Dr Visits, Deconstructed?

[Anonymous]

You can eat a high carb diet (50g of sugar per meal - total at least 150) in the few days leading up to the test. It is less likely to give a false positive and will not mask any real issues with your sugar levels.

[Anonymous]

I just found all of this very interesting. Not saying I'm going to refuse the test or anything, but it seems a bit odd. I'm super thin and if anything have been on the low side of the weight gain average, so I'm not really terribly concerned anymore. But Dr. Google (and a quick look at some of the peer reviewed pregnancy books I have) had some interesting things to say about routine GD screening:

Neither the OGTT nor the screening test are reliable tests in that they give different results when repeated in the same person (8,24). In addition, blood glucose values rise as pregnancy advances, but no adjustments are made for this. This means you could “fail” a test in week 28 that you would have “passed” had you taken it in week 24 (17). The various thresholds used to diagnose GD are purely arbitrary (11,28-29,40,43). None of them correlate with the appearance of or a marked increase in complications. Studies fail to show that treatment reduces adverse outcomes such as overlarge babies (16). However, being identified as a gestational diabetic greatly increases the chance of having a cesarean simply because of the diagnosis, not because of problems such as overlarge baby (5,21,37,42). For these reasons, several organizational bodies have opposed GD testing. A Guide to Effective Care in Pregnancy and Childbirth, the bible of evidence-based care, relegates screening, diet, and diet plus insulin to “Forms of Care Unlikely to be Beneficial (16).” The American College of Obstetricians and Gynecologists says no data support the benefits of screening (1). The U.S. Preventative Services Task Force and the Canadian Task Force on the Periodic Health Examination both conclude that there is insufficient evidence to justify universal GD screening (7,15).

In the meantime, a GD diagnosis appears to significantly increase mom's chance of having a c-section imposed by elevating doctors concerns about a big baby even if that is not truly the case and even if the sugar levels were only borderline high (which some experts simply believe to be a natural and necessary function of pregnancy). GD diagnosis can also lead doctor to recommend mom restrict calories or manipulate glucose with insulin, which affects the growth mechanism of the seventy to eighty percent of babies who would not weigh in the upper range even if GD were left untreated, not to mention the ten percent or so who genetically were supposed to be big. Aggressive diets and insulin use can cause starvation metabolism (ketosis), which produces byproducts known to be toxic to the baby (27). These diets can also result in underweight babies, and symptomatic episodes of low blood sugar (hypoglycemia) (5,30,32). Limiting food intake can also lead to malnutrition (26).

The numbers in parentheses are references to page numbers in Effective CAre in Pregnancy and Childbirth.

Interesting that nobody ever second-guesses this test. I think I'll just ask my doctor what he thinks about it and to explain all of these things to me the next time I'm in.

[Anonymous]

I know there have been a lot of posts on this thread about the validity of the GD test.

Just keep in mind that there is a margin of error with just about every test administered in the doctor office.

Hec, you can even twist statistics and grill skeptical oncologists about how effective mammagrams are in detecting lumps. As we know, mammograms aren't 100%, but they are still pretty darn good (and better than nothing) and, so far, the best screening tool so far and it's still wise to get one done.

[Anonymous]

Anonymous wrote:I know there have been a lot of posts on this thread about the validity of the GD test.

Just keep in mind that there is a margin of error with just about every test administered in the doctor office.

Hec, you can even twist statistics and grill skeptical oncologists about how effective mammagrams are in detecting lumps. As we know, mammograms aren't 100%, but they are still pretty darn good (and better than nothing) and, so far, the best screening tool so far and it's still wise to get one done.

Don't want to play devil's advocate (or beat a dead horse if there have been other posts about the GD test) but what is the downside to a mammogram other than a little bit of pain? I'm asking b/c I don't know -- haven't gotten to the stage of needing or having one yet. That said, there do seem to be real significant downsides to the GD screening. Once diagnosed, many docs tend to start from the point that you are going to have a large baby with a problem and treat aggressively. You're more likely to get a c-section, and the treatment for the GD can be worse than the disease.

I'd say considering the fact that some women get sick from the test, the screening results are often unreliable, and the consequences are further testing, treatment, and categorization, and sometimes birth options based on an incorrect or trumped up worry, I'd say there's much to gain by questioning the procedure and there IS in fact quite a lot to lose by failing to question.

Similarly, I have not had any genetic tests done -- given the inaccuracies and the fact that I do wouldn't change the outcome of my pregnancy on the results. I'm not a fan of overkill even without negative results, and think the GD test might start to be looking like it falls into at least that category and might even carry some harm.

Just saying...