talk to me about declining the GD testing

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talk to me about declining the GD testing

So that's one of the things that will risk you out of the birth center we go to. I didn't have GD last time, but my sister had it with one of her daughters (not sure if there is a family history connection with this or not, but wanted to add it just in case!)

I don't mind declining it and I'm hoping they "allow" me to decline and still see me as a patient. BUT my hesitation is, what if I *do* have GD? I am so not educated in this area and don't know what the real risks are.

Any opinions, advice?

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Thank you for posting those! Definitely easy to understand, well laid out articles. I will bookmark them to pass on to friends who may be interested in the future.

So basically the big "risk" is a large baby? Uh, ok. Big babies don't scare me! I'm going to go back and read in my binder of information from the birth center b/c I'm pretty sure they've said (I remember from last time as well) that we can decline any of this. But I'm also pretty sure that having GD would risk me out, so I don't know if they *can* require the testing or not. I'll ask and find out at my appt tomorrow.

Thanks again!!!!!

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I know my birth center isnt allowed to decline it, but it also might depend on your risk factors too. I have to do the complete fasting test because I have PCOS which gives me a higher risk and the fact that I'm over weight also gives me a higher risk.

They also said i can go for a walk after taking the drink to 'burn off' some of the sugar.

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I'm declining it- I have no risk factors for it. If I had suspicions of having GD, I may or may not test- either way, you just watch what you eat, take good care of yourself... just kind of common sense.

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I didn't do it. I think starving a pregnant mom for 12 hours and then pumping her full of sugar water just to see what happens is stupid and dangerous. Plus, too many ladies on my BB failed the 1 hr test only to have to waste 3 hours of their lives to pass the 3 hour one. Give me a HEALTHY breakfast and do a quick finger stick 2 hours later. Seriously. That is more accurate and gives you less chance of fainting or puking.

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My MW asked me if I wanted it or not, the only pro to having it done for me was the yummy drink LOL, but I can get an orange crush anytime so I declined, my reason's are the same as Jenn's.

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I have declined with every pregnancy. My babies are large (3 of the 4 were more than 9lbs) but we have a family history of large babies without being diabetic. We also don't have a history of diabetes...I don't know how I would feel if I had a sister who had GD.

Babies of diabetic mothers are bigger, but they are bigger in a different shape than just a big baby. They are statistically most likely to have shoulder dystocia and other delivery complications because of how much bigger the shoulders tend to be.

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I am actually declining it and I had GD with my 2nd pregnancy. I meet a number of the risk factors. I am 38 years old, my mother has severe type II diabetes and I ALL of my kids have been big. Samantha was 9lb 13oz at 40w2d, Lilly was 9lb 13oz at 38w2d and Isaiah was 7lb14oz at 36w1d (can you imagine if he had went to term, eeek). I actually passed the stupid test when I had GD, but my doctor knew I had it anyway and sent me for the food test. That test has you eat and then have your sugar tested 2 hours later. I think the tolerance test is incredibly flawed.

From what I know Emily is correct. The problem with "big baby" is where they are big. GD babies tend to be big through the shoulders and chest.

I would just make sure you research it throughly and then decide what is best for you. Good luck!

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There are some other risk factors for GD babies whose mothers aren't well controlled other than just being "big". They can have heart problems, respiratory problems and be hypoglycemic. There serious risks come about with uncontrolled GD and from what I've researched it has to be pretty bad. I had GD with the pregnancy I just got done with, but it wasn't too bad and was pretty easily controlled once I got the hang of that stupid diet.

The biggest problem I have with the GD test is that the test is becoming so stringent it is including women that are just barely close to the line and probably wouldn't have had any problems with their pregnancy had they not been included in the count. So, it's stupid to risk someone out of a birth center delivery just because you barely fall within the guidelines that they consider risky and it seems they consider so many more women risky now than ever before. My specialist actually said they are including a higher number of women in that group because of the stringency of the guidelines, but she said it was for safety because you never know (which is over-reactive and just plain ignorant if you ask me, but no one did).

I don't know if I'll skip the test next time (probably not) but I also won't be risking out of anything and therefore don't have anything to lose by knowing my numbers. I'll probably just take my sugars randomly in the beginning of the pg and then a little more often as I reach the magical 28th week. If I find them getting weird again I'll probably just go back on the diet.

