Let me just start by saying this is basically a brain dump so I can quit worrying and thinking on this issue. Second, some background as to why I’m thinking and worrying about it in the first place:
Last week, I had a regular OB check-up. I’ve been healthy all through my pregnancy, and so has the baby, with normal growth, a strong heart, and frequent movements. At no time has there been any indication that I should be considered high risk. Last week, though, I was sent for a fetal weight estimate. I’ve never had one before, nor even had one offered, and didn’t think anything of it. However, the ultrasound indicated my baby, at 33+ weeks gestational age, measured at 37 weeks, and this sent both the ultrasound tech and my midwife into a tizzy. My midwife was so concerned that she asked if I’d take the glucose tolerance test now, even though I’d declined earlier, and I like her so much, I agreed. I almost instantly regretted it.
First, gestational diabetes (GD). I have issues with actively attempting to diagnose a “disease” that has no symptoms and disappears upon delivering the baby. Is it an actual disease, or just a natural physiological response to growing a baby? I can’t answer that, of course, but I do know that the stated primary benefit of universal testing of all pregnant women for GD is to identify those women who might be at risk later in life of developing Type II diabetes. A secondary benefit is to identify the women who might deliver a larger than average baby in advance, but this is somewhat dubious, because at the outside, fewer than 10% of larger-than-average babies can be linked to any particular risk factor, GD only one among them; the rest are just large babies.
Now I don’t actually know why they suggested the fetal weight estimate. The medical literature I’ve read seems to agree that ultrasounds are very good at estimating gestational age in the early months, but are grossly inaccurate during the third trimester, and especially anytime after thirty weeks, deviating by as much as 4 weeks from reality. The only thing late-term ultrasounds are good for is increasing the likelihood of interventions, which I have now inadvertently set myself up for. If I’d known this in advance, I would have skipped it. The reality is large babies can only be identified after they’ve been delivered.
And I have a history of delivering larger-than-average babies. Of the three who were over nine pounds, two were boys and two were ten days late. Both sex and the increased length of gestation undoubtedly contributed to their larger sizes, as well as genetics. My husband is 6’2″ and very well built, and our children all display these particular genetic contributions. This pregnancy is the first time I declined to take the Glucose Tolerance Test, and I did so for two reasons: First, it makes me feel really bad, nauseated and shaky. I would never actually consume enough sugar to make me feel like that in my real life, and if it makes me feel so bad, what does it do to my very sensitive unborn child? Second, the medical establishment doesn’t trust it anyway.
With all seven of my previous pregnancies, I have taken glucose tests of all kinds: one hour fasting, one hour non-fasting, and three hour fasting. On the basis of these tests, I have never been diagnosed with GD. However, when each of my three over-nine-pounders was born, it was assumed that I must have had undiagnosed GD, and all three were subjected to heel pricks after each nursing to determine whether they, too, were suffering from high blood sugar. Not a single one of them ever had an issue. With this pregnancy, when I reported on my previous deliveries to both the nurse who took my information and, later, my midwife, both were doubtful about my GD status and still insisted it must have been undiagnosed, in spite of both me and my babies passing all of their tests. It’s no wonder they doubt their own test; my research suggests that the oral glucose test is only around 70% accurate. It seems that blood glucose levels can be affected by all sorts of things, including fear of needles, stress before or during the test, worry about the results, and even the regular diet. (Low-carb diets tend to produce false positive results, as the body isn’t used to handling that heavy of a carb load.)
It seemed to me to be a case of damned if I do, damned if I don’t, so I opted for don’t.
What I did do was take a blood test called A1C. It measures the sugar load on blood hemoglobin, which are presumed to live approximately three months. As they float along in the blood stream, they pick up sugars, and how much sugar they are carrying can be a good indicator of how well your body is processing it. My research indicates that this test, too, can be faulty, that a healthier individual can have longer lived hemoglobins that will therefore have more time to pick up sugars, resulting in a false positive. The converse is also true. A diabetic can have shorter lived hemoglobins that don’t remain in the bloodstream long enough to pick up indicative loads of sugar, resulting in false negatives. For what it’s worth, I did pass this test, and it’s probably at least as accurate as the other.
In spite of my affection for my midwife, though, and my desire to alleviate her worries, I’m still not going to take the oral glucose test. My original reasons still stand: I don’t believe it is good for the baby and they won’t believe it anyway. But at this late stage, I’m also less likely to even pass it. It seems that maternal blood sugar levels rise pretty steadily throughout pregnancy to feed that growing baby, and I seriously doubt that my stage of pregnancy will be considered in the results. I’m a good two months past the recommended testing window.
Also, I can’t see how the results will effect the outcome. By this time, the baby is going to be as big as the baby is going to be, and I wouldn’t want it any other way. I have not sought to limit my weight gain to approved levels, and as a result, I’m about five pounds past their recommendations. Fifteen is probably all mine, as that’s been my seasonal weight swing since moving to the farm – less activity in the winter means a little more weight – and that leaves twenty pounds, so far, for the baby, which is not actually above their standards. My diet consists of organic, soy-free meat, dairy and eggs, fresh fruits and vegetables, more whole grains than not, very little processed or fast foods, and no sugary drinks. Since GD is treated first with diet and exercise, I don’t see how they’re going to improve on that.
I’ve done a lot of internet research and conferred with nurse friends, and I’ve also considered my own health and experience in the making of this decision. The risk factors for gestational diabetes are the same as for regular Type II diabetes. I am neither obese or inactive. My diet is much more nutritious than that of the general population. And I tend toward longer gestations and larger babies, period.
I’ve talked this all over with David. He says he’d just take the test and be done with it, and I know he would, but he also said, “This isn’t your first rodeo. You know better than anyone else what you need.” And then he said nobody would do anything to me or my baby that I didn’t want done. “Just let me know. Very few people have the guts to say no to me.” My hero, defending me in battle, being my protection against the wickedness and snares of the medical establishment. I don’t know why, but that makes me feel a lot better.