I am opting out of the glucose challenge test for gestational diabetes. (Gasp!) At my last prenatal appointment, my midwife brought up the topic of screening for gestational diabetes. She gave my husband and me information on the potential effects of the disease as well as recommendations for screening. According to The American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association, a pregnant woman is considered low risk for developing gestational diabetes under the following criteria:
- Age 25 or younger
- Not in an ethnic group with an increased risk for developing type 2 diabetes
- Body mass index of 25 or less
- No previous history of abnormal glucose tolerance or adverse obstetrics outcomes usually associated with gestational diabetes
- No known history of diabetes in a first-degree relative
I am white, and my body mass index prior to pregnancy was 22.7. At week twenty-eight of my pregnancy, I have also gained only a respectable 12 pounds, meaning I have not gained an excessive amount of weight. Because I have never given birth before, I have never taken the glucose challenge test or given birth to a baby with problems due to gestational diabetes. As for my age, I am only 26; the risk suddenly does not skyrocket because I celebrated one extra birthday. Finally, none of my first-degree relatives have been officially diagnosed with diabetes. Based on the stated risk factors, I am low to lower risk for developing gestational diabetes.
I have also based my decision to opt out of the glucose challenge test based on the recommendations of other authoritative institutions.
- The American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for gestational diabetes by patient history, clinical risk factors, or a laboratory screening test.
- The American College of Obstetricians and Gynecologists recognizes that low-risk women may be less likely to benefit from screening with laboratory testing.
- The American Diabetes Association states that low-risk women need not be screened with glucose testing.
- The American Academy of Family Physicians has concluded that the evidence is insufficient to recommend for or against routine screening for gestational diabetes in asymptomatic pregnant women.
- The U.S. Preventive Services Task Force concludes that “[c]urrent evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes mellitus, either before or after 24 weeks’ gestation.”
In other words, the glucose challenge test is not necessary for all pregnant women. Instead, my midwife and I are screening for my risk of gestational diabetes with other detection methods. For example, at each appointment, I take a urine test that screens for sugar and protein in my urine. Sugar in the urine can be a symptom of gestation diabetes. (Protein in the urine can be an indicator of preeclampsia.) We are also watching my weight and the growth of my baby. Should I begin to gain an excessive amount of weight or should the baby begin to grow too quickly, then I would consider the glucose challenge test. Until if and then, however, I am confident that my decision to opt out of the screening is the best decision for me and for my baby.
References
U.S. Preventive Services Task Force. 2008. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine 148(10). 759-765.
Image Credits
Device to Check for Diabetes: http://commons.wikimedia.org/wiki/File:Device_to_check_for_diabetes.jpg
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