Pregnancy Week 24: Refusing Gestational Diabetes Testing
At our most recent meeting two weeks ago, my midwife recommended I test for Gestational Diabetes (GD). This is common, though more so in Obstetrical care where virtually all pregnant women undergo this test.
GD is a weird beast. It's not a true disease, like Diabetes. There is no chronic impairment of insulin functioning. The concerns for GD are different than regular Diabetes. With regular diabetes one worries about kidney functioning, insulin functioning, circulation and the body's ability to heal itself. With GD the concern is that the baby may put on too much weight and experience hypoglycemia when it is born, taxing it's internal organs before they've had a chance to get strong.
With traditional diabetes, one either doesn't produce adequate insulin to process sugar (type 1) or one's body doesn't use the insulin properly (type 2). Type 2 diabetes is often developed because one's abuse of sugars (such as table sugar and high-fructose corn syrup) leads to the body's chronic inability to adequately process that sugar. Of this second type of diabetes, it is often wholly treatable/manageable through lifestyle changes, as it was a condition most often created via lifestyle.
With GD, the pregnant body, all pregnant bodies, break down sugars at a slower rate the more pregnant one is. In this way, all pregnant women have GD to one degree or another.
This pattern of becoming progressively more sugar intolerant poses a problem for testing. One can test on one day and not be diagnosed as having GD and be tested two weeks later and suddenly be diagnosed as having GD. A third test can show different, higher levels. In science, a test that cannot be repeated with the dame results both times is not a scientifically rigorous test. Some object to the GD testing for this reason.
And, then, the moment the baby is born, GD disappears from the radar. This is very unlike traditional diabetes, which can not truly be cured.
As flawed as the test is and as misleading the condition's name, in cases where women are having real problems, it's good information to have. Most often the condition is managed through diet. In extreme cases, insulin may be given. But, if a woman has a severe case, one won't need to do GD testing to figure it out. There will be signs.
So, when my midwife recommended the test to me, I declined, letting her know that I wasn't comfortable with the test and the stress the test and it's possible findings would cause in my life.
The midwife said that she was asking me to do the test due to two risk factors: my age and my weight.
But, risk factors are not symptoms. I'm at risk of developing yeast infections more often in pregnancy, but I'm not at the lab every week getting swabbed. I'm also at increased risk of having a baby with chromosomal problems but I wasn't rushed off for an amnio at 12 weeks.
I have no symptoms associated with GD. I haven't gained any weight, the baby is measuring fine, I am not spilling glucose into my urine, I haven't been particularly thirsty or urinating frequently and I haven't been fatigued or nauseous. I've had one yeast infection and a UTI, but those were under non-normal circumstances.
My nutrition has been better this pregnancy than last (except for this week when I suspect baby is going through a growth spurt because I could eat till the cows come home and I'm craving sugar something awful!). I'm quite proud of the lifestyle changes I've already made and I continue to make more. Since the majority of GD cases are treated through nutrition, I feel there is no real reason to take the test, as I'll be implementing the same changes I've already made in my diet. Minus the soda, of course!
I made a deal with my midwife, though: if I start exhibiting actual symptoms, I'll get the test. Until then, I'll continue to focus on continuing to improve my eating habits.
GD is a weird beast. It's not a true disease, like Diabetes. There is no chronic impairment of insulin functioning. The concerns for GD are different than regular Diabetes. With regular diabetes one worries about kidney functioning, insulin functioning, circulation and the body's ability to heal itself. With GD the concern is that the baby may put on too much weight and experience hypoglycemia when it is born, taxing it's internal organs before they've had a chance to get strong.
With traditional diabetes, one either doesn't produce adequate insulin to process sugar (type 1) or one's body doesn't use the insulin properly (type 2). Type 2 diabetes is often developed because one's abuse of sugars (such as table sugar and high-fructose corn syrup) leads to the body's chronic inability to adequately process that sugar. Of this second type of diabetes, it is often wholly treatable/manageable through lifestyle changes, as it was a condition most often created via lifestyle.
With GD, the pregnant body, all pregnant bodies, break down sugars at a slower rate the more pregnant one is. In this way, all pregnant women have GD to one degree or another.
This pattern of becoming progressively more sugar intolerant poses a problem for testing. One can test on one day and not be diagnosed as having GD and be tested two weeks later and suddenly be diagnosed as having GD. A third test can show different, higher levels. In science, a test that cannot be repeated with the dame results both times is not a scientifically rigorous test. Some object to the GD testing for this reason.
And, then, the moment the baby is born, GD disappears from the radar. This is very unlike traditional diabetes, which can not truly be cured.
As flawed as the test is and as misleading the condition's name, in cases where women are having real problems, it's good information to have. Most often the condition is managed through diet. In extreme cases, insulin may be given. But, if a woman has a severe case, one won't need to do GD testing to figure it out. There will be signs.
