When you’re at the end of your second trimester or beginning of your third trimester, most practitioners like to do the gestational diabetes test. (If you are showing symptoms, your doctor will do this earlier as needed.) It is routine for all pregnant women, however, around 28 weeks, and many practitioners require it.
What Is It?
The gestational diabetes test checks to see if you have gestational diabetes — that is, if your blood sugar is too high only while you are pregnant (however, if so — you are at risk of developing diabetes later in life). If you have it, you’ll require a special sugar-free diet to control your blood sugar, and a few women even need insulin (but this is rare).
There are two different tests, and most women take the first kind. The one-hour test doesn’t require fasting; you eat normally. Then, one hour before you take the test, you’ll drink a 50-mL glucose solution. Normally, you’ll have been given this at your last appointment so you can drink it at home. When you arrive, they’ll ask you what time you finished drinking the solution so they can take your blood as close to one hour later as they can. They’ll draw some blood and check out what your blood sugar is (they will probably also check for anemia). If it is within a normal range, around 100, then you are fine. If it is elevated, suggesting that you’re not metabolizing sugar well, then they will ask you to take the second test.
The three-hour test does require fasting, so it’s usually completed in the morning. You won’t eat for 12 hours beforehand (or as your doctor instructs). You’ll be given a 100-mL glucose solution to drink, and your blood sugar will be tested at 1, 2, and 3 hours after to see how you are metabolizing the sugar. This test is more accurate than the first because it measures only the sugar they’ve given you (due to fasting) and over a longer period of time, to see how you’re really metabolizing it.
What Happens if I Fail?
Failing the first test isn’t too uncommon. If you’ve eaten a carb-heavy meal during the day before you took the test, that might throw off the results. It only means you need to take the second test to see what’s really going on.
Failing the second test means that you have gestational diabetes. Your practitioner will recommend that you avoid all forms of sugar, and check your blood sugar a few times a day. You will have to be very careful about what you eat during the rest of your pregnancy.
Women who have gestational diabetes are more likely to give birth to unusually large babies — 10 lbs. or more. These babies are not meant to be this large; the excess sugar in your blood causes them to be heavier.
Do I Have to Take This Test?
According to many doctors…yes. Some will even kick you out of the practice for refusing it.
However, ACOG came out a few years ago and stated that women who are under 25, have no family history, no personal history, and are otherwise low risk do not necessarily need this test. Doctor practice has been slow to catch up, as is typical. (They also recommend against routine ultrasound, but no doctor seems to know that, either.)
There are alternatives to the test, though, if you or your doctor feels you need it but you don’t want to take it the traditional way.
The glucose solution is full of artificial flavors and colors, which is one reason not to drink it. Some doctors will allow you to drink an equal amount of grape or orange juice instead (having 50 mL of glucose is the important part). Others will recommend a meal that contains 50g of carbs instead. These are ways to take the “usual” test without drinking the glucose solution itself.
Others, often midwives, will recommend checking your blood sugar at home after meals for about a week. If it is consistently normal, you don’t have gestational diabetes. This is a “real world” test and even more accurate. However, this requires a lot on your part — remembering to check and being willing to buy the supplies and prick your finger multiple times a day — so it is not preferred.
You can also choose to skip the test. I did this in my second pregnancy (I was 24 and had no risk factors), and will do it this time too. My midwives check my urine for sugar at each appointment and I have no detectable levels. If I were, in fact, having issues, sugar would show up in my urine.
If you do these urine tests and glucose does show up, either a few times in a row (at low levels) or once at a higher level, it would be wise to take some version of the test. Alternately, if you don’t feel well, are gaining weight quickly, etc. — take the test.
Normal women with no risk factors and no symptoms (the urine test is key) do not need to take it.
What Should My Diet Be?
If you are eating a traditional diet that is high in protein and fat and lower in carbs, you probably would not show as having gestational diabetes anyway. The traditional diet for diabetics is a fairly high-carb diet. The carbs are usually whole grains and are usually meted out carefully so as not to spike or drop blood sugar.
However, blood sugar remains more consistent when you eat proper protein and fat and only consume carbs in smaller amounts, and always properly-prepared whole grains.
Especially if you are at risk, or have had gestational diabetes in the past, it is important to eat a healthy pregnancy diet.
Have you ever had gestational diabetes? Do you or will you take the test?
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I just took this test on Monday! I really didn't think I needed it, but went ahead and took it. I will have to keep the juice alternative in mind to ask about for my next pregnancy!
