HELLO, SECOND TRIMESTER! Ahh, so many amazing things about hitting the second-trimester milestone. For many, morning sickness starts to decrease and energy levels begin to slowly increase. The awkward "I look like I ate a large burrito, not like I have a baby in here" phase starts to turn into a very obvious baby bump. And...you'll make several decisions about common screening tests such as the Gestational Diabetes Glucose test.
Should you choose to take this test, it is commonly done between 24-28 weeks in pregnancy.
There are two common time frames for this test. The "1-hour", and the "3-hour test" (done after the 1 hour if the results are concerning).
Your provider may offer these methods for testing:
-50g of raw sugar diluted in water
- A 50g Glucose drink from a pharmacy
- A "jelly bean" test (usually some form of dye-free candy)
I really like this explanation by Evidence Based Birth:
“To understand gestational diabetes, it’s helpful to first learn how the body metabolizes sugar. After you eat or drink carbohydrates (often called “carbs”), your gastrointestinal system helps the carbohydrates enter your bloodstream as glucose (often called “sugar”), which your body must turn into energy. Insulin is a hormone produced by the pancreas that helps deliver glucose from the blood into your body’s cells, where the glucose can be turned into energy that fuels your body’s functions. Insulin also helps convert extra glucose into fat for storage.”
Being diagnosed with GD isn't necessarily due to a "bad diet". It is a pregnancy-related inability to produce enough insulin to remove glucose (sugar) from your blood, and push it into your cells where it can be used as energy. Every pregnant person will go through metabolic changes, and for some- GD happens. Although, changing your diet, exercising and lowering carbs can definitely help control glucose variability.
The biggest and most realistic byproduct of GD is rapid fetal growth. If the baby's belly and chest become larger than the head due to abnormal growth from GD, this increases the risks of a vaginal delivery (but doesn’t make it impossible).
The problem is, testing methods have pros- ability to plan vaginal delivery safely, and cons- including false positives, ultrasound margin of error, and inconclusive data among all sources of glucose for testing.
Even OBGYNs and Midwives disagree about the best ways to test for insulin resistance, and what the threshold for blood sugar should be.
Let’s Evaluate Your Risk Factors:
-Over The Age of 35
-African American, Hispanic, South Asian Ethnicity
-Preexisting Glucose Abnormalities
-Direct Family Member with Diabetes
If you are in one or more of these categories, you are at a greater risk of developing GD and may consider more heavily- getting tested.
Now aside from using a blood sugar test to look for insulin resistance, your provider may ask you to do another ultrasound to look at your baby’s growth. The diameter of your baby’s head in an average pregnancy without GD should be larger than the diameter of your baby’s chest/belly. But sometimes when people have GD, the opposite will be true. This is where the concern for safe vagina delivery may be brought up by your provider.
The safest way for a baby to be born is the largest part of the body (head) coming out first.
However we know that every baby, body, and genetics are unique and the body is beautifully capable of vaginal birth in many “non textbook“ variations like breech, or LGA (larger for gestational age) babies.
We also know that ultrasound error has a marginal error of up to 2lbs. That makes quite a difference when deciding if your GD diagnose should affect your birth plan. (An ultrasound diagnosis of a LGA baby does not automatically equal an induction or a cesarean.) So bottom line is: there are many ways to diagnose GD, many ways to manage it, and many ways to plan a birth with GD. By no means does this diagnosis necessarily mean you cannot have a safe, normal vaginal delivery. By no means does it mean you HAVE to be induced. By no means does it mean you can’t seek care from a midwife. It means that should you decide to get tested for GD, and should you get diagnosed with it, there are some things to consider with your provider, your partner, and your Doula (click here to learn about Doulas In Omaha who are experienced in working with families birthing with this diagnosis) as far as creating a birth plan you feel good about, while still considering the risks of GD.
Knowledge is power. And informed decision-making is empowering!