We’ve discussed the issues with oral glucose tolerance testing (OGTT) in pregnancy before, especially the false positives in women who follow a moderate to low carbohydrate diet.
I also have an issue with some of the advice given to women with a pregnancy blood glucose level (BGL) of 5.1 mmol/L or HbA1c of 5.1%.
Before I go on, I’m not saying:
1. That every women’s experience is like this.
2. That there aren’t incredible nurses.
3. That gestational diabetes mellitus (GDM), when properly diagnosed, doesn’t need to be monitored closely.
What I am saying is that with a BGL of 5.1 mmol/L or HbA1c of 5.1%, there is absolutely no need for the nurse to launch into a fear-based conversation on the dangers to the baby and the likelihood of an increased birth weight. What I am saying is that with a BGL of 5.1 mmol/L or HbA1c of 5.1%, there is absolutely no need for the nurse to launch into the threat or even prescription of insulin.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) state the cutoff of 5.9% should be considered diagnostic of GDM. [Note: the reference range is narrow and there is a considerable difference between 5.1 and 5.9%].
The Royal Australian College of General Practitioners (RACGP) state “a random plasma glucose level has low specificity, and the OGTT is not necessarily predictive of later GDM. HbA1c with levels of 41-46 mmol/mol (5.9-6.4%) may identify women at higher risk of adverse pregnancy outcomes”.
For a HbA1c of 5.1-5.9%:
- What about dietary and lifestyle suggestions, including reducing sugar, increasing exercise and adding meditation?
- What about education on home blood sugar monitoring and how to determine foods and meals that increase blood sugar too much?
- What about a discussion on the risks of insulin for mumma and bubs?
We have been taught to fear pregnancy and birth enough. We need more support, a greater focus on education, and less judgement, well before pharmaceuticals are even mentioned.
Remember, GDM means high blood sugar in pregnancy, and for the vast majority can be managed with the right support and without pharmaceutical intervention.
Learn more in my interview – Exploring the Oral Glucose Tolerance Test & Gestational Diabetes with Lily Nichols.