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Is Gestational Diabetes Really an Issue?
In the past decade, obesity has become rampant in our country. With it the rates of diabetes in the general population, and gestational diabetes (GDM) – which is an excessive increase in glucose intolerance in pregnancy (some increase in glucose intolerance is actually normal and allows more sugar to get to the baby for growth) – have risen dramatically. Current estimates are that 5%-7% of pregnant women in the U.S. develop GDM.
Gestational diabetes increases a host of risks of serious medical problems for mother and baby. However, at levels even lower than those that would qualify a woman for a GDM diagnosis, chronically elevated blood sugar also puts mother and baby at much higher risk of pregnancy and birth complications.
Elevated blood sugar creates a condition in the body called "oxidative stress." In pregnancy, which is already a state of somewhat increased oxidative stress, this can lead to high blood pressure, preeclampsia, and preterm birth. Also, babies born to overweight or diabetic moms have a much higher lifetime likelihood of developing chronic health problems associated with obesity and diabetes. Women who develop GDM also have at least a 50% change of becoming diabetic later in life.
So yes, gestational diabetes is a big issue we should be aware of! But does that mean we need universal screening of all pregnant women, and are oral glucose drinks (called "Glucola") our best – or only – option for testing?
About Glucose Testing for Gestational Diabetes
Gestational diabetes is a dangerous condition — actually so is high blood sugar even if below the level that qualifies for GDM. Women who are at moderate to high risk do require some form of testing for GDM so they can be followed and treated appropriately if detected.
Current guidelines recommend what is called a "two step approach" for screening for gestational diabetes. The first step is a glucose challenge test. Women are given a "drink," called "Glucola," which contains, among other things, 50 grams of a sugar polymer. Your blood sugar level is measured 1 hour after drinking the "Glucola." Women who screen positive go on to the second step, the Glucose Tolerance Test (GTT), with either a 75-gram two-hour test or a 100-gram three-hour test. Again, the glucose drink is given as the vector for the sugar. It comes in concentrations containing 50, 75, and 100 grams of sugar.
The medical community considers this "drink" harmless, though it is well recognized that some women just cannot tolerate it due to the digestive system side effects that include nausea, vomiting, bloating, and diarrhea, as well as other adverse reactions including headache, dizziness, and fatigue.
But really, it might not be that harmless after all!
The Problem With Glucola
In an age of increasing concern about the toxic exposures babies are exposed to before birth and the impact of these exposures on their short and long term health, including the impact on their DNA (genes), it is important to note that at least one of the glucose test drinks, EasyDex by Aero Med (note that ingredient lists from the test companies are notoriously hard to find online), contains something called BVO, or brominated vegetable oil. BVO is also found in at least 10% of all soft drinks in the US, and is included to keep the favoring from floating to the top of the beverage.
According to the Center for Science in the Public Interest,
"Safety questions have been hanging over BVO since 1970, when the FDA removed BVO from its 'Generally Recognized as Safe' list of food ingredients."
At that time, the FDA granted BVO 'interim status' as a food additive which allowed its use in soft drinks, but it was and continues to remain banned from European and Japanese soft drinks. BVO is patented in the U.S. and overseas as a flame retardant. Yet it is in EasyDex, a medical testing "drink" consumed by presumably hundreds of thousands of pregnant woman in the US!!!
Vani Hari (aka The Food Babe), a food activist who is bringing fresh attention to the hazards of the chemical additives in our foods, brought the BVO issue to my attention when we were chatting at a conference. We both agreed that this toxin should not be given to pregnant women! Here is a picture, shared with Vani's permission, of the ingredients in EasyDex, including BVO.
So What's Wrong With BVO?
BVO contains bromine, which is known to interfere with thyroid function. Even more frightening, it is found in the brominated flame retardants that are used in upholstered furniture and children's products, which I wrote about here.
Research has found that brominated flame retardants build up in the body and breast milk. BVO leaves residues that accumulate in body fat, the brain, the liver, and other organs. Studies in animals demonstrate that BVO is transferred from a mother's milk to the nursing infant. BVO has been associated with heart lesions, fatty changes in the liver, and impaired growth and behavioral development, and both animal and human studies have linked BVO to neurological problems, fertility problems, changes in thyroid hormones and precocious puberty.
Charles Vorhees, a toxicologist at Cincinnati Children's Hospital Medical Center, told Scientific American that
"Compounds like these that are in widespread use probably should be reexamined periodically with newer technologies to ensure that there aren't effects that would have been missed by prior methods ... I think BVO is the kind of compound that probably warrants some reexamination."
Well, Charles, I agree and then some!
What About Other Glucose Test Drinks?
Even if the glucose test drink you are offered doesn't contain something as obviously noxious as BVO, they pretty much all contain artificial flavors and colors, high fructose corn syrup, and the glucose itself is derived from corn – most certainly not GMO-free! Not ingredients I would want to drink during pregnancy (or ever).
What's a Mom to Do About Glucose Testing?
As women, many of us were taught to "be nice" or "be seen and not heard." As patients, this can translate into accepting tests, procedures, and treatments that we feel we do not want or need, or that, in this case, might not be safe for us or our babies!
You certainly have the right to read the label on the glucose test drink you are being offered before agreeing to the test!
You also have the right not to be screened for GDM, as well as to choose your preferred screening method. In fact, in 2001, ACOG clearly stated that gestational diabetes guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice. And further, and more importantly, ACOG clearly states that a pregnant woman's autonomy is to be respected, and that judicial authority should not be used to implement treatment regimens aimed at protecting the fetus, for such actions violate the pregnant woman's autonomy.
The fact is that the GTT test has a wide margin of error – the test misses many women who have GDM, and diagnoses others who do not have it at all. Thus women who need extra nutritional counseling might not get it at all, and others with normal healthy pregnancies might get unnecessarily put into high-risk categories, such as receiving a potentially toxic drink for the sake of a less than reliable test.
If we all say NO to toxic glucose test drink ingredients, we might be able to put enough pressure on the manufacturers to change and remove unnecessary and potentially toxic ingredients (including things like ester of wood rosin!).
It's really important to know that this is not an emergency decision, and that you do have a choice!
If you are at risk for GDM, or are just planning to have the testing to make sure everything's okay with your blood sugar, then consider other reasonable testing options:
- If you are in your first or early second trimester, consider a Hemoglobin A1C test. It is a simple blood test that does not require you to ingest anything prior. While there is no set level that determines gestational diabetes (there are levels for non-pregnancy-related diabetes), done early enough in pregnancy, it can determine whether you already had undetected diabetes before even becoming pregnant, and a level of 5.45% may be associated with gestational diabetes, in which case you can make dietary changes and wait until 24-28 weeks gestation, when the glucose challenge and GTT are typically done, and then decide whether to test.
- Consider an excellent diet and random glucose testing. This just requires finger stick blood testing which can even be done by you at home, and is a commonly used alternative for women who can't tolerate the Glucola. However, one test result alone is not enough to diagnose or rule out GDM, so you'll want to work with your doctor or midwife to come up with a reasonable schedule for testing and assessing your results.
- Consider "The Jelly Bean Test." This test, which has you eat 28 jelly beans, which also provide 50 grams of sugar, has been popular amongst midwives for decades, and now there are GMO-free and naturally-colored brands to choose from. While some data suggests that the results are not entirely as reliable as using the oral glucose test drinks, an article published in a major obstetrics journal states that jelly beans are a reliable alternative that are actually preferred by women and have fewer side effects.