Here's what I've found out since I had my baby about GD. I really thought it couldn't have that much to do with baby and had to be me (all me and my diet). However, my blood sugar numbers now compared to when I was pg are soooooooooooo different. When I was pg and I would eat a really good meal with lots of protein and few carbs I would get high numbers. Since the pregnancy I've had a few carb bender meals and my numbers are just fine (I've been doing random checks just out of curiosity). It almost doesn't seem to matter what I eat now, they're doing great. So, obviously it has to have something to do with the pregnancy.

fyi......I don't have a single person in my family that has ever had diabetes or GD. And, I only met 1 of the 4 risk factors and that was already having 1 baby over 9lbs.....that's it.

KUP on what you find out about refusing the test. I'm curious to see if they will let you. I wonder if it's set in stone though that you risk out. If you failed and were labeled with GD but you were one of those women who's numbers just barely put her in that category couldn't you argue your case that the test itself is subjective and the diagnosis has been overused.

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I have always done the GD test and passed. I meet several of the risk factors for GD (overweight, family history of Type II diabetes, and big babies).

The reason I've done it, even after passing so many times before, is that because my babies are huge (my smallest was 9lbs 13oz, my biggest 12lbs). I've never once in 4 pregnancies had sugar in my urine at office visits and I've always gained the recommended amount of weight. But, I want to be able to confidently say I *didn't* have it. Babies of GD mom are prone to other problems, but especially hypoglycemia in the first 24 hours after birth. Often their blood sugars (and sugars of especially large babies) is monitored with hourly tests and then supplemented if low. If mom is GD, then baby can have problems, but I didn't want my kids to be poked unnecessarily. I would rather do the test myself.

If you do decide to it... Do not fast before! Eat like you normally would, with maybe a little more protein than usual.

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If they won't let you decline, I wholeheartedly agree with the above--DO NOT FAST. My birth center didn't even tell me to fast, they said eat normally, just don't eat anything sugary (fruit juice, syrup, etc.) for 12 hours beforehand. A healthy, protein-heavy, sugar-light breakfast will give you much better and more accurate results than fasting. And seriously, the instructions for this test are so all over the place, I have a hard time believing that it's a good measure of anything. But if you HAVE to do it, do it in a way that is the least painful way possible. I'd also ask if you HAVE to drink the drink or if you are allowed to eat something with equivalent sugar but less Red Aluminum 40 Lake, if you know what I mean. I meant to do that but never did--have heard of some women having luck with it, though.

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Hmm. My birth center has me on a sugar restricted diet this week (my GD testing is the 25th). They said this is the best way to get an accurate result. They said to work the sugar out of my system this week and limit sugar to minimal this week - low glycemic diet. Then, on monday, I go in for a fasting test. They said anyone who has potential for GD has to do the fasting test (for me, PCOS and overweight). The people who are not at risk are to eat a high protein breakfast and drink 2 glasses of juice and come in and get drawn from that.

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Thanks so much for your answers!!!

I met with the mw today and asked if I had to test. She said no. They never force anyone to do any testing. She said they recommend it of course. I asked if I would be risked out and she said only if it were severe enough to require insulin to control it.

Plus, I didn't even think about it until I met with her today and we looked at my history. My grandfather has diabetes. So I guess that plays into the family history with my sister that had GD with her daughter.

I did ask that if I did do the test, could I avoid doing the glucose drink and just do a meal. She said that we could definitely work that out and that's how they used to do it years ago. So I'm going to keep researching and see. I currently eat much better than I did with my pregnancy with DS - waaaay less processed foods and more real, whole foods. I'm more active than with DS.

Thanks again ladies! It's such good info to have.

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The big thing they're worried about with GD is your baby being born with too little blood sugar. What can happen if your blood sugars are consistently too high during pregnancy is your baby will make more insulin to compensate for the extra sugar your body is giving it. When the baby is born, their blood sugar will significantly drop cause their little bodies are still creating lots of insulin, but they don't have the extra sugar you were giving them. This can cause your baby to have breathing problems.

