I’m seeing so many questions lately regarding gestational diabetes (GDM) and the glucose tolerance test (GTT), that I felt it was time to record my thoughts in a blog post. Because it gets tiring typing out the same answer each time!
So many women are asking whether the test is reliable, what are the risks, what are the alternatives; I’m seeing women told that they had undiagnosed GDM despite doing the routine test and women who fail the test and then never have another blood sugar level (BSL) issue again for their entire pregnancy. Women are asking about evidence: for and against the GTT; for and against induction for GDM; for and against routine scans because of GDM.
Suffice to say that women have questions. And care providers seem to be struggling to answer them.
One of my biggest beefs with the GTT, as a standard test for all pregnant women, is that it makes a couple of really big assumptions.
Assumption 1: That a body that struggles to efficiently process twice the daily recommended intake of glucose, first thing in the morning, is somehow defective.
Honestly – my pregnant body struggles with a lot of stuff. I struggle to tie my shoelaces, carry my toddler and deal with the smell of cooking sausages. It would seem a little strange to me if my body was totally up to the task of efficiently processing that much sugar. Without so much as a coffee to help it out.
Assumption 2: That “normal” blood sugar levels are the same for everyone.
Normal is just a setting on the washing machine. We are all unique and what works best for one body will be slightly different to others. Why shouldn’t this be the same for blood sugar levels as well? More important things to look at would be individual health and individual BSLs over a period of time so that each woman has an idea of what is normal for her.
Assumption 3: That a one off test, in abnormal circumstances, is an effective indicator of overall health.
For a start, blood sugar levels can and do fluctuate over the course of your pregnancy / week / day. Anyone who has ever tracked their BSLs for a period of time will tell you that sometimes, just completely randomly, they will be higher than (your own!) normal. And if you have regular higher end readings, every now and then the levels will just randomly be lower than normal. Depending on which day of the week you do your GTT can determine whether you get a diagnosis of GDM or not.
The other thing about this assumption – the one off test isn’t even in your normal circumstances!
I told someone recently that I don’t really care how my body reacts to a 75 gram glucose load first thing in the morning because I don’t make it a habit to consume 75 grams of glucose first thing in the morning. I want to know how my body reacts to what I normally consume. In my normal circumstances.
Stress and illness can adversely affect BSLs. I don’t know about others – but rushing out the door first thing in the morning when I’m hungry, juggling small children AND worried about “failing” a test and having that impact on my baby and my birth is a great way to increase my stress levels.
I’m not saying that you shouldn’t ever do the GTT. I’m not here to tell you what you should do with your body. But I do think that you should test your assumptions about the GTT.
You should always be making an informed decision – about ANY test or procedure.
And an informed decision means consulting a variety of different sources.
And asking a variety of questions.
The most important question being: Considering my individual health, goals, knowledge, experiences, values etc is this test right for me?
Do you need help formulating questions and testing assumptions? As a doula I can help you get clear on what you need to know in order to feel informed and make the best decisions for you. Get in touch now to book a consultation.