Treatment for Gestational Diabetes - Does it Improve Outcomes?
The entire medical industry has built a huge business around the diagnosis and treatment for Gestational Diabetes fully believing that it prevents fetal deaths, congenital anomalies, newborn complications, macrosomic babies, lessens birth injuries due to macrosomia and decreases c-section rates.
Diagnosis and treatment for
Gestational Diabetes
has not changed outcomes AT
ALL! No
more moms or babies are saved with current treatment of GD than
without. The death rates, birth injury rates, congenital
anomaly rates, everything,
have stayed the same.
Today, nearly ALL women with GD, even those whose GD is well-controlled, will have their babies by induction or planned c-section despite NO evidence that this improves outcomes.
Because the standards by which treatment for gestational diabetes is determined are biased against racial groups and do not take the truely diabetic mothers out of consideration, hundreds of women are mistakenly diagnosed with GD. Their pregnancies are then labeled “high-risk” and they are pushed into needless interventions that don’t improve outcomes anyway!
Glucose level in itself is a poor predictor of
macrosomia. Other
factors such as race, age, number of previous pregnancies, sex, and
especially maternal weight, far outweigh glucose intolerance in
determining birth weight. Birth weight and glucose are only
correlated in babies over the 90th percentile for weight, which
typically represents mothers with true diabetes that wasn’t
diagnosed
until pregnancy. They don’t have GD, they actually
have Type
II Diabetes!
Late term ultrasound is also notoriously inaccurate as a measure of fetal weight. A one-time late term ultrasound has a measure of error of +/- 2 pounds! That means a baby estimated to weigh 8lbs could it reality weigh as little as 6lbs and as much as 10lbs. In either case, weight is also not a true predictor of which babies will experience birth injuries or be difficult to birth. Too many factors go into the equation, from head circumference and baby positioning to your birthing positions, interventions used, and maternal pelvis size. The only way to know if a baby is “too big” is a trial of labor.
The definition of GD itself is shaky because blood sugar levels rise linearly as pregnancy progresses, meaning that your sugars will and should be higher during pregnancy. The Oral Glucose Tolerance Test (OGTT) has also been abandoned as an indicator of true diabetes because its results are too variable. This is also true of the Glucose Challenge Test (GCT).
In addition, the cut-off scores of treatment for
gestational diabetes were
arbitrarily determined by
the control group (which was flawed) and do not represent the levels
under which complications occur.
What should I do if I am diagnosed with GD?
First of all, decide if you even want to be
screened. If you
don’t have any risk factors and are symptom-free, then
consider
declining it. Remember, treatment for gestational diabetes
does not improve outcomes
unless you were truly an undiagnosed diabetic.
Instead of submitting to the GCT, ask for a hemoglobin A1C: it’s a blood test that gives a three-month measure of your sugars over that time. It’s a much better snapshot of what your sugars have done over time than the GCT or OGTT. If they’ve been high during the past three months, then the odds are greater that you do have GD.
If you are diagnosed with GD, work with a
nutritionist or dietician to
control your sugars. If they are within normal limits, then
you have no increased risks of complications and should
be treated like any other patient. You may have to undergo
Biophysical Profile (BPP) and non-stress tests at the end of pregnancy,
but if they are fine there is NO REASON to have an induction or
c-section. You should be able
to birth freely in whatever position you choose. Also,
advocate for food and drink during birth! If your sugars get
too high/low, it will impact the baby’s sugars.
Once the baby is born, nurse
IMMEDIATELY! This will stabilize
the baby’s sugar. Do NOT let anyone take the baby
for a blood
test right away. By depriving the baby of food right away,
they will cause the baby to become hypoglycemic. Also, mild
hypoglycemia without any other symptoms isn’t usually cause
for
concern.
Top of Treatment for Gestational Diabetes
References
Tuffnell DJ, West J, Walkinshaw SA.
Treatments for gestational
diabetes and impaired glucose tolerance in pregnancy. Cochrane Database
of Systematic Reviews 2003, Issue 3. Art. No.: CD003395. DOI:
10.1002/14651858.CD003395
Lamar ME, Kuehl TJ,
Cooney AT, Gayle LJ, Holleman S, Allen SR.
Am J Obstet
Gynecol. 1999 Nov;181(5 Pt 1):1154-7.
Atilano LC, Lee-Parritz A, Lieberman E, Cohen AP, Barbieri RL. Alternative methods of diagnosing gestational diabetes mellitus. Am J Obstet Gynecol. 1999 Nov;181(5 Pt 1):1158-61.
Goer,
H. OBSTETRIC MYTHS VERSUS RESEARCH REALITIES: A GUIDE TO THE MEDICAL
LITERATURE. Westport: Bergin and Garvey, 1995.
"Gestational
diabetes," INTERNATIONAL JOURNAL OF CHILDBIRTH EDUCATION.
1991;6(4):1991.
Stephenson MJ. Screening for gestational diabetes mellitus: a critical review. J FAM PRACT 1993;37(3):27-283.
http://www.aafp.org/afp/20031101/1767.html
http://www.aafp.org/afp/20040301/putting.html
Brody SC, Harris RP, Lohr KN. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003; 101:380-92.
Catalano PM, et al. Reproducibility of the oral glucose tolerance test in pregnant women. AM J OBSTET GYNECOL 1993;169(4):874-881.
Keller JD. et al. Shoulder dystocia and birth trauma in gestational diabetes: a five-year experience. AM J OBSTET GYNECOL 1991;165(4 Pt 1)928-930.
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