Aviva Romm and the quack attack on Glucola

Fetus copy

Aviva Romm is a quack.

She’s a certified professional midwife (CPM) and an herbalist, both quacks by definition. She got an MD (from Yale!!!) and completed a family practice residency, which apparently taught her a few things. No, it didn’t teach her to give up quackery. It merely taught her to avoid any situation where should could be held accountable for her quackery. Delivering babies was awesome when she planned to take no responsibility. Now that she has an MD, and carries malpractice insurance, it is suddenly too dangerous to do or to even back up.

Dr. Romm has helpfully provided us with an excellent example of the standard quack attack in her most recent post, Gestational Diabetes: Please Don’t Drink the Glucola Without Reading the Label.

All quack attacks rest on two foundational claims:

1. Don’t trust the people who are trained in the specific area under discussion, the people who went to school, undertook an internship and residency in obstetrics, and have provided obstetric care to thousands of women, and stand ready to accept responsibility for the advice that they offer; trust me (who did not do a residency in obstetrics, and chooses not to practice obstetrics, and intends to take no responsibility for her obstetric advice) instead.

2. Obstetricians aren’t simply ignorant, they are actively conspiring to harm your baby with chemicals … AND THEY ARE HIDING THEIR EVIL INTENT.

Sounds stupid, right, but Romm, like all quacks, bets on the stupidity and gullibility of her readers.

In addition, quacks are always selling something, in Romm’s case, her books, her courses, and her services separating the worried well from their money at a high end clinic that caters to the rich and charges exorbitant prices.

Consider the specific claims in Romm’s quack attack on Glucola, the test dose of sugar used in screening pregnant women for gestational diabetes.

I’m a midwife and MD who specializes in the health and wellness of pregnant mommas. While I’m one of the original crunchy mamas, I got the science thing down tight in my medical training at Yale, so I can keep you informed on what’s safe, what’s not, and what are the best alternatives.

Bullshit. She isn’t an obstetrician or an endocrinologist so she DOES NOT specialize in the health of pregnant women. She has no business giving obstetric or endocrinology advice. She went to medical school at Yale. Woop-de-doo! Did they teach anything about Glucola in medical school? I doubt it.

The medical community considers this “drink” harmless though it is well recognized that some women just can’t tolerate it due to digestive system side effects including nausea, vomiting, bloating, and diarrhea, as well as other adverse reactions including headache, dizziness, and fatigue.

But Romm thinks she knows better, despite lacking the requisite training. And Romm thinks she knows that … cue the creepy music … obstetricians are secretly trying to poison your baby!!

… [A]t least one of the glucose test drinks EasyDex, by Aero Med (note that ingredient lists from the test companies are notoriously hard to find online!) contains something called BVO, or brominated vegetable oil. BVO is also found in at least 10% of all soft drinks in the US, and is included to keep the favoring from floating to the top of the beverage.

According to the Center for Science in the Public Interest, “safety questions have been hanging over BVO since 1970, when the FDA removed BVO from its ‘Generally Recognized as Safe’ list of food ingredients.” At that time, the FDA granted BVO ‘interim status’ as a food additive which allowed its use in soft drinks, but it was and remains banned from European and Japanese soft drinks. BVO is patented in the U.S. and overseas as a flame retardant.

Classic quack attack characteristics: isolate one product and let it stand in for all products of that type, insinuate that the product is harmful, list the countries where it is banned (don’t say in what dose or why), imply that because it has other uses, it must be poisonous.

How about proof?

Don’t be foolish. Quacks don’t need any proof. Quacks quote lay people as if they were scientists and blogs as if they were scientific papers.

Vani Hari (aka The Food Babe), a food activist who is bringing fresh attention to the hazards of the chemical additives in our foods, brought the … issue to my attention when we were chatting at a conference. We both agreed that this toxin should not be given to pregnant women!

Romm uses another favored quack source, the product label. As she undoubtedly knows, doctors don’t read the product label to learn about a medication and you shouldn’t either. The product label has more to do with legal protection than with medical knowledge.

Can Aviva Romm point to anyone who has been harmed IN ANY WAY by Glucola? Of course not. Doctors who care for patients need actual data. Quacks just need insinuations.

All the central quack claims are here, rolled into one: don’t trust your doctor, your doctor is trying to poison your baby, read the product label (not the scientific literature), scary insinuations and no actual proof of ANYTHING.

Now that Aviva has filled the heads of her gullible minions with her conspiracy theory, she presses on with phase two of the quack attack: praise those who believe her bullshit as educated and empowered.

As women, many of us were taught to “be nice,” or “be seen and not heard.” As patients, this can translate into accepting tests, procedures, and treatments that we feel we don’t want or need, or that, in this case, might not be safe for us or our babies!

You certainly have the right to read the label on the glucose test drink you are offered before agreeing to the test!

You also have the right not to be screened for GDM, as well as to choose your preferred screening method…

Just what women need, encouragement to be arrogant in their ignorance.

But I have bad news for Romm’s minions, eager to believe that they are learning something that other women don’t know:

Aviva Romm is in the pocket of Big Placebo. Her income rests on tricking women into paying her for her useless (and often harmful) “wisdom,” instead of learning from the people who know the most about obstetrics. She is shilling for her products and her pocketbook.

And if you think she cares about what happens to your baby, I have a bridge for you to buy in Brooklyn.

Aviva Romm KNOWS that homebirth kills babies. That’s why she refused to discuss the MANA data; she KNOWS it shows that homebirth is dangerous. And that’s probably why she refuses to have anything to do with homebirth as a practicing physician. She no longer wants to be responsible for the death and injury that may result.

Romm should be ashamed of herself and her quackery, but she probably has no time; she’s busy making money from fooling unsuspecting women, and potentially harming their babies in the process.