I have to disagree with your post. There are many women out there that are diagnosed with GD, and have small babies. I had GD with two of my pregnancies. My last baby also a GDbaby was the smallest baby yet for us, and weighed in at 7 pounds. So – that said not all GD babies are big. He did however have an issue with his sugar level shortly after he was born. It was remedied with breastfeeding every 2 hours after his birth. GD is a very intense subject and there are many factors in it.
Just letting you know it is not all cut and dry.
Warmly,
Jill
My midwife was fine with me not taking the GD test since I am a very thin person and had not gained much weight nor had my urine ever showed glucose. Still, big babies run in my family (though no one was ever diagnosed GD b/c they use to not test for it and I am the first in my generation to have a baby). So I asked for the test and she suggested we do a two hour post prandial test. I fasted overnight and then ate a yummy breakfast of pancakes and maple syrup. Then we checked my blood sugar at 2 hours and it was 187! Definitely had GD. My midwife was shocked. She was sure that big babies just ran in my family. So I cut out most all carbs and sugar and checked my sugar regularly. I never needed insulin and my baby was born at 42 weeks a healthy 7 lbs 10 oz – the first baby in my family under 10 pounds. Everyone was shocked. But I was very very careful about my diet. I also walked 3 miles a day everyday until I went into labor. I don't know if I would have been that careful had I not done a GD test. But I am very glad I did not have to drink that nasty glucose drink. A 2 hour post-prandial test after a high carb meal is just as effective. And no woman should be discouraged about GD. My baby was born at home, was perfectly healthy, and had absolutely no complications! Just watch your diet and exercise!!!
I did the GD testing with my first two children. Although the tests were negative for GD, the glucose drink severely sickened me for several WEEKS afterward, both times. I did not do any GD (or other) testing with my third baby. With my fourth, I was using an OB as a "back up" for my second home birth, and I had done a ton of research before it was time to do the GD test. Not just reading articles, but reading research and scientific studies. What really helped me make the decision was this: Neither the GD testing, OR TREATMENT, has been shown to improve outcomes for mothers or babies. (seriously – that's what over 50 years of research has proven!)
I went to my OB armed with FACTS and when she brought up the testing, I told her that I'd be happy to do an alternative testing (I had testing protocols for a fruit juice alternative, a meal alternative, and a jelly bean alternative), but that I would not subject my body or my baby to the glucose protocol. Instead of having a conversation with me, she came back with "scare" tactics.
"Why would you want to put your baby at risk?" and "Your baby could die if you don't do this." She refused to even consider the alternatives. I pointed out that I did not have ANY of the risk factors for GD, and I refused to consider the glucose after what it had done to me the two prior times. Finally, she "put her foot down" and said "You've already had two big babies. If you don't do the test, you'll have to have a c-section." I told her that neither of my two "big babies" qualified as macrosomic (the scientific term for a large baby; at the very minimum a baby born at 40 weeks has to weigh 8 lbs 13 oz to qualify), as they'd been 8 lbs 9 oz and 8 lbs 7 oz, in that order. She retreated back to the scare tactics. I told her that I would follow the GD diet for the rest of my pregnancy (which I already was, so no hardship). She wouldn't budge – I had to do the test or she would automatically do a c-section and not "allow" my homebirth.
I ditched the doctor. And I had an amazing homebirth (7 lbs 5 oz at 40 weeks, 2 days). I know that other people have different circumstances, and may need to consider doing the testing, or at the very least following a diet that will keep any possible GD in check. I highly recommend that anyone who is pregnant read Henci Goer's excellent "Thinking Woman's Guide to a Better Birth" for information on all the pregnancy tests and birthing interventions. For GD specifically, here are two of her articles that might help: http://www.ivillage.com/gestational-diabetes-common-sense-approach/6-a-129188
http://www.ivillage.com/gestational-diabetes-3/6-a-129187
@Jennifer
There are absolutely cases where TREATING the GD can have a marked improvement in outcomes and I'm definitely one of those cases.
