Monday, November 26th, 2012
While we’re all still coming down from the most glorious pie holiday, and the lesser known, but just as important subsequent holidays, “pie for breakfast” and “mashed potatoes at midnight,” let’s talk pregnancy and nutrition. What can I say, I’m a glutton for punishment.
Last week I hit another pregnancy milestone, the glucose screening test, or the drink that pregnant ladies love to hate, but personally, I think tastes like the nectar of the gods.
When the nurse handed me the drink and reminded me that I had 5 minutes to finish it, I had already guzzled that soda-orangey goodness before she could complete her sentence. Please ma’am, sugar and I are no strangers. I heard rumor that one practitioner gives his patients a Snickers bar instead of the drink. I’d like to sign up for that test. Weekly.
Overall, I’m a rule-follower. I do what I’m told. I was the dorky kid who could not comprehend the classmates who didn’t do their homework (but what will you tell the teacher?!), or how a person’s guilty conscience doesn’t shame them out of the carpool lane when they are clearly not carpooling. Rebels, all of them. I’d be way too scared of getting caught. Okay, so maybe rule-follower equates to wuss.
Either way, prior to completing the screening, I called to see if I could get the drink beforehand, since it is not administered at my doctor’s office, drink it at home, and then come in to have my blood drawn. The nurses response on the phone made me feel as if I’d just told her I was a vampire planning to suck the blood of her first born child. She was aghast at my request.
She maintained that this was an impossible request and I must come and sit on my fanny for an hour. Ooooookay lady, I’m bringing my toddler, “sit” is a vocabulary word familiar to dogs, not small children. But being a rule follower, I did as I was told.
Maybe it was the sitting that irked me. Maybe it was the fact that my pregnant friends told me they guzzled their cup o’ orange drank in the luxury of their own home and then went in. Maybe it was the fasting. Maybe it was the fact that I didn’t get a Snickers bar. Whatever it was, I was annoyed.
(Just to show that nurse who was boss I took my daughter to the bathroom 4 times in a hour because even though I follow rules, sometimes, when I’m all jacked up on glucose, I test the boundaries a bit. Read: danced down the hall all the way to the bathroom. Take that nurse lady.)
I’m not trying to be cavalier about the importance of the test. Let me explain.
As a rule-follower, I do not advocate for skipping the glucose test, even though one can opt out. Even more important than just being a rule follower is the health of my baby and forgoing the screening puts her at risk because gestational diabetes is serious, especially undetected. “Between 2 and 5 percent of expectant mothers develop gestational diabetes, making it one of the most common health problems during pregnancy.” It can even lead to fetal demise.
The administration of the screening got my my knickers in a knot and lead me to talk to my pregnant posse and turn to my main squeeze, Google Scholar. Apparently, there’s a lot of different ways to administer the glucose test, and the range for testing positive is not very concrete, which leads me to feel the test itself is a bit flawed.
Flaw #1: The requirement to fast prior to taking the test is an interesting one and is not universal. Some sources such as American Pregnancy state that fasting is not required while others, such as WebMD, state fasting is necessary.
Regarding fasting, it feels counter-intuitive to deprive the body of food and then load it up with high levels of sugar. It seems plenty of bodies would flip if they didn’t eat anything for a few hours and then their first source of “nutrition” was liquid sugar. Don’t even get me started on how fasting makes many a pregnant lady hangry. It ain’t pretty. The most common side effect is a rage blackout, says me, a serious hangry sufferer. Fasting during pregnancy is not ideal. It can be done, but if it is not necessary for accurate results, why do some practitioners require it?
Flaw #2: The test also has a notable number of false positives. Women screen too high “15 to 23 percent of the time,” which then requires a three-hour glucose tolerance test. Most women whose screening tests show elevated blood sugar don’t turn out to have gestational diabetes. Then again, why are there so many false positives? A pregnant woman’s sugar levels are often elevated because growing a baby requires additional nutrients and therefore, glucose, to do important things like growing cells and producing energy.
Flaw #3: Apparently, different practitioners use different standards for determining whether the level is too high. Some place the cutoff at 140 milligrams of glucose per deciliter of blood plasma (mg/dL), others put the cutoff at 130 mg/dL. It seems that they are trying to catch more women with gestational diabetes, but it also seems questionable as the way to test for it is to get sugar wasted, which if a woman has GD, is the exact thing to avoid.
More accurate measurements of glucose levels are emerging, which give a more telling picture, but they are in no way replacing the current glucose screening test administered nationwide.
Flaw #4: The sitting. I admit, I was peeved by the sitting. For the record, my toddler lady was a champ for the duration. I however, was not. I felt like a chastised child, who stupidly questioned the medical intelligence of my superiors. Yet I felt jilted. There was no consideration for my lifestyle, my diet, my exercise, and genetic components (age, history, race, previous pregnancies, etc). This again makes the test feel flawed. Each pregnancy, and pregnant body for that matter, is so very different, so why does each individual take the exact same test regardless of important lifestyle and genetic factors? It seems like each body handles sugar very differently, yet the cutoff is the same. The administration is the same.
Flaw #5: I am an advocate for nutrition during pregnancy but I hear little about it unless I take the time to research it myself. I remember being shocked to learn with my first pregnancy that really the pregnant bod only needs 300 extra calories a day in the first trimester. Luckily, that’s almost the equivalent of a Snickers bar. I jest, I jest. But I do not jest that women should be counseled on nutrition prior to the 28 week screening. It would be better to emphasize nutrition before testing, which forces a woman to focus on it.
Given these flaws, I have so many questions about this method of testing. Why is so much sugar necessary? Why is a woman required to sit? Why are these the practices of some doctors and labs but not others? I understand passing out from fasting could be an issue, but it seems like a woman would give a more normal depiction of what her body was doing with sugar if she is able to go about doing her normal routine as well as eating normally and healthily prior to the test. In isolation, the screening seems inauthentic to everyday life and what the body is actually doing.
I am not a doctor. I am a rule-follower. And now, apparently a questioning rule-follower. My inquires lead me to question if there is a better method for detecting gestational diabetes. And additionally, why pregnancy and nutrition is not emphasized more. It seems as long as a lady passes the glucose screening, all’s fair in pregnancy and face stuffing. I have a beef with this (see what I did there?).
Gestational diabetes should be taken very seriously, but with a test that gives women the best way to truly assess their risks. And if it turns out that eating a Snickers bar is the most accurate way to do that, this rule follower will oblige.
Image: Candy bar via Givaga/Shutterstock.com