So, when my midwife recommended the test to me, I declined, letting her know that I wasn't comfortable with the test and the stress the test and it's possible findings would cause in my life.
The midwife said that she was asking me to do the test due to two risk factors: my age and my weight.
But, risk factors are not symptoms. I'm at risk of developing yeast infections more often in pregnancy, but I'm not at the lab every week getting swabbed. I'm also at increased risk of having a baby with chromosomal problems but I wasn't rushed off for an amnio at 12 weeks.
I have no symptoms associated with GD. I haven't gained any weight, the baby is measuring fine, I am not spilling glucose into my urine, I haven't been particularly thirsty or urinating frequently and I haven't been fatigued or nauseous. I've had one yeast infection and a UTI, but those were under non-normal circumstances.
My nutrition has been better this pregnancy than last (except for this week when I suspect baby is going through a growth spurt because I could eat till the cows come home and I'm craving sugar something awful!). I'm quite proud of the lifestyle changes I've already made and I continue to make more. Since the majority of GD cases are treated through nutrition, I feel there is no real reason to take the test, as I'll be implementing the same changes I've already made in my diet. Minus the soda, of course!
I made a deal with my midwife, though: if I start exhibiting actual symptoms, I'll get the test. Until then, I'll continue to focus on continuing to improve my eating habits.
posted by mamaloo at 12:21 PM
9 Comments:
I hated that test. And because of "risk factors", they made me do it early, at like 11 weeks. And then I failed the one hour, but passed the three hour. And then, they made me do the three hour AGAIN at like 24 weeks. Yuck. I wish I'd read your post before all of that (of course, that was ~4 years ago...). Good luck.
We were just musing on the weird test early thing I've been hearing about lately. I mean, this is a test that is recommended to be completed between 24 and 28 weeks as it isn't accurate at other times. Weird to hear so many OB patients getting the test down around 12 weeks!
Very intersting, I didn't realize how inaccurate the test was. Honestly I don't know too much about it, just know the test sucks!
I know I'm probably going to get skewered for this, but I declined the majority of the testing my OB pushed me into during the first pregnancy the second time around, especially the trifecta - the one that tests for spina bifida, downs and something else i always forget. about 80% of my friends who had been pregnant received a false negative on that one. i just feel like it adds unnecessary stress and worry to pregnancy. if i had a family history of downs i might have felt differently, but i also felt that if i was going to have a child with special needs, then so be it. knowing about it in advance wouldn't have changed the outcome. i agonized over the spina bifida issue because they told me i could possibly do something about it to help the baby, but in the end i chose not to. And with my last baby in 2004, there was even a pre-screening test for cerebral palsy i believe. nope. i think your approach is responsible and well-educated, and i support you . . . not that you needed it!
Cristina, I don't think anyone's going to skewer you for making a reasonable choice for yourself and your family.
I didn't want to do the triple screen either, thinking the same thing as you. We didn't with our first and our outcome was fine.
This time Sean was more nervous, whether it be our age, our broader knowledge of how difficult parenting in the best circumstances can be or our lack of extended health insurance - this time he lobbied to be screened.
It came back with the predictin that I had a snowball's chance in hell of having a Down syndrome, trisomy 18 or neural tube defect problem with the baby. The mid term U/S backed that up.
here's one for ya. with 4 children, the youngest being 12 1/2, i've never had an ultrasound. never had the testing for downs, etc. i have, however, had that awful GD testing with both boys. it's bad enough they want you to drink enough water to make it painful when they want the ultrasound, but to fill your belly with some unpalatable shit just because it's de rigeur (sp?) is crap. i puked both times, because my stomach couldn't handle that much crap. and the nurse TOLD ME I WOULD. what is the sense in that, especially since i was not overweight (i weighed 125 when i got pregnant with liam, and 130 with sean (wish i weighed a ny where near that now, lol)), nor was my age an issue (26 & 28). if i were pregnant now, you bet your sweet bippy i'd refuse. i think i'd refuse the trifecta as well, even though i am older now. no history in my family of those things (heck, i'm the oldest, and my mother was 38 with me!). and, being RH negative, i ended up getting stuck way too many times with all 4 kids. sigh. what they'll do to prevent stuff that has the slightest, teensiest chance of happening. i'll love the child regardless. i'm just afraid that to "defend the child" they'll start making this crap mandatory.
It's not just about you and future complications for you if you have GD. GD can cause your baby to become very large for dates (macrosomia) which can cause early breakdown of the placenta, shoulder dystocia during birth that can lead to broken collarbones, cerebral palsy or other problems, and fetal death. GD has been linked to premature birth and to certain birth defects also. There are other complications to the fetus with ongoing undiagnosed GD, which is why they test everyone for it now. The assumption that you will automatically have symptoms if you have GD or if GD is a "problem" is totally false. Many, many women have gone into the GD test thinking they were totally fine and found out they had GD. Diabetes of any type can go on for some time before people become symptomatic and you can experience huge changes in your blood sugar without being aware, which is why people with diabetes do regular and frequent blood-glucose testing. Ask 10 Type-II diabetics if they had clear symptoms before they got tested - probably 8 of 10 will say it was only in retrospect that they realized they had symptoms of diabetes. That's why diabetes is called a silent killer - many people don't realize they have it until their disease is very advanced. In this case it could be a silent killer of your baby, not you.
