protocols after diagnosis? If not to prevent those issues (and others) from arising with proper care & treatment, what is the purpose of GD testing?

I think many doctors (and even midwives) and patients are quick to submit themselves to an easier route of defined steps and not look at the situation as a whole and plan accordingly so they just do the test. As I said earlier, I think that for many the diagnosis is the start of a whole new type of pregnancy with different outcomes and expectations (that are certainly not always warranted). I applaud those practitioners that act differently, but they're certainly not the norm where I live.

I totally support watching for risk factors and monitoring each individual on a case by case basis, but I think that many women are settling for fear based care and we're seeing that often times "treatment" doesn't necessarily guarantee a better outcome, just different concerns and issues. I'm sorry, but I don't see how blanket protocols can be in the best interest of anyone and unfortunately, I think that for many a GD diagnosis leaves them little to no choice if they choose to stay with mainstream medical care or regulated midwives OR at least leaves them feeling like that's the case. Ultimately, I think depending on your options (and what you feel comfortable with) that avoiding the test can leave you with the most options and opportunities to address the particular needs of your body and baby.

What happens if you decline or take the test is so individual, from the physical, emotional, and legal depending on your location. It's just best to have all the particulars first, I'm comfortably knowing that I can decline any procedure here (if I think it's without justification) but not everyone has that option...
 

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My OB forgot it. And I have 2 OBs who don't know about the other. So you would think one of them would have remembered. With my last pregnancy, my OB forgot it. I stupidly brought it up. But, she acted all shocked she never ordered it. Then ordered it and did not pay attention to if it was done. I am overweight too, so I would think they would just want it done. I think if you ignore it and it gets brought up in the future, then you could either say you had it done and let them believe they lost the report (doctors don't seem to care when their stuff goes missing and it seems to on a regular basis) or act surprised and say you forgot.
 
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