Hello there! It’s Fertile Friday again. This time last week we were flying to Scottsdale for a lovely weekend of R&R (with maybe one conference lecture presentation thrown in!). This week it’s a quiet, normal weekend, and that actually feels really good! Today I want to ask the question – Gestational Diabetes – is it overdiagnosed? I know for myself, and for several other mamas in my circle, that the whole issue of gestational diabetes was a thorn in their side during pregnancy, perhaps unnecessarily.
Before I go any further, let me be clear that Gestational diabetes (GD) is a very real issue, with very real and potentially very serious effects for both mother and baby. I am not making light of that, nor am I implying that all cases of GD are misdiagnosed. I’ll just tell you about my situation, and say that I am not the only one who has had this experience. The more I talked to people, the more prevalent this type of situation seemed to be.
I went into my pregnancy 5’10” and 140 lbs. I gained a healthy amount of weight during pregnancy (32 lbs all together). Because of my “advanced maternal age”, the only test I was offered was a 2-hour glucose tolerance test. It’s the grossest thing where you have to guzzle this sugary, syrupy liquid, and they measure your blood sugar 1 hour later and 2 hours later. Let’s just say that my body is not familiar with sugary, syrupy liquids. I don’t eat any sugar, except for a piece of pie at Thanksgiving and another one at Christmas. I don’t drink soda (ever), and I eat a low-carb diet (I did incorporate some brown rice and sweet potato during my pregnancy). I’ve never had any history of blood sugar problems, nor is there any family history. Nevertheless, I failed the 2 hour reading – my levels were a few points above where they were supposed to be at that time. Interestingly, when I discussed it with my acupuncturist who specializes in pregnancy, she said that her healthiest, cleanest-diet mothers often failed the test because their body’s weren’t accustomed to metabolizing that much artificial gunk in one sitting.
After that, the label of GD was put on me, and seemed to overshadow every aspect of my pregnancy from that point forward. We were hoping to have our baby at a birth center within a local hospital, and they had rules and guidelines about GD and being able to deliver in the birth center. GD itself was not a rule out, but medication for GD was, and certain parameters around baby size were.
After the diagnosis, I was issued a glucometer, and dutifully took my blood sugar levels four times a day – once fasting first thing in the morning, and after each meal. In a 10-week period, I never had an abnormal reading, I had the healthiest blood sugar readings the midwife said she’d seen in ages, but no one would reconsider the diagnosis and it hung over me like a storm cloud.
Then I was the “advanced maternal age” mother with gestational diabetes to boot. I was doomed! Never mind that I consider myself healthier than most 30 year olds, was running 25 miles a week up until week 25 then walking 3 miles four days a week, as well as doing pilates once a week and prenatal yoga once a week right up to the end. But no one would look that with one lab test showing a value a few points higher than normal range, compared with 3 months of great blood sugar readings. I requested a repeat test but that was not granted.
I was also sent off to compulsory nutrition classes run by the hospital. The irony was, I truly believe if I had eaten the amount of carbs recommended by the hospital, I would have ended up with diabetes! Their “gestational diabetes management” guidelines were way less healthy than how I was eating, containing sugars and high-glycemic carbs.
So on we went with our prenatal care, thinking that since my levels were checking out well, and since there was no need for medication, we would still be eligible for the birth center. Until the 38-week ultrasound. At that visit, the ultrasound tech looked at my chart, and immediately made a comment about my GD and the impact of that on the baby’s size. Less than a minute later, she announced that our baby was estimated at 10 lbs, and that the abdomen: head ratio was out of whack (another possible outcome of GD). Boom, that was it, in that moment we were risked out of the birth center due to the ratio she predicted. In reality, Valentina was 8 lbs 12 ozs with a completely normal abdomen: head ratio.
Another outcome of the GD diagnosis was the non-stress tests that I was required to do twice weekly for the last few weeks. I would have had to do them anyway because of my age, but those tests required me to go to the hospital, have a fetal heart rate monitor checking her heart rate, and an ultrasound each time to measure amniotic fluid. I ended up doing about 12 of those all up over the last six weeks. What I found interesting was that in chatting to the nurses, they had expressed that the non-stress test rooms had become packed and that they were way more busy than ever before. I asked them why they thought that was the case, and they told me that the hospital had recently changed its guidelines on GD parameters, and that lots more people were getting diagnosed with it. Hence they had a steady stream of patients coming in for non-stress tests. I’m not saying this was their only motivation, but given mine cost me $50 out of pocket after my insurance paid their part, it must have been a nice boost in revenue for them.
I wonder what would happen if I did get pregnant again. I’m guessing I’d be flagged again as high risk because of the previous diagnosis. Of course, now I’m ancient, not just old, so that won’t help. I do know that I’d do everything in my power to avoid the 2-hour glucose tolerance test, but I’m not sure if I’d be given options this time around since I wasn’t last time around. But that’s all just theoretical anyway and is likely a moot point.
As it turned out, we still had midwife care and still had the natural birth we wanted, just not in the birth center. Ironically, no one ever checked my blood sugar postpartum, nor the baby’s, and it was never mentioned again at any of my post-natal visits. Being labeled with a diagnosis of something based on one aberrant test result, when I had weeks if not months of perfect blood sugar numbers, was a very frustrating experience. Even with my knowledge and background, and my confidence in the health of my body and my baby, it was easy to feel disempowered. When Valentina decided to wait until 42 weeks to be born, and all the midwives and doctors were wanting to induce, I studied up on the statistics around big babies, damage at birth and risk of neurological problems, I had to really stand my ground to avoid being coerced into induction. I didn’t let fear get in my way, but I can see how many people would.
I realize that midwife care and a home birth could have circumvented all of this. I know of midwives outside of hospital settings who will let pregnant women do their glucose test eating real food, which might have had a different outcome. But we wanted to be in a hospital setting so we had to play by their rules.
I wonder how many women have similar experiences – I certainly know of quite a few just in my circles. I also want to point out that we loved our midwives and many parts of our experience were wonderful. It just makes me wonder how many medical interventions are unnecessary or at least overdone.