  • Leslie Wetzel-Moldenauer CA

    When you start off a document by calling someone a quack…it speaks go your character and I read no further. Well done!

    • Taysha

      So what do you suggest we do when people start off their comments disregarding doctors and scientists as “evil” and willing to “harm babies”?

      • Leslie Wetzel-Moldenauer CA

        I think it is important to shine as the bigger person and not resort to the things that offend you. You can get your point across, show the science, and let people do their own research to come to their own conclusions. I am a blogger myself, name calling does not typically get you any followers.

        • Linden

          Nope, I’m really happy with the approach that calls a spade a spade. Especially if it is completely justified, as it is here.
          Dr T. isn’t name-calling, she’s providing examples of the fearmongering and unscientific thinking that harms real women and real babies. So tone trolls can go hang.

        • PrimaryCareDoc

          Fascinating blog you’ve got there. Filled with woo and essential oils. And you’re currently doing a correspondence course in woo. Great. I think you probably qualify to be called a quack, also.

        • Sarah

          Yes, nobody ever reads snarky blogs at all. Perez Hilton has no followers.

        • Taysha

          I’m a scientist myself and I call things like they are, with the data to back them up. Florid language is great, but you can only bullshit so much before you choke on it.
          I can show the science till I turn blue, but most people have no idea how to read the science, understand the science or even care about the science because “they feel so strongly”, “read a blog” or “took offense” because they “felt attacked” at the fact that someone proved them wrong.
          Tough shit. Welcome to the world.

          • Nick Sanders

            There’s more than one anti-science community where I’ve been called a troll simply for persistently disagreeing.

    • PrimaryCareDoc

      Well thanks! You sure added a lot to this conversation. So you’re a blogger? How many hits to you get a month? I guarantee it’s not as many as Dr. T, so maybe you shouldn’t be giving her lessons on how to get followers.

    • LibrarianSarah

      The concern troll is concerned.

  • CommanderRiker

    am i weird because i actually liked the taste of glucola? it was orange flavored, my favorite. also, no GD for me and my little man, so yay.

    • Kate

      I’m not sure if glucola was the drink that my OB gave me at my GTT today, but I also thought mine was delicious!

      • Stacy48918

        Reminded me of those kiddie drinks in the little plastic barrels with the foil top.

        I didn’t think it tasted “delicious”…but it wasn’t awful. Certainly didn’t vomit or anything.

  • I fucking hate pseudo-science has picked this up.

  • Joy

    The UK makes you drink Lucozade. It is a nasty, slightly fizzy, odd tasting, thick, and caffeine filled sports drink. It was enough to give me the boak.

  • Jenny_from_da_Bloc

    So I posted the following on Aviva’s blog after doing some research and making a phone call: From a clinical standpoint something containing BVO with less than 3-5 ppm would have pretty much no chance of having a toxic effect on an established pregnancy. BVO is an emulsifier used in citrus flavored drinks to kept the flavor from separating from the actual liquid drink. The amount consumed to have a toxic effect would have to be larger than 2 liters a day, which is proven. The amount of BVO in Glucola is not enough to have a toxic effect on a human mother and fetus. (I’m actually on hold with Vegamed, Glucola’s manufacturer to get an actual amount and ppm in the drink.)

    The problem with doctors who are not pathologists or clinical chemists ) giving advice on laboratory testing and unproven alternatives are the reliability of the alternatives. They do not understand how quantitative lab testing works and the amount of analysis and testing required to substantiate claims that 28 jelly bean are equivalent to a precise formulary product. There are obvious analytical issues involved with alternatives like jelly beans and orange juice. There is no way to determine the exact amount of sugar or glucose in each jelly bean or glass of o.j and no way yet to standardize the dose of jelly beans for accurate testing. Are the sugars as bioavailable as the sugars in Glucola and will the kinetics of absorption be the same? How do you determine a standard dose that is reliable/accurate and how do you keep the standard dose in supply? These are legitimate questions to the efficacy of the alternatives in comparison to Glucola. The precise amount of glucose in jelly beans cannot be established and can lead to unreliable test results and false negatives. Although this article is well intentioned, most healthcare workers and lay-persons do not understand the empirical evidence that goes into lab testing and guidelines. Basically, their understanding of chemistry and laboratory testing is limited. The jelly bean substitute has preanalytical issues that cannot be determined and it is too ambiguous to give reliable results. A false negative is more dangerous than consuming Glucola in order to receive a reliable test result and the consequences of untreated GDM are more dangerous to a mother and neonate than consuming glucola. The study linked in the above article only addresses palatability and side effects of jelly beans vs. Glucola in a small sample of women (160). It does not address the accuracy of the results of the jelly bean alternative vs. Glucola, because the dose is clearly not standardize and the amount of glucose consumed cannot be determined as it is with Glucola. In other words the advantages of using jelly beans do not outweigh the risk of receiving a false negative or drinking Glucola. Changes to testing criteria should not be changed by doctors, nurses, midwives or dieticians. To quote the College of American Pathologists, “Although it is likely that a jelly bean dose could be found that would be acceptable at the commonly used 140 mg/dL cutoff, this is only extrapolation. A jelly bean alternative that has been shown to be as sensitive as, or more sensitive than, the liquid dose at the 140 mg/dL screen cutoff has not been verified or validated.” Meaning jelly beans are not a reliable method for testing. Also, there non-glucose challenge testing alternatives like a fasting plasma glucose or a casual plasma glucose diagnostic test completed on different days if you determine Glucola to be too dangerous to ingest.Also, just to explain a ppm. 1 ppm = 1/1000000 = 0.000001 = 1×10-6 or 0.0001%. It is used to measure the chemical concentration in a solution of water. So, if 10oz of Glucola or 300ml of Glucola contains 3 ppm of BVO that means that the Glucola contains 0.0003% of BVO or 0.09mg of BVO. Hardly a dangerous amount and it is surely destroyed by the hydrochloric acid (a very strong acid) in your stomach as it is a such a minute amount of bromine and vegetable triglyceride before it would ever make it to the small intestine to be absorbed into the bloodstream. Leaving little to no chance that it would affect a developing fetus unless the mother consumes 2 plus liters of Glucola a day. So, 0.09mL of BVO is equal to 1.8 drops of water, hardly a toxic amount.

