GD Screening

On Monday morning, I went in for my one hour glucose screening test. I had been considering waiving this test, and only went through with it because I’m a wimp and don’t like confrontation. I’m not measuring large, don’t have a history of gestational diabetes in my family, have been running and eating healthfully throughout. My midwife suggested I not fast on the morning of the test so that I wouldn’t feel too sick. I had breakfast, went in, drank the gross drink, sat for an hour, went home feeling exhausted and queasy, and dragged myself back to work for practice.

On Tuesday, I got a call that I’d “just missed” the screening cut-off and would need to go back for the three-hour test. I will admit that I felt defensive, embarrassed, and caught off-guard, but I also felt, logically, that this test was unnecessary. I learned that many women who went in without fasting failed, and that 2/3 of all women who fail the one-hour test ultimately pass the three-hour test. I asked what the alternatives were and were told there are none, other than taking my blood five times a day for the rest of my pregnancy.

On Wednesday, I went in and drank 100g of glucose on an empty stomach. First I started shaking as though I’d had seven cups of coffee. Then I got really tired. Then I got nauseated. Then I got a headache. I went home, thinking I’d take a short nap and then clean the house, do some errands, and go back to work for practice. Instead, I could barely drag myself out of bed to reheat dinner. I’d never drink 100g of glucose, period, let alone on an empty stomach, while pregnant, and then not eat for hours afterwards. I really can’t imagine that this “routine” test is harmless.

In the hours since the test on Wednesday, I imagined that I gave myself diabetes from the test (I mean, I’d worry if I ate that much sugar EVER, so why would drinking it in a doctor’s office make it safe?), that I was going to have a 14 pound baby, that I was going to be told to exercise more. I felt like the fat 13 year old I once was, embarrassed to go to the doctor, acutely aware of her disdain. I also felt like an indignant conspiracy theorist. BIG PHARMA. INSURANCE COMPANIES. LIABILITY PARANOIA!

After spending yesterday with my stomach in knots, checking my phone throughout the day and repeatedly logging on to my health records to see if the numbers were in, I called the office first thing this morning. My numbers had come back totally fine.

Of course I’m relieved, and I’m annoyed that I let myself spend so much energy being nervous, scared, embarrassed, defensive, and angry. I’m also surprised that even after having sought out a practice that avoids unnecessary testing as much as possible (while still being, you know, a legitimate medical practice), I’d been subjected to a test that was not only inconvenient, but unhealthy.

I’m also struck by how deep the feelings of shame, inadequacy, and guilt that I felt were. Someone was accusing me of being fat. Someone was accusing me of not exercising enough. Someone thought I wasn’t taking good enough care of my baby. It made me remember how much I used to hate going to the doctor. How I could sense my weak, waifey pediatrician shuddering at my chub as a kid and until I started going to my prenatal appointments with my midwives, would have done anything to avoid going to the doctor and possibly having to get weight. Even after I was running 70 miles a week and obviously no longer overweight. What a toxic cycle. It also made me sad that this positive medical experience had been made a little less loving, a little less positive, a little more guilt-inducing.

I know logically that lots of thin, fit women get gestational diabetes, and that a lot of the guilt, shame, and anxiety are my own hangups. But, the more research I’ve done, the more it really does seem that the three hour test is over-perscribed, and that GD itself is over-diagnosed. I know (anecdotally) many women who were diagnosed with GD despite never measuring large, having no risk factors, and who delivered small babies vaginally. Perhaps some of these woman had the small babies and never measured large because they controlled GD with diet and exercise, but it also seems highly likely that some of these women never had GD to begin with, but perhaps had trouble processing… oh, 100g of sugar on an empty stomach?

If I do have another baby someday, I hope I am a little less afraid of confrontation, and a little better equipped to advocate for a different method of monitoring for gestational diabetes.

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