That's the reason why I can't deliver at the hospital I wanted to, cause they don't have the supplies to help baby if that senario does happen.

Other than that, unless you become insulin dependent they usually won't bring up induction, especially if you're under the care of midwives. Once I became insulin dependent, Kaiser requires that I switched to the care of doctors and they do want to induce my at 39 weeks. I don't know if all health care providers are like this. This doesn't have to do with the big baby thing (I don't buy into the big baby thing). The insulin will make the placenta less effective as the due date comes up, so they don't want to wait too long before delivering. At least that's the way my midwife explained it to me. She did express that if the baby doesn't appear to be under stress, they are open to moving that induction date back to allow for natural labor.

Also, if your sugars aren't maintained where they should be it can cause delays in the development of baby's organs, though from my understanding that is much rarer and not as much of a concern as the other risks. It's more of a risk for momma's who were diabetic before pregnancy and didn't monitor their sugars in the beginning.

Not an option I'm looking forward to, but in the end it's about having a healthy baby. I'm going to have my doctor strip my membranes starting at 37 weeks and again at 38 weeks to try to induce naturally. I do not want pitocin and am going to try to find other options. Speaking as someone who has GD, where insulin was necessary since my sugar was too high even with changing my diet, I'm really glad I got tested.

All that being said, odds are you don't have it. Smile I just think being aware and doing something about it is much better than not. It's a very personal decision, though. Good luck with whatever choice you make!!

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I can't say 100% but I'm fairly sure that the GD testing is not an 'option' up here, that or every doctor I've ever had simply didn't give me the choice. I'm not in any way a high risk for GD but every pregnancy I haul my butt to the lab drink some nasty flat orange pop and get blood taken to tell me that lol...

I've never had to fast, or eat a low sugar diet, just show up, drink the stuff and get the blood taken... is it even the same test that you guys have? Cause honestly I don't see why not to get it apart from saving 2 hours out of my day and a horrible drink LOL

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"newtomom" wrote:

I asked if I would be risked out and she said only if it were severe enough to require insulin to control it.

that is how our birth center is...if you can control it with diet alone, you can still deliver at the birth center.

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first of all, i want to say that all i can think when they give me that orange drink is "this would be REALLY GOOD with vodka!" and i'm not a big drinker.... Smile

my OB's office did not ask me to fast with DD, in fact, they didnt warn me and i had 2 HUGE BOWLS of marshmallow mateys for breakfast before that appointment! and my sugar was fine. i have no family history of GD or large babies, BUT both my grandpa's are diabetic, one controled with diet one needs insulin, and DD was born at 38 weeks, 8lbs 8 oz, i blame her 6'5" father for that though.

i do the test willingly because i personally feel it does no harm, my diet could use improvement, i do have a few risk factors, and i like passing the test and knowing that my body still functions right.

if i had a better diet, i'd be declining it if i could, but i have a sweet tooth.

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"gypsy86" wrote:

if i had a better diet, i'd be declining it if i could, but i have a sweet tooth.

I've been worrying myself with this lately. 90-95% of my diet is great....We cook a lot with real food, but I've been way more into sweets in the past month than I was with DS's entire pregnancy. I am by nature a sweets eater, but last pregnancy and until a month ago this one, sweets were not appealing. I've been eating waaay more than I would normally eat not pregnant in the sweets area, so I think I'm going to cut it way back on the sugar.

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I think my food before hand threw my numbers way off. I still don't think I ever had it.

I had 4 white breadsticks and potato soup. My body apparently hates refined white flour.... to this day it will spike my sugars when even candy and fruit juice don't.

I LITERALLY washed down my food that day with the glucose drink. At that point I had no idea how carbs effected sugars!

I think I am having some slight issues right now with sugars... but I have been eating like crap this entire pregnancy. They wanted to test me at my 15 week appt but we will literally have just gotten back from our trip.... and its impossibe to eat well on a road trip. I asked them to push it back to my 20 week appt so hopefully cutting back the candy will help!

pico83 (not verified)

I'm thinking of declining it this time. I passed with flying colors with my first two. No family history of any diabetes, my babies were exactly average size, I'm thin and eat well, I'm young... and my doctor does a urine check for sugar at every appointment, so i figure they'd catch it that way.
I only did it last time because we were moving late in pregnancy and I didn't want any issues switching doctors (turned out I didn't have to switch).