    And the moderator will not approve my comment because it proves Aviva wrong.

    • Jessica S.

      Great response. Too bad they don’t care about quality.

    • You can get bladder cancer from diet soda, do you know? One of the sweeteners used has been shown to cause cancer in rats 100% of the time — but here’s the joker in the pack. To get the same amount of the sweetener that gave the all the rats cancer, you’d have to drink 800 cans of diet soda every day for 20 years, since adult humans weigh rather more than rats.

      Pass me another Zero cola, please.

    • Captain Obvious

      I’ve said it before, college frats hazing rituals with drinking excess water was banned because kids have died from hyponatremia. Will Aviva ban water now for everyone?

  • Sue

    OT: reviewed in the current issue of the Medical Journal of Australia: “Labour induction linked with lower caesarean risk.” This is a systematic review of 157 RCTs published btwn 1975 and 2012, comprising over 30,000 births. They found that the overall risk of Caesarean delivery was 12% lower with labor induction than expectant management, with a reduced risk of fetal death, NICU admission and no impact on maternal death.

    The paper is in CMAJ 2014 28 April (online).

    • Gene

      I’ve had two induced labors culminating in two vaginal delivers. I joke I can’t give birth without Pit. So my N=2 supports this.

  • ngozi

    It is so important to find out whether or not you have gestational diabetes. If untreated, blood sugar levels can absolutely sky-rocket even if you think you are eating ok and feeling well. It is not worth it for your placenta to become so damaged from gestational diabetes that your baby almost dies. I have lived (and fortunately so has my son) through this. If I had it to do again, I’d drink a Bud Light (I can’t stand beer) it would help, much less Glucola. Just drink the damn Glucola!!

    • Karen in SC

      In the years before routine screening, a petite slender friend had a stillbirth, then a 12 pound baby with a BPI due to shoulder dystocia. For her third pregnancy, she switched doctors and ended up needing insulin injections. She was told that her new doctor believed that GD was responsible for many of the stillbirths of the time. His protocol was inducing as soon as an amnio showed lung development around 36-37 weeks. (and my friend’s babies were still big)

      This screening saves lives – it’s just like vaccines, no one remembers those “before times” when babies were lost.

  • Jessica S.

    This is timely – I’ve got to do the three-hour tolerance test tomorrow, b/c baby’s measuring over three weeks ahead (I’m 32 weeks, due July 19). I’m annoyed, but not b/c of the EE-VUHLS of Glucola, or that my doctor is recommending it (she’s right to rule it out) – I’m just annoyed with being pregnant. :/

    I have never done the three hour. I did the one-hour a month or so ago with no troubles, but I was able to eat breakfast beforehand still. Is the three-hour more likely to make me feel sick? Or just sick of sitting around being stuck with needles? 🙂

    • FormerPhysicist

      Bring a good book. Or something.

      • Jessica S.

        I’m thinking I’ll nap in the car with my phone alarm on, for the draws. 🙂 Not very often that I can take cat naps in the morning, since I’m usually chasing my 3.5 year old!

    • Anon4now

      Hardest part for me was not being able to drink water the whole time. = I’m okay with fasting of food, but water killed me. And I was pretty tired afterwards, but it wasn’t as bad as I thought it’d be!

      • Jessica S.

        The hilarious thing is that the no (or only sips of) water part I’m ok with, other than the pain of being really thirsty. I have a terribly shy bladder, to the point that I can’t pee in public (well, public restrooms that’s is – I don’t have a habit of peeing in public!), even being ginormously pregnant, and so I’m actually more anxious about having to go at the clinic but not being able too. Again, not usually a problem at 8 months pregnant, but I’m weird that way. Maybe if I sneeze a whole bunch in the bathroom, I’ll just force it out. 😀

    • thankfulmom

      Take a snack for right after the test. I felt terrible afterwards because my blood sugar was swinging all over the place. The MFM said it looked like I ate a candy bar mid-way thru the test.

      • Jessica S.

        Yeah, I’m definitely bringing food for after! Especially having to drive home. I may be forced to wander slowly around Target while I snack on something, before going home to relieve my husband of toddler-wrangling duties – you know, just to be SAFE! 😉

        • Bombshellrisa

          I wandered Target too!

    • JC

      About an hour into the test I felt really sick. I laid down for a few minutes and that helped. It’s definitely not fun! Good luck.

    • Jessica

      I recall needing to lie down during the first hour of the three hour test. By the end I felt pretty good, and I ate a quick snack in my car before heading back to work. I actually think I felt worse after the one hour test.

    • Kq

      I was dog sick my whole pregnancy, but it wasn’t notably impacted during the 3 hour test. I just brought a book, because they stressed how the blood draws had to be EXACTLY on time. It was boring as hell, but nothing more here.

    • Haelmoon

      I failed the test in all three pregnancies – not because I had gestational diabetes, but because I had hyperemesis. I actually could not keep the drink down. I ended up checking fasting and PC sugars for a week each time. I am not really sure why we bothered trying the third time, but hey, there is always optimism. My finger pricks were always normal, but I was otherwise low risk. You actually need a good functioning placenta to have diabetes – something I never had with my abruptions and IUGR. I never had a problem with what was in the drink, how many people actually avoid all food laced with added chemicals. We all eat processed foods from time to time, the risk of not taking the test is definitely greater than taking the test.

