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Dear Stephanie, I’ve been following a Whole30-ish diet for almost a year and was just told that I need to drink a sugar solution to screen for gestational diabetes. Do I really need to drink it? Do I have other options?. Please Help! – An Instagram Mama
On behalf of moms all over the world, thank you for asking this important question. It’s important to know your options before making any choice, so I appreciate you taking the time to voice your concern. Many moms I’ve spoken to and worked with over the years were surprised to know that there are options outside of the standard glucose screening test, so I’m happy to get this information out there.
The traditional test
As you approach weeks 24-28 of your pregnancy, your provider will likely discuss screening for gestational diabetes. (Note: If you have risk factors for diabetes, you may be screened for undiagnosed type 2 diabetes at your first prenatal visit).
In the U.S, there’s a “two-step approach” for screening and diagnosing gestational diabetes. The first step requires you to drink a solution containing 50-grams of glucose. Your blood sugar is then tested one hour after drinking the solution. If the screening is positive (your blood sugar level is elevated), it’s recommended that you take a three hour test that includes drinking a solution containing 100-grams of glucose (known as the glucose tolerance test). If your blood sugar is elevated at two or more points during the glucose tolerance test, you will be diagnosed with gestational diabetes and be given a treatment plan.
ACOG currently recommends these two criteria:
For the 50-gram, 1 hour sample*:
Less than 140 mg/dL is considered a “normal screen”
Greater than 140 mg/dL is considered “abnormal” and requires a glucose tolerance test
Some providers prefer to use 130 or 135 mg/dL instead of 140 mg/dL as a cut off as it can more accurately identify women with gestational diabetes.
For the 100-gram, 3 hour sample*:
Fasting: 95 mg/dL
1 hr: 180 mg/dL
2 hr: 155 mg/dL
3 hr: 140 mg/dL
If your blood sugar meets or exceeds two of these levels, you’re considered to have gestational diabetes.
*Some providers may use different numbers.
In some cases, especially outside the U.S., a two hour test that includes drinking a solution containing 75-grams of glucose is used. There is discussion about changing the way screening is done in the U.S, but ACOG is currently sticking with their standard guidelines.
Opting Out Of the Glucose Test
Just like you mentioned, if you’ve been following a whole-foods diet for any period of time, the idea of drinking a sugary solution that contains artificial colors, food additives, and genetically modified corn doesn’t sound like a great option.
Some moms also want to avoid the common complaints (headache, dizziness, fatigue, digestive issues) that often accompany drinking the solution. They may have experienced this with previous pregnancies or heard about these issues from other moms in their community.
In addition to the reasons above, some moms also want to avoid the inconvenience of taking a two or three-hour test that requires multiple finger pricks.
Your Alternative Options
There’s no doubt that gestational diabetes is becoming increasingly more common amongst pregnant woman. There are negative consequences associated with gestational diabetes for both mom and baby including birth defects, being large for gestational age, hypoglycemia in baby, and preeclampsia in mom. Additionally, moms that experienced gestational diabetes have at least a sevenfold increased risk of developing type two diabetes.
So this, by no means, suggests that women shouldn’t be concerned about or screened for gestational diabetes. I simply want you to have information about alternative tests, potential errors with the test, and your rights as a pregnant woman.
The information is here, the choice is yours.
Option #1: Hemoglobin A1c Test and Fasting Blood Sugar
Some midwives and providers will order a hemoglobin A1c and a fasting blood sugar test in the first trimester. The hemoglobin A1c test is a simple blood test that doesn’t require you to drink a sugar solution and measures your average blood sugar over the past three months. In fact, in one study a first trimester A1c of 5.9% or greater accurately predicted the development of GD 98.4% of the time. If you’re experiencing elevated blood sugar prior to the second and third trimester (when placental hormones are at their peak and insulin resistance spikes) this suggests preexisting prediabetes or diabetes instead of diabetes as a result of pregnancy.
The good news is that screening early allows you to make dietary and lifestyle changes early on in your pregnancy. However, I’d still recommend additional testing later on in your pregnancy as these first trimester tests are simply early screening tools and your blood sugar control may change over the course of your pregnancy.
Option #2: At-Home Finger Stick Blood Testing
Instead of, or in addition to drinking the sugary solution, you can consider at home finger stick blood testing. You’ll want to work with your healthcare provider to determine a reasonable schedule for testing and assessing your results. This is what I often recommend to moms, especially those who are following a low-carbohydrate diet and test positive on the initial one hour screening.
For both of my pregnancies, I performed a week of at home finger stick testing combined with the first trimester fasting glucose and hemoglobin A1c. The finger stick testing provided me with valuable information about how my blood sugar responded to a wide variety of food combinations and confirmed that my body was keeping my blood sugar at healthy levels throughout the day.
Option #3: Get More Accurate Results
If you’ve been following a very low carbohydrate diet and wish to take the test, you may want to eat a higher carbohydrate diet (at least 150 grams/day) for about a week prior to screening. This will help kick your body out of a low-carbohydrate induced insulin resistant state and help you handle the higher sugar load. Of course, work with your provider to safely do this.
Option #4: Jelly Bean Test
Eat jelly beans instead! Some providers will give you the option to eat enough jelly beans to provide 50 grams of sugar instead of drinking the sugar solution. Since there are cleaner brands of jelly beans that are GMO-free and are naturally-colored, this may be a better alternative for someone that is turned off by the ingredients in the drink. The caveat is that we can’t be 100% sure of how much sugar you’re getting, even if the package says there are 50 grams of sugar in 28 jelly beans.
Option #5: Eat A Carbohydrate-Dense Meal or Drink 100% Fruit Juice
Eat pancakes with real maple syrup or drink a large glass or 100% fruit juice. I’m kidding, kind of. Some providers will give you the option to eat a meal or drink a glass of fruit juice that contains at least 50-grams of sugar and then take the test. Other providers may just ask you to eat the highest carbohydrate meal you’d consume throughout your pregnancy and then test. The caveat here is that you’re getting nutrients outside of just simple sugar, which is what the test is designed for. The protein, fat, type of sugar (fructose, glucose, sucrose) and fiber found in the meal and juice will impact how your body responds. Similar to the jelly bean test, this option isn’t standardized to 50-grams of pure glucose, which impacts results and accuracy.
Option #6: Refuse The Test
ACOG states that “you reserve the right to refuse care.” If you believe your risk is low, you’ve been eating a lower carbohydrate real food based diet, you’re not inflamed, you’re not overweight, you’re not a smoker, and you’re exercising, then you may choose to skip the test. I personally would suggest that you at least consider at home finger prick testing to gather insightful information and double check your levels, but it’s your choice.
There are more options available than the six listed here, but I think this gives you a few good options to consider.
So, to answer your question, yes, you have many options when it comes to glucose screening in pregnancy. Unfortunately, these options aren’t always discussed with you by your provider, so I’m happy you asked and hopefully this information can help guide you and other mamas who are asking the same question.
Of course, please discuss your plans with your provider and come up with a reasonable solution for your unique context. If your provider is really giving you pushback about alternative testing options, you may want to reconsider who you’re working with. You should feel respected and heard when it comes to all choices and decisions throughout your pregnancy. Make sure to check out our series on choosing a birth provider for more information.
You have a voice, you have a choice. We’ll be diving deeper into this topic throughout August. For more personalized pregnancy support, join our Pregnancy Program.
Stephanie Greunke is a registered dietitian with a master’s degree in nutrition who specializes in women’s health. She is a certified personal trainer and prenatal and postnatal corrective exercise specialist. Stephanie guides and supports women locally and globally through her web-based private practice, Stephgreunke.com.