Gestational Diabetes Screening and Informed Decisions

In honor of a strong first time mama I met this year, who endured a confrontation from her care provider when she dared to decline the routine glucose screening test for gestational diabetes, I wanted to provide some information about the actual risk factors, signs of gestational diabetes, and screening alternatives.

Lamaze International states,
"You have the right to ask about and understand why each test is being recommended, the particulars of how a test will be done, all the risks associated with a test and if there are less risky approaches to diagnosing a problem or concern."

Doctors can easily rattle off a list of common and not so common risks to any procedure. Usually we just smile and nod and accept. But if you have questions about necessity of this, or any test, a key question is, "What other options are available for assessing this potential issue?" Another great question. "What happens if we do nothing?"

Remember your BRAIN

B = benefits

R = risks

A = alternatives

I = intuition

N = do nothing

When deciding if you will accept or decline the gestational diabetes screening, ask yourself these questions:

• Am I overweight?
• Am I related to anyone that has diabetes now, or had it anytime in their lifetime?
• Am I Hispanic/Latina, African American, American Indian, Alaskan Native, Asian American, or Pacific Islander?
• Am I older than 25?
• Have I had gestational diabetes in a previous pregnancy?
• Have I had a stillbirth or miscarriage?
• Have I had a baby greater than 9 pounds?
• Have I had polycystic ovarian syndrome (PCOS) or another health condition linked to problems with insulin?
• Have I every had problems with insulin or blood sugar, such as insulin resistance, glucose intolerance, or "prediabetes" ?
• Do I have high blood pressure, high cholesterol and/or heart disease?

The greater the number of "Yes" answers, the greater your risk for developing gestational diabetes.

Lamaze International continues...

"Your healthcare provider should let you know that you have the right to refuse a test, and he/she should welcome your questions and respect your decisions."

((Sooo...that might mean NOT YELLING at PATIENTS. I would think.))

After her confrontation, the care provider finally conceded that a simple blood test without drinking the sugar mixture would be an acceptable alternative. Sometimes it is not easy to have these discussions with your doctor or midwife, but exploring your options and becoming confident in your pregnancy decisions will go a long way towards increasing your lifelong birth satisfaction.



References
1. Centers for Disease Control and Prevention. (2011). National Diabetes Fact Sheet: 
National estimates and general information on diabetes and prediabetes in the United 
States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for 
Disease Control and Prevention.

2. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. 
(2009). Committee Opinion No. 435: Postpartum screening for abnormal glucose 
tolerance in women who had gestational diabetes mellitus. Obstetrics & Gynecology, 
113, 1419-1421.

Other Sources
American College of Obstetricians and Gynecologists Committee on Obstetric Practice. 
(2011). ACOG Committee Opinion No. 504: Screening and diagnosis of gestational diabetes 
mellitus. Obstetrics & Gynecology, 118, 751-753. 

American Diabetes Association. (2011). Diagnosis and classification of diabetes mellitus. 
Diabetes Care, 34 (Supplement 1), S62-S69.

American Diabetes Association. (2011). Standards of medical care in 
diabetes. Diabetes Care, 34 (Supplement 1), S11-S61.