      • Jessica S.

        Your pregnancies were really rough!!

    • sara

      Three hours with no stimulation is horrendously boring. Make sure you have a book you enjoy, and a couple of good games on your phone, and a book of crosswords.

  • Stephanie

    Haha. What do I know. I’m just an LMT and probably bundled in with the other ‘quacks’ that the author is referring to. Saw a misleading article on cranial sacral therapy by this person and began to browse. There is a pattern being written in these articles concerning those in “quackery medicine’. That’s all.

    • Irène Delse

      It has nothing to do with being an LMT. Aviva Romm, MD, has a medical degree and she happily promotes so-called cranial sacral therapy, despite the fact that 1) it’s nonsense (you don’t breathe through your cranium, ffs!) and 2) it has risks (at least one baby dead) but no benefit. I doubt Romm really believes in all she promotes, though.

      • Stephanie

        🙂 sounds like you need some cranial:) have a pleasant day

        • Guesteleh

          Apparently you can say any passive aggressive and nasty thing you want and as long as you have a smiley face next to it, you don’t have to take any responsibility for being a bitch.

    • attitude devant

      Stephanie, your posts will make a lot more sense if you go just below the thing you’re answering and hit ‘Reply’

      • Stephanie

        🙂 thanks but I’m done… Off to some quackery!

        • the wingless one

          Typical…parachute in to “educate” us poor sheeple, only to realize the majority of the commenters here are far more educated and knowledgeable than you (for the record I am not one of those people, just a mom that doesn’t want babies dying needless deaths due to misinformation) so you flounce off instead of attempting to defend your indefensible (by facts/science) position.

          • Jessica S.

            No kidding. And further, if you say you’re leaving – JUST LEAVE!

    • Jenny_from_da_Bloc

      I love a good massage and nobody said that was quackery.

      • Bombshellrisa

        Exactly-a good massage make you feel good. It’s when you start trying to say that massage can “cure” something and suggest treatments that do not have proven, consistent results all the while trying to sound like a medical professional that you start sounding like a quack.

        • Jenny_from_da_Bloc

          Yeah DIsqus is acting up for me and putting my comments in the wrong place and cutting them off. The rest of my sentance said, “Sticking to your area of expertise is advisable in regards to this content because natural alternatives cannot test for GDM and a massage isn’t going to cure it either.” I offended Nym below because it posted response to STephanie to Nym and I’m quite embarrassed by Disqus’s placement of my response. Evil computers lol!

          • Jessica S.

            It happens all the time, when I’m reading a long thread particularly – I’ll be reading new comments and they’re all under the same name, until I refresh the page. It’s weird! And comical, if you have two commenters arguing back and forth – it reads like they’re arguing with themselves! That’s one of many disqus quirks I’ve noticed.

          • Stephanie

            I posted here because my comment on the misleading article regarding the cranial was magically erased. I did not argue that pregnant women should to be checked for diabetes and if some you actually read my post, you would see that is true. My point is a pattern I see regarding this website. It is wrong to group all persons of a certain profession into a lump sum because one person is not behaving ethically. Hence the poor choice of words in this article stating that being a midwife or herbalist in itself is quackery. Ridiculous. I did not post to say herbs,holistic medicine, or even mt can cure the world. No. But it’s close minded thinking that prevents both from working together. Hence this website. I am merely defending a ridiculous posting regarding cranial sacral therapy that states because one person who facilitated it caused harm to an infant. I don’t care how many letters you have behind your name or educated to are. Thinking like that is stupidity and elementary….and btw the person who called me a bitch. Perhaps you shouldn’t believe everything you read on the internet…because I’m a dude, asshole seems more fitting I believe

          • Box of Salt

            Stephanie “I posted here because my comment on the misleading article regarding the cranial was magically erased.”

            Do you mean this comment? “Haha. What do I know. I’m just an LMT and probably bundled in with the
            other ‘quacks’ that the author is referring to. Saw a misleading article
            on cranial sacral therapy by this person and began to browse.”

            It’s the lead comment on the subthread where you have replied.

            If you follow comments from the sidebar, they are often re-sorted on the way in – a drawback of this commenting system. If you go to the top of the comments and select a different way of sorting the “missing” comments reappear in the right place.

            Why were you so quick to assume your commentn was erased?

          • Stephanie

            We’ll my bad then. I never comment on things but felt that I had to for that one. My apologies.

          • Jenny_from_da_Bloc

            She probably didn’t refresh her feed or just doesn’t know that if you click on a reply not on the feed you can’t see all the comments. I do not believe a comment has ever been removed on this website, even the one where a troll called me JEnny with a COck

          • Stephanie

            No I do not mean that. I mean under the cranial article

          • Box of Salt

            Stephanie “I mean under the cranial article”
            From Feb 2011?

            D’oh! I was wondering why you hadn’t posted over there in the first place.

            Did you inlcude a lot of links? That usually leads to spam filter moderation (although it may appear that it went through at first).

          • Box of Salt

            Stephanie “because I’m a dude, asshole seems more fitting I believe”

            If you are a dude (and DIsqus has not messed up names again), why are you complaining that you were mistaken for a woman after posting under a female ‘nym?

          • Jenny_from_da_Bloc

            Not really, I’m a medical professional who has seen first hand what kind of damage and misery a lay-midwife or CPM can inflict on a mother and infant. I’ve been called to the ER and NICU many times to deal with these types of tragedies from quacks and the poor mothers who give them money to kill their babies. So, no I don’t believe everything I read on the internet because I see it with my own eyes and experience all the time.