I understand the testing is not fun. It was certainly not fun for me. I had three strikes against me going into GD testing - I was overweight, I had a history of PCOS, and I had insulin resistance. I still passed the test. Other women in my due date group had no risk factors and no symptoms and failed. This is one of those things like Group B strep testing - many women claim it's "invasive" or "unnecessary" but the bottom line is that GD, if it goes untreated, can kill your baby. Is it worth the risk to avoid your own discomfort with the testing? I am sure you are doing many things you would rather not to do for the health of your baby right now. Try to look at this as one more thing you need to do, not as something burdensome or onerous.
Anonymous, I thank you for your in-depth comment.
I believe, however, that you overstate the case a bit.
Yes, badly maintained gestational diabetes can lead to Macrosomia, or a baby weighing 10lbs or more. However, a baby weighing around 10lbs would not be far out of range for a woman of my stature (5'10" on the broad and big-boned side - once described by my highschool history teacher as having a Spartan figure: good for having big babies who would grow up to be strong warriers).
A large baby or the possibility of dystocia doesn't scare me much. I don't plan to be on my back to birth, thereby granting my pelvic outlet an extra 30% more room than most women birthing in a hospital setting with OBs.
My prenatal care includes regular fundal height measurements and palpations of the fetus, I trust that those will be a factor in seeing whether this baby begins to grow out of control. I believe the standard of care is that if a woman measures 4cm over dates two measurements in a row, she's automatically slotted for an OB consult, which will likely include an U/S to take measurements of baby. When I spoke of symptoms, I didn't mention it, but the measuring large for dates would be one of those symptoms where I would consent to further testing related to GD.
This is the first time I've ever heard of GD related to Cerebral Palsy. Since CP is something that is determined in early pregnancy (as baby is fully formed by midway through the pregnancy and either does or does not have a neural tube defect, and we've checked, this one doesn't) GD, which develops in late pregnancy, is not likely to be a contributer. Diabetes can be a contributer, but I don't believe I was diabetic previous to getting pregnant. I have had blood testing for diabetes a few years ago and the tests came back totally normal.
I see this exactly like GBS testing and the widespread prophylactic use of antibiotics. It's quite rare that a baby dies of GBS infection related illness. GBS can be managed through non-medical means and non-medical precautions can be taken in labour to prevent infection. OBs aren't interested because they have a vested interest in managing women's labours and contributing a certain amount of income to peers, clinics, technicians and hospitals. Not to mention, guiding women into caring for themselves in a particular way and then monitoring that is too time consuming for OBs.
For me, self-awareness is at the heart of my pregnancy care. Most women aren't as involved in their own care, nor are they as in tune to themselves as I am attempting to be. I have every confidence that even without blood testing, there will be indicators that something is wrong long before the baby grows out of control to 11+ pounds (though babies this big are not uncommon in my paternal family's history). Should such indicators start popping up, I will happily revisit the issue of GD testing.
Until that time, I fully trust that not only am I going to be able to understand when things aren't right with my body, but that my midwives will be able to notice when something out of the ordinary. Like if a very Macrosomic baby shows up on the radar. They will work with me to form a healthy and safe plan of care, which could include a transfer to hospital during labour, a switch to hospital before labour or an OB assisted labour.
While I am aware of the risks of such conditions as GD, I don't let fear guide my well woman care. As of now, I am a well woman.
I too am expecting to be skewered, but I feel it must be said:
several things you said are actually incorrect. For some, gestational diabetes doesn't truely dissappear. I was diagnosed with gestational diabetes twice, and was heavily dependent on insulin both times. Though I am not considered diabetic at this point in my life, my doctor has warned me that I MUST watch what I eat, that I MUST excersize or I WILL end up with type 2 diabetes. I have to take medication twice a day to keep my blood sugars in check, and I probably will for the rest of my life.
Even tho both of my babies are now healthy children, and even though I did everything I could to keep my blood sugars in check, they were both quite large, which resulted in emergency c-sections both times. They were difficult and traumatic births because of their size. Both had to be in oxygen tents for their first 2 weeks of life.
while you may consider yourself a "well woman", i think your blogpost may lead others to think that it is unecessary to have such a noninvasive test as the 27 week GD test. It is not to be made light of, regardless of how "well" you or anyone else may think they are.
I certainly thought I was "well", until I saw the results of my test. I wasn't sypmtomatic, but obviously things were amiss.
I now look at my insulin resistance as an oportunity to change my eating habits and have increased dramatically my overall physical health. But no matter what I do, gestational diabetes is (in a way) always with me.
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