KUP on how it goes!

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"emommyof2" wrote:

I can't say 100% but I'm fairly sure that the GD testing is not an 'option' up here, that or every doctor I've ever had simply didn't give me the choice. I'm not in any way a high risk for GD but every pregnancy I haul my butt to the lab drink some nasty flat orange pop and get blood taken to tell me that lol...

I've never had to fast, or eat a low sugar diet, just show up, drink the stuff and get the blood taken... is it even the same test that you guys have? Cause honestly I don't see why not to get it apart from saving 2 hours out of my day and a horrible drink LOL

It's absolutely optional. It's your body. No one can force you to take a test you don't want to take.

The reasons to decline are listed in the first article I posted:

"Several organizational bodies that have looked critically at the GD research have come out against GD testing. A Guide to Effective Care in Pregnancy and Childbirth, the bible of evidence-based care, relegates screening for gestational diabetes to “Forms of Care Unlikely to be Beneficial (12).” 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 (4,11)."

"GD treatment per se has never been shown to have benefits. In fact, it is virtually untested. The first and only random assignment trial, the standard for determining care because this design eliminates many sources of bias and ensures similar groups, was published in 1997. It concluded that intensive treatment offered no advantages over advising women to eat healthy (16). Meanwhile, several studies have found that identification as a gestational diabetic in and of itself substantially increases the odds of cesarean section (3,19,38,50).

Individual components of GD protocols also fail the safety/effectiveness test:

* Diet or diet plus insulin therapy: The standard GD diet is a healthy diet. However, while it reduces blood glucose to normal range in most women, it has little or no effect on birth weight (54). Many women, though, are prescribed limited calorie diets. Reducing calorie intake by more than one-third causes the body to switch to a starvation metabolism (ketosis) that produces byproducts known to be harmful to the baby (31). Limiting food intake can also lead to malnutrition (27). Aggressive insulin use can cause underweight babies and symptomatic episodes of low blood sugar (hypoglycemia) (3,32). A Guide to Effective Care in Pregnancy and Childbirth lists both diet treatment and diet plus insulin treatment under “Forms of Care Unlikely to be Beneficial (12).”

* Tests of fetal well-being: Of the four random assignment trials of nonstress testing, the most commonly used fetal surveillance test, none found any benefit for testing, although they were in populations of women at moderate to high risk (41). All tests of well-being have high false-positive rates, meaning the test says there is a problem when there isn’t. This leads to unnecessary inductions and cesareans with all their attendant risks.

* Fetal weight estimates: Ultrasound predictions that the baby will weigh over 4,000 grams are wrong one-third to one-half of the time (6,9,14,20,33,56). As with fetal well-being tests, the belief that the baby is big leads to unnecessary inductions and cesareans. Two studies showed that when obstetricians believed, based on ultrasound, that women were carrying babies weighing over 4,000 grams, half had cesareans, versus less than one-third of women not thought to have babies this big, but who actually did (35,56).

* Induction of labor or planned cesarean: Many doctors induce labor in the belief it averts cesareans due to big babies. Some think induction or planned cesarean prevents shoulder dystocia (the head is born, but the shoulders hang up). Studies of induction and planned cesarean for suspected big baby show no benefits for either practice (6,9,14,20,33,49,56).

* Monitoring newborn blood sugar: The reasoning behind this is that if the mother has high blood-sugar levels, the baby will produce extra insulin. After birth, this excess insulin can cause low blood sugar. No studies have tested whether checking the blood sugar of a baby who shows no symptoms of low blood sugar has any value. However, test results can lead to the baby being given a bottle of sugar water or formula, which interferes with establishing breastfeeding, separation from the mother for observation in the nursery, or both.

Finally, treatment also fails to prevent increased incidence of preeclampsia, impaired glucose tolerance in children, and childhood overweight (42,44-45,53).

Another rationale given for diagnosing and treating gestational diabetics is identifying women at risk for developing Type II diabetes. However, predicting who is likely to develop diabetes can be done equally well on the basis of race, ethnicity, and weight."