          • Jenny_from_da_Bloc

            Oh and don’t forget all those dangerous and untested herbal preparations that the lay-midwives give their laboring and birthing mothers causing the neonate to go into respiratory acidosis or they just were born not breathing to begin with because the best advice and treatment they have is call babies name real loud and blow in his face etc, etc. Then they refuse to tell what they gave the mother/baby and they conveniently forget to bring their notes and the bottle of “medicine” to the hospital, if they just don’t just drop mom and run. Making my job and the neonatologists/pediatricians jobs that much harder. Unfortunately, I know what I’m talking about

          • Stephanie

            I’ve seen with my own eyes as well healthy and happy children who were brought in this world by mid-wives. The individual is responsible for incompetency, not the entire group. It’s like saying all surgeons are incompetent if a surgery goes wrong.

          • Bombshellrisa

            Not just any midwives, since you have read so much of this site, then you realize the midwives causing the most damage are the lay midwives/traditional midwives/Certified professional midwives. We are not speaking of Certified Nurse-Midwives.

          • Jenny_from_da_Bloc

            CPMs and Lay-midwives should not be practicing anything but goat midwifery and those happy/healthy are more like lucky to be alive. Statistics don’t lie and my eyes don’t lie. We are not talking about Certified Nurse Midwives, who are wonderful, properly educated and competent enough to deliver human babies and know what is within their range of care, unlike CPMs who are without a doubt dangerous snake-oil salesman who kill and maim innocent babies.

          • Stacy21629

            “nothing but goat midwifery”
            As a veterinarian, I must speak for the goats. CPMs are not even qualified to care for them.

          • Bombshellrisa

            And I have seen with my own eyes people who die because they embrace herbal cancer treatments and go to a doctor when they are past getting treatment, walk around in chronic pain because they choose chiropractic and massage therapy over getting a rotator cuff repair, end up with third and fourth degree tears after being in labor 36 hours and pushing for six hours while their certified professional midwives cheered them on from the side of the birthing tub and still others who refuse to control their diabetes with medication and do testing, opting to use cupping therapy and herbal remedies instead (and with an A1c of 8, it’s clearly not working). It IS the entire group of people who practice these therapies and promote them as safe and natural who need to be called out. You can’t be an ethical practitioner and after taking a medical history and doing the appropriate tests and making a diagnosis then encourage someone to pursue unproven and inconsistent therapies.

          • Lisa from NY

            Is it hard to sew up a third and fourth degree tear? How long does it take to heal? Does it go back to normal?

          • fiftyfifty1

            “Is it hard to sew up a 3rd or 4th degree tear?”
            It takes A LOT of practice to learn how to do it, but after that it is not so hard (or so I am told by OBs)

            “How long does it take to heal?”
            Depends on when you consider something healed. It may hurt for many months.

            “Does it go back to normal?”
            No. Although it may heal well enough that the anal sphincter functions well enough. Or not.

          • Amy

            For me, not. I have not gone back to normal. It’s a terrible feeling to wonder every minute of the day if you’re going to pee or poop on yourself.

          • Karen in SC

            You need to look up the blog, Peace out of Pieces. A mother with fecal incontinence is doing well with an implant and she is a “spokesperson” for the company. Maybe reading about her treatment would be helpful to you.
            If I got the name wrong, it’s one of the blog links at the Awaiting Juno blog listed on the right.

          • Amy

            Thank you for this, I will research it more. I really didn’t think anything could be done so I’ve just kind of been dealing with it.

          • fiftyfifty1

            I feel your pain. There’s nothing like crapping yourself at work, eh? Now that incontinence appears to be my lot in life it seems I run into many others in the I-always-keep-an-extra-pair-of-pants-in-the-car Club. If nothing else, you are in good company.

          • Amy

            My 4th degree tear took weeks to heal. I wasn’t even healed by my 6 week checkup. It was f’ing horrible. My daughter is 14 months old and i am still suffering from incontinence. I wish I would have just had a c-section. I can’t go anywhere where there isn’t a toilet 15 feet away.

          • MaineJen

            But if the competent midwives aren’t calling out and denouncing the dangerous and irresponsible midwives, but are instead supporting them and helping them to raise money for their legal defense because they were responsible for the death of a baby (or, in many cases, several babies), then yes, I’d say there IS a problem with the entire profession.

          • The Bofa, Being of the Sofa

            It’s like saying all surgeons are incompetent if a surgery goes wrong.

            No, it’s like saying that surgeons as a group are failing if they don’t hold all their members to the highest standards possible.

            It is absolutely important that professions set standards for their practitioners, and this is easily seen in the number of professional associations that exist, for pretty much every profession.

            There is a professional association for hairstylists for pete’s sake!

            https://www.probeauty.org/

            Their objective?

            The Professional Beauty Association (PBA) advances the professional beauty industry by providing our members with education, charitable outreach, government advocacy, events and more.

            So they want to work together to advance the industry. Among the things they want to do

            Go to their website and read the part about “Take the Pledge.”

            PBA wants you to Take the Pledge to ensure and promote integrity in the professional beauty industry. PBA expects all members to abide by the standards which are reflected in the Codes of Ethical Practices for Distributors, Licensed Professionals, Manufacturers and Salon/Spa.

            In addition to the Codes of Ethical Practices, PBA endorses and advocates Best Practices to ensure that Licensed Professionals and Salon/Spa section members achieve the highest levels of success and represent the professional beauty industry in a positive manner.

            This is the mission of the association of salon hairstylists. See, they care about competency, and expect it for all their members, because they know that incompetent providers are harmful to others in the profession.

            But midwives? According to you, nope, who cares if some people practicing are incompetent loons?

            If only midwives had the integrity of hairdressers.

          • Jenny_from_da_Bloc

            Direct and straight to the point! Most of these cases we see at my hospital the midwife won’t even enter the ER or visit the family after she kills their baby. Where is the professional integrity in that?

          • The Bofa, Being of the Sofa

            Direct and straight to the point!