I am overweight, have PCOS, and have a family history of type II diabetes. With my first pregnancy I passed the 3-hr test, but by the end of the pregnancy I had immense swelling, had gained tons of weight and my blood pressure had skyrocketed. I did not have pre-eclampsia as I was spilling no protein in my urine and my liver and kidney function was fine. When my little boy was born he had low blood sugar, breathing difficulties that landed him in the NICU, severe jaundice that required a longer hospital stay and nearly a week of treatment with bili-lights and he was 8 lbs at 38 weeks…all signs of a GD baby. (Now, don't get me wrong…I'm not one to freak out about big babies at ALL. In the grand scheme of things I know he wasn't huge, but he definitely had the potential to top 10 lbs if he'd gone full-term or longer.) Afterward everybody said that I most likely had uncontrolled GD and that was why me and my baby had the struggles that we did.
With my 2nd pregnancy, at 28 weeks my blood pressure was starting to climb again, I was getting very swollen by the end of the day and it seemed as though I was headed down the same path as I had with my first. The thing that turned it all around was being diagnosed with gestational diabetes. Within 2 weeks of starting the diet my blood pressure had completely normalized and I didn't have a bit of swelling the rest of my pregnancy – and this was in the hot, humid summer! I needed a small amount of medication to control my fasting numbers, but followed the diet exactly (even reducing the carb amounts as I feel that the recommendations for diabetics are far too carb-heavy) and exercised daily. Even though my baby tested Coombs positive he was barely jaundiced and his birth was a MILLION times better than my first. He was a full-term baby and weight 8 lbs 13.5 oz and was long and lean…unlike his older brother who was extremely puffy and swollen when he was born.
The difference between these two pregnancies was like night and day to me…and I think the thing that is so telling to me is that my elevated BP reversed as well as my swelling. The difference was the GD diagnosis.
Now I'm 29 weeks pregnant and "technically" passed the 3-hr test (still failing 1 number, however). My doctor gave me the all clear and said I didn't have to worry about GD this time, but I didn't feel so sure. I started testing my fasting and postprandial numbers and low and behold, they are quite elevated. I've started following the diet closely again and will show him my numbers at my next appointment to get his take. These numbers before meant GD…I don't see how the results of one random test on one random day could be more significant than my numbers day in and day out. It just doesn't make sense.
My only issue with a GD diagnosis is the increase risk of c-section…and it's all just related to doctors being terrified of big babies. I think it's becoming more and more understood and accepted that there is absolutely no benefit to an induction for size…even in moms with GD…but that doesn't mean that there's no benefit to treating the GD.
For my 1st pregnancy we moved (and changed providers) at about the time I would have taken the GD test, so somehow in the shuffle I missed it and my new OB didn't mention it.
For my 2nd pregnancy I had a homebirth with a midwife. She didn't do the GD test, she just pricked my finger once to check my blood sugar level, which was fine.
Now, early in my 3rd pregnancy, I've yet to find a midwife (we moved again). However, I don't think I'll be taking any GD test.
@Lindsay,
I'm glad that following the diet (or rather, a more carb-restricted diet) was able to help you with your subsequent pregnancy, and may help you this time too. My comment "Neither the GD testing, OR TREATMENT, has been shown to improve outcomes for mothers or babies." was only meant to point out that the GD protocol is based on 50 years of research studies showing that there was no difference in outcomes between testing and treating women and not testing and not treating them.
To put it another way (seriously simplified), assume you have four groups of women. First group, you don't test (and by extension, don't treat) anyone. Second group, you test everyone, but treat no one. Third group, you test everyone and treat those that show positive for GD. Fourth group, you don't test anyone but you treat everyone as though they all had GD. If you compared all four groups you would find that they all average the same for fatalaties in mother and baby, the same for serious medical problems for mother and baby both pre- and post-partum, the same for normal deliveries. The ONLY difference in all four groups is that the women who were positive for GD and the women who were treated as positive for GD had overwhelmingly higher rates of C-sections.
I don't argue that some women may have a tendency toward GD, or that it shouldn't be treated. My beef is with the testing protocol itself. Honestly, I believe that if all women followed a low-carb, high-fat & high protein diet of whole foods (both before pregnancy and during), the GD rate would be 0. I can guarantee you that GD, and all its various symptoms, was unheard of 120 years ago.
You can have an absolutely perfect diet and exercise routine and still have GD. What it comes down to is how your placenta is functioning.
Blaming it on diet 100% is incorrect and mother shaming.
I have had 8 children, all in Canada. Only with the last (at age46) did I have glucose testing, and only because my 7th was over 10 lbs. (BTW, I passed with flying colors!) As usual, US medicine is reflective of the litigious society which propels its choices.
My OB felt that the weekly urine tests were sufficient.
