First, Gestational diabetes statistics!
- 6% : the percentage of pregnant women that will be diagnosed with gestational diabetes (commonly called GDM, and AKA diabetes of pregnancy). Pregnancy itself puts women in an insulin resistant state, which subsequently increases the risk of developing diabetes (temporarily).
- 10%: percentage of women in the US that are considered “low risk” for developing GDM given baseline health status. That means 90% of us have some risk factor that makes it possible, and sometimes even likely, that we will develop GDM. Even low risk women may develop some potential risk factors during pregnancy – hello significant weight gain. That means universal screening is recommended – that means screening for every.single.one.of.you (and me during both of my pregnancies).
- 24-28 weeks of pregnancy: normal screening window. If you have significant risk factors, such as a history of GDM or very large baby in a previous pregnancy, first degree relative with diabetes, obesity, and/or insulin resistance before pregnancy, I recommend screening early in pregnancy and again during the normal window.
Testing and screening for gestational diabetes:
To screen for gestational diabetes, nearly every OBGYN office uses a pre-formulated glucose load in the form of a Fanta-esque drink, sin gas. Orange and fruit punch flavors are common. Most women tolerate it, some women fear it, others refuse it.
2 common screening options:
- The “2 hour” screening test – a fasting blood test, a 75 gram glucose load, a second blood test 2 hours later. If you pass, you’re done. If you fail, you are diagnosed with GDM.
- The “2 step” screening test. First step: a 50 gram glucose load followed by a blood test 1 hour later. If you pass, you’re done. If you fail, you do the follow up 3 hour test – a fasting blood test, a 100 gram glucose load, then blood tests at 1 hour, 2 hours, and 3 hours. This is the kind of testing I do – it’s onerous for women who have to do the additional 3 hour for confirmation, but the 1 hour test is relatively painless if you don’t mind the sugary drink. I routinely ask my patients if the drink was better or worse than expected – most of them say it was better!
Tips to make the drink more tolerable:
- serve it chilled or over ice.
- You are allowed to drink water, so follow it with a big swig of water too.
- Bring a protein snack to eat once the blood draw is done.
- Make the time go by faster: my office gives the patient the glucose drink at their previous appointment with instructions. Patients drink it on the way in, and with LA traffic that can be a long car ride. This way patients aren’t waiting in the waiting room for an hour. Also, we schedule a doctor’s appointment during that visit too – do the testing and appointment at the same time. We’re efficient like that!
- If you’re waiting at a lab: plan to watch a show, or read a magazine, or catch up on your gossip rags in that time. Whatever it is, just plan it as a treat so you have something to look forward to!
Can you refuse to do the test?
Of course you can. I don’t suggest it unless there is a medical indication (such as history of gastric bypass surgery). This is because the glucose load is the most accurate way to diagnose GDM, and GDM can have severe effects on the pregnancy and baby. Knowing whether or not you have GDM is extremely important for the health of you and your baby (which is why we screen everyone).
But if the thought of that orange drink makes you throw up, or you actually do throw up and can’t do the test, here are some alternatives:
- Checking accuchecks every day. You use a glucometer (available from most pharmacies, and often covered by insurance), lancets (the small sharp prick to draw blood), and test strips to check your sugar level multiple times a day – I usually start with 4 times daily – fasting and then 1 hour after each meal. Write down your numbers and show your doctor. Sometimes we stop after a week, sometimes we continue on with accuchecks. If the diagnosis isn’t clear, continuing to check accuchecks at home can bring extra data that is needed.
- Do the 50 gram or 75 gram or 100 gram glucose load (see previous post about the differences) in a different form. When my mom was pregnant, she was instructed to have a “big pancake breakfast”. Conveniently, there was a Denny’s across the street from her doctor’s office – “go there and then come back” they told her. Jelly beans, gummy bears, main stream sodas, and candy twists have all been proposed. Unfortunately these alternatives aren’t as accurate and sugar content not as predictable. None have been studied as extensively as the traditional glucose load. Some potential issues: multiple candies can take longer to consume than a small juice bottle. Some candy alternatives, like a Snickers bar, have additional protein and fiber, which may alter the metabolism of sugar in your body. It really needs to be a simple sugar. But I’m a proponent of an alternative method and hope one comes out!
I am a board certified OBGYN at Cedars Sinai in Los Angeles.
I am co-founder of Female Health Education, a platform offering digital courses, striving to empower females through health education.
My passion is promoting and demystifying health information to the public. My blog, Dr. Sara Twogood’s LadyParts Blog, provides comprehensive information about fertility, pregnancy, and gynecology topics. I am on the medical board for the period tracker app Flo; contribute as a medical expert for pregnancy app and website The Bump; and serve on the Byrdie Beauty and Wellness Review Board (Byrdie.com). I have been featured as an expert for the podcasts The Dream and Her body, Her Story and quoted in numerous online and print publications.
I am honored to be named “Top Doctor” in Los Angeles magazine for years.