            And the first thing I pulled off the top of my head. Seriously, I just googled “professional association of hairstylists” as a random whim (other occupations that jumped in my head were electricians and exterminators, but I already knew that the exterminators association is pretty hardcore), so I went with hairstylists, and this is what I found.

            It doesn’t surprise me that hairstylists care about the integrity of their profession. That’s because they are actual professionals. In contrast to midwives.

          • Amy M

            Oh, incidentally, your comment probably wasn’t erased. Disqus does weird things with comment order and sometimes assigns comments to people who didn’t make them. Dr. Amy doesn’t usually erase comments unless they are seriously profane.

  • attitude devant

    I recently had a patient insist that she couldn’t do the glucola because it was high-fructose corn syrup. Well of course it’s not fructose at all, but she was adamant. Sigh.

    • Jacob Wrestled (Danielle G.)

      This is the part of the mentality that makes no sense. Setting aside the ingredient list for a moment, let’s say it DID high fructose corn syrup. And let’s say that high fructose corn syrup bad for us. (It’s certainly no health food.)

      The choice is still: drink equivalent of a couple big sodas of junky sugar vs. miss a case of diabetes.

      This is a no-brainer. The problem is that people are stuck on the notion of drinking “scary things,” but not of illness. Our perception of danger is so irrational.

      • Amy M

        I bet the jelly bellies the midwives tell them to use instead have hfcs.

        • Irène Delse

          If it has “belly” in its name, it must be good for pregnant women, right? Right?

        • thankfulmom

          That is hilarious! You are probably right. They just taste better than the glucose drink.

        • me

          No HFCS in Jelly Bellies. The first two ingredients of all the flavors are sugar and glucose syrup.

          Don’t know about other brands (still have some jelly bellies leftover from Easter 😉

      • LibrarianSarah

        It’s because they are sure that they are not going to get sick so long as they hold on to the talisman. The world is an unfair and dangerous place so people construct talismans to ward off sickness and to convince themselves that they are virtuous instead of lucky. For people who hold talismans, the illusion of permanent future health is more valuable than the reality of controlling sickness and preventative medicine. For this person, nutrition is her talisman.

        • Guest

          Very well said.

    • Young CC Prof

      See, the thing about glucose is that it ISN’T fructose.

      Chemistry might help there.

      • Jacob Wrestled (Danielle G.)

        BUT THEY RHYME!

        • Young CC Prof

          Hmm. Good point. They must be basically the same thing, then. But fructose sounds like fruit, and glucose sounds like glue, so I think I’d rather have the fructose.

          • araikwao

            Don’t you read *anything* on the internet?? Fructose is BAD, and it will make you fat, sick and dumb! (I think I have actually just quoted one website verbatim)

          • Trixie

            I’m on the no glu- diet. No glucose, gluten, glucola, glue, gluttony, glutamate, gluhwein or gluons.

          • Mishimoo

            No gluhwein?! But it’s so delicious!

      • attitude devant

        Yep. Exactly, YCCP

      • Sheila

        Fructose has the same chemical formula as glucose (C6H12O6), but the atom arrangement is slightly different. (an isomer of glucose) The liver converts fructose to glucose. The complexity of fructose and glucose metabolism is fascinating! Are you a biochemist?

    • Jenny_from_da_Bloc

      The quackers have the worst logic and reasoning for rejecting standard testing, vaccines and just about everything else. I’m sure she had a coke that afternoon or ate ketchup recently without a problem. Ignorance is bliss until your baby weighs 12 lbs

      • attitude devant

        And has had a brachial nerve injury from the shoulder dystocia.

        • Jenny_from_da_Bloc

          don’t forget the NICU stay and then ill effects of uncontrolled sugars

          • OldTimeRN

            Don’t forget the EVIL poison, meaning formula to stabilize the blood sugars. Birth plan fail! That evil hospital.

    • OldTimeRN

      I recently had a delivery from a Mom who was denial of her diabetes. She was non compliant with her diet and insulin. Her baby ended up being born with a syndrome called Mermaid syndrome. Yeah it looks just like it sounds. Basically the baby will never be “normal” and will have to see every doctor imaginable. GI,Neuro,Ortho,Urology and so on… If the mother above is lucky her baby will only have low blood sugars or need a section for a large baby, because the alternative could be so much worse.

      • araikwao

        But the case you’re referring to would have to be pre-existing diabetes, not GDM..

        • Jenny_from_da_Bloc

          Either way, she should have controlled her sugar. i just googled that mermaid syndrome and that is no life to live.

  • Stephanie

    Wow. From navigating your sight, it appears you are threatened by anyone who chooses a different path. I suppose any form of natural therapy is quackery to you from what I can see. There is room in the world for both natural and what we Americans have come to know as ‘traditional’ medicine. News alert! herbalists have been around longer then you’ve held your license to practice medicine and can also be effective! Also I live near the Amish. They go to mid-wives and have home births. And guess what? Most of the time they are done safely. It is unfortunate that an presumably intelligent person as yourself sees ‘alternative medicine’ as some kind of voodoo that has no merit. I’m sure an herbalist would tell you aloe can help some burns, but I guess that’s just quackery.

    • The Bofa, Being of the Sofa

      I suppose any form of natural therapy is quackery to you from what I can see.

      Of course not. Taxol is a great cancer treatment. For that matter, aspirin has it’s uses, even. Both completely natural.

    • attitude devant

      Oh I just love the type of troll who drops in a completely unrelated topic to expound their point of view. News flash: this is a piece about glucola.

    • Jacob Wrestled (Danielle G.)

      “There is room in the world for both natural and what we Americans have come to know as ‘traditional’ medicine.”

      Well, sure, unless you care about results.

    • Elizabeth A

      When an herb works well, we wind up calling it medicine. Plain old medicine. Not ‘alternative’ or ‘traditional.’