Thank you for this post.
With my first ds my pregnancy was a dream!
With my dd, up to 21 weeks was a dream and seemed effortless. Then I started having contractions 3-4 minutes for hours( I was also 3 centimeters dialated), we went to the hospital and were told, we had about 10% chance of baby staying inside through the night. If our baby arrived int he next 12 hours she had about 50% chance of living and 50% chance of having delays. They were going to do everything they could to keep baby in for 12 hours and then try for 24, then get through 48 and so on, they gave me the two steriod shots to mature her lungs, gave me a sleeping pill to relax me, pumped fluids into me until I felt like a human water balloon. Baby stayed in, but from that day on I was on bed rest with almost constant around the clock 3-4 minutes apart contractions, I took my pills every 4 hours to slow them down and stayed on strict bed rest, with a hubby gone from 5 a.m. to 7 p.m. almost daily and a not quite 2 year old, home alone, by myself. We had several ultrasounds done including a 3 d one to confirm that baby was indeed okay and nothing was going on in her little world and since I measurered small it confirmed that she was jsut going to be a bit smaller than her big brother (8 14 @ birth). During my first blood test all numbers came back normal, my second was not the same, evidently it showed that I had erratic blood sugar levels, that rose to staggering hights. I was told flat out 30 minutes after learning this, that I was going to die in child birth and my baby would too and my baby would be so huge I would have to have a c section to deliver. After a week of checking my sugars at home, my numbers were in fact very normal, in fact my sugar tending on the lower side of the scale. I was scared stiff and silly, I was stressed beyond comprehenstion, I was overtired and confused. My lovely doctor told me to jsut stop the nonsense and not worry about it, stop the pills, do modified bed rest and rest as much as I could, just make sure i got rest! She said, “eat healthy, and small meals all day” I went to full term, delivered a 7 lb 1 oz baby, who was absolutely perfect, she had no sugar issues and no weight issues, she has no mental issues or delays in fact she is ahead of her age in all accademic areas.
I think these “test” are 90% unreliable and 99% unnessecarry. We as women KNOW when something is not right with our bodies and or babies and all we need to do is listen to our bodies and then do some digging to find the fix. ‘
We just found out that we are pregnant again with baby # 3, I will be using a midwife and having a homebirth and I will be having 1 ultrasound (My hubby and I love to know what we are having:) and we will be opting out of the blood glucose test, I already own a test kit since my mom is diabetic and visits for a week or two at a time and I like to have that handy, so I will check sugar when my midwife suggests, and we will go from there.
If you are a mom who has troubled pregnancies, then by all means, you are the 9 % or 1% who needs these tests so take them:)
Great article. I refused the fast test and drink and only then did they admit and offer to test via fingerprick. They aren’t as accurate, but if you do one on several visits and have normal readings, there’s no need to do the fast test.
check out the article title The Emperor has no clothes! I challenged my doctors after I felt they bothed my one hour test. Here was my scenario. … There was four of us pregnant women there. Three of us did the one hour test. The lab was so busy that morning when my test was addministered the technician opened a brand new bottle poured the drink in front of me and never measured. My results came back at 140. I was told to come back for a three hour test. So as good little patient I did what was told but by the end of the day I just did not feel right about the test. Began doing research especially after the painfull bruise left on my arm. 1 hour tests have a 6 times higher rate of a false positive. Given my family history there was no diabetes in my family. Also found out the 3 hour test was based on research conducted back in 1964. This is what is maddening. … The research was based on 752 women. Talk about a small sampling. Anyways after firing that info back at my doctors the scare tactics came out. Did everything I could do to not jump on the doctor and give him a black eye. He basically called me a bad mother in not so many words. I finished the d@$# test and told them, “See I knew I didn’t have GD.” So I then asked if it was normal to not feel movement from the baby, because with the 1 hour test he was bounceing off the walls. Thats when they started to mess their pants. They suggested doing more tests. I gotup and said no more. Been watching baby closely after that. Took three days for him to get his strength back. Still concerned because he could have had his first bowel movement in utero now. Oh as a side bar… I had to have my gallbladder removed at 20 weeks. This can also effect the pancreas in processing sugars if it happens to get in flamed and was told by my surgeon to expect 6 to 12 weeks of different digestion. Gee 20 weeks to 28 weeks talk about number squews. Becareful and do your research and listen to your body.
That’s too bad you had that experience. 🙁 Doctors should use research, not scare tactics!