      Herbalists have been around forever. Doctors these days tend to have bigger toolkits and to get better results.

    • moto_librarian

      Do you know what we call herbal medicine that works? Medicine.

      So what would you recommend that we do to diagnose gestational diabetes? Assume that since mama eats a steady diet of kale and does yoga every day that she doesn’t have it? Give her homeopathic insulin? Please, enlighten me.

      • Jenny_from_da_Bloc

        What most people don’t know is that many pharmaceuticals are plant derived, but that is all big pharma telling lies and trying to make money. They have no stake in helping people or saving lives!! Sigh… palm to forehead

        • The Computer Ate My Nym

          Many pharmaceuticals are plant derived. Taxol, taxotere, vincristine, navelbine, marinol, doxorubicin, coumadin, etc. Others are animal derived. Hirudin, heparin, corticosteriods, etc. The thing is that plants aren’t standardized. They may contain random amounts of the desired active ingredient. So it’s safer–MUCH safer when you’re talking chemotherapy–to take the active ingredient, isolate it, titrate it, and give the patient exactly the amount he or she needs, not just the amount the plant happened to make. Furthermore, plants don’t just make one compound. They make many. Some of them could have nasty side effects. It’s much safer to give only the desired compound and not everything in the plant.

          Yes, I know you know this, I just have the compulsion to explain it to the lurkers.

        • Trixie

          Not insulin, though. It’s derived from the ebil GMOs.

    • The Computer Ate My Nym

      What’s the evidence that aloe works for burns? Does it work better than, say, an inert gel of the same temperature (maybe it’s just having a cool gel rubbed on the skin that helps, not the specific ingredients in aloe)? Does it affect healing? A substance might feel good when it is applied and yet have negative consequences. What are the risks of using it? For example, how many people are allergic, etc. These are the sort of questions that people in real medicine ask. Not just “has someone told me that it works?”

      • Jenny_from_da_Bloc

        What are you even talking about? Yeah aloe works for a sunburn, but what does that have to do with GDM? Nobody is against natural remedies if they work for you then hey great! The whole point of this thread and article is that advising pregnant woman to not test for GDM is quackery and just plain bad advice.

        • The Computer Ate My Nym

          Stephanie, above, said that “an herbalist would tell you that aloe works for burns”. I was just pointing out (or trying to point out-may have flubbed the communication) that just having someone say, “hey, this works” isn’t enough. I’ll admit it was a bit off topic. But to bring it back to the actual topic…similarly, it’s not enough for Romm to say that glucola is dangerous or BVO is dangerous. What’s her evidence for that statement?

          • Jenny_from_da_Bloc

            Sorry, I was replying to Stephanie and Disqus put it as a reply to you!

          • Jenny_from_da_Bloc

            I think we replied at the same time to Stephanie

          • Jenny_from_da_Bloc

            I feel so bad right now because I really like Nym!

          • The Computer Ate My Nym

            Don’t feel bad! I thought you were reproaching me for letting myself be distracted by the off topic argument. Which would completely have been a fair point if you had been.

          • Jenny_from_da_Bloc

            I get distracted by these arguments more often than not, it’s the name of the game lol! I just didn’t want you to think I was insane

      • My illiterate, “primitive”, Iraqi mother-in-law would smear my fair-skinned kids with leben (a soured-milk product similar to buttermilk with the consistency of yogurt) when they got too much sun. Worked a treat, and cheaper than aloe vera gels. But a mild, painful sunburn is more an inconvenience than a life-threatening or serious condition. There is a time and place for most things. Reacting appropriately is the key. Too many of the “always alternative” crowd don’t seem to be able to make that distinction.

    • Jenny_from_da_Bloc

      The problem with your statement is that there is no natural alternative to testing for gestational diabetes. This article is about how dangerous it is to listen to people with no proper education in the matter of testing and treating GDM. It is beyond dangerous and just plain bad advice to advise a woman to not be tested for GDM because the orange flavored glucola contains trace amount of BVO. It is a one time test, not something you have to drink everyday.

    • Amy M

      I don’t think “threatened” is the right word. Maybe “angered.” And not by those who choose a different path, per se, but by those who choose snake oil and woo over science. Mostly by those who peddle it to the unsuspecting public, many of whom can’t tell the difference.

    • LibrarianSarah

      Wow. From navigating your sight, it appears you are threatened by anyone who chooses a different path.

      If by “choos[ing] a different path” you mean “promoting ineffective and often dangerous pseudoscience” and by “threatened” you mean “angered or annoyed” then yes.

      There is room in the world for both natural and what we Americans have come to know as ‘traditional’ medicine.

      There is “room” for medicine that has been proven effective and relatively safe. Anything less and you are taking advantage of the most vulnerable sections of our society.

      News alert! herbalists have been around longer then you’ve held your license to practice medicine and can also be effective!

      Slavery has also been around for a long time. Should we reinstate that as well? Also, barring Pharmacognosy, demonstrate that herbalism is effective or superior to what we have now.

      Also I live near the Amish. They go to mid-wives and have home births. And guess what? Most of the time they are done safely.

      That’s because most of the time, birth does work out pretty well. However, the times that it goes wrong, it goes terribly wrong and seconds matter.

      It is unfortunate that an presumably intelligent person as yourself sees
      ‘alternative medicine’ as some kind of voodoo that has no merit. I’m
      sure an herbalist would tell you aloe can help some burns, but I guess
      that’s just quackery.

      It depends on the type of burn now doesn’t it? Sunburn? Yeah aloe and vinegar will probably sooth it but sunburns go away on there own don’t they? Good luck rubbing aloe on a third degree burn.

    • Guest

      I live by Amish too. Many of them do go to hospitals for delivery, especially if they’re high risk. And guess what, they DO drink their Glucola. The Amish who deliver at home are also completely fine if their babies do not make it, which some do not. They do not believe in carrying insurance and often cannot afford a hospital birth. Can you say the same? Are you really willing to take that risk, even if it is small?

      • Trixie

        I can attest to this. The ones who go to responsible CNM practices do drink their glucola.
        The hospitals near here have special cash payment plans for Plain church members, as well as payment plans.

    • OldTimeRN

      I hope nobody I know ends up on the other side of “most”.

      • OBPI Mama

        Yes, me too. A friend who is a medic told us of an Amish woman who died because of a post-partum hemmorhange. By the time the ambulance got to her, it was just too late and there was nothing they could do. I forgot to ask if the baby lived. It was really hard for our friend to see.

    • The Bofa, Being of the Sofa

      Also I live near the Amish. They go to mid-wives and have home births. And guess what? Most of the time they are done safely.

      And most people who drive drunk make it to their destination just fine. In fact, the chances of getting in a car accident while drunk driving is about the same as the baby dying in a “low-risk” childbirth. That’s just getting in an accident – not the chance of dying (which is something like 200 times lower)

      So, given that most people who drive drunk do it safely, do you think there’s “room in the world” for drunk driving?

    • Trixie

      I live near Amish, too. Diane Goslin CPM likes to kill their babies by giving them herbs instead of antibiotics for group b strep. They’re not litigious, those Amish. You should read the grand jury report on her sometime.

      • Mac Sherbert

        Good for them! It’s one thing to pass your woo on to women who have access to wide array of information quiet another to mislead women who have very limited education and access to current information!

        • Trixie

          It takes a special kind of evil to be Goslin.

    • Kq

      You know what they call alternative medicine that had been tested and proven to work?

      Medicine.

    • Karen

      I love doctors and have so much respect for them but completely agree THERE IS ROOM FOR BOTH. Alternative medicine and preventive healthcare measures have changed my life and healed me in ways I never thought possible! Alternative medicine can work wonders and allopathic medicine can save lives. We are each so unique in our molecular make-up it is ridiculous to think that one approach works the same for all people. I’m saddened to hear about the death of rates via home birth but surprised no one is bringing up the deaths that occur in hospitals too. – Let’s face a bigger problem than evil midwives (always have to find someone to hate right?!!) and focus on the high rates of preterm births in America which is the leading cause of infant mortality- delivered in the hospitals by the way. Enlighten yourselves: http://stanmed.stanford.edu/2013fall/article2.html

  • Screening works and universal screening is particularly important for anything with a stigma attached to it. Diabetes (particularly type 2) has a stigma attached, people think the women who are overweight and eat poorly get it – but while they may be at greater risk, anyone can develop it – even those who eat well and were of a healthy weight prior to pregnancy. Other things we should universally screen for: Post-Partum Mental Wellness, Pelvic Flor Disorders.

    • Susan

      What do you think about universal drug screens? Curious. I kind of think that should be part of prenatal care for the reason you site.

      • fiftyfifty1

        The problem I see is that that might discourage drug-using women from getting timely prenatal care (e.g. “I better wait an extra 4 weeks before making that OB intake until all traces of THC are out of my system”)

      • Renee

        I think this is one of those things that sounds great in theory but I don’t see it as too useful IRL. I am not a fan, because it will make moms that do drugs less likely to get care promptly, or at all.

        Also, it’s not that great at catching those that would need interventions the most, as the true, daily use, addict just won’t get seen at all, but it might catch moms that were occasional users of pot, as it stays in your system awhile. Any weekend warrior types, that aren’t addicts, know that it doesn’t take too long to test clean if need be.

        In theory, moms that do drugs would get solid, caring professional help, that would allow them to quit. IRL, they are bullied, treated horribly, denied proper pain relief, and often turned into CPS. Some moms may need CPS, but more often than not, it is just destructive for the whole family. Unintended consequences and all.

        Testing those at risk, and taking behavior and other shot signs into account, is much better.

        • Susan

          Very interesting answer. I feel like I am seeing lots more THC and there is newer research that it’s really a bad combination with breastfeeding. Like so much we see here, it’s seen as natural and therefore harmless. When we try to educate patients about it, or even other nurses, it’s seen as judgment rather than just information. It’s such a confusing topic. I do agree with you that how we care for these mothers is so screwed up that universal screening just would put more people in that boat. But as it stands now women with money can avoid what poor women cannot. That bothers me.

          • Renee

            I think giving all moms some factual info about pot and BF would be super helpful. MANY moms would never smoke during pregnancy, but will start right after the baby is born. Crunchy ones have no issue with pot in breast milk, because they think its harmless. Few know the current findings on this.

            No matter how you talk about it, some will always take it as judgement, even when it’s not at all. Make a little document with the info with the simplest, most basic facts, easily presented without judgement. Preferably from a neutral source (even better would be a pot friendly source). Add links to the current research in case they want to look it up. Make sure to point out that this is NEW INFO, so its understandable that they did not know before.

            Then let them have it, but alone, not with a bunch of other docs. Pot smokers *will* read it.

          • Renee

            Also, some drugs will elicit better quality help than others, and it’s always location dependent.

            A friend of mine conceived while on heroin, told her OB, and was sent to a high quality methadone clinic. She had no issues legally because she followed the program fully. She was able to totally quit drugs, and get excellent follow up care.

            The clinic tests for all drugs (weekly to monthly, based on patient), and follows the patient regarding other issues (mental health, homelessness, abuse, neglect of other kids, etc). The OB can feel confident that the patient isn’t using, and is being closely cared for. If the mom doesn’t follow the rules, and keeps using drugs, only then would CPS get involved (assuming there aren’t other issues).

            She was VERY lucky to be in a town where treating her opiate abuse was possible, and not harsh, or even dangerous (quitting often causes miscarriage).

            If you are on meth? No such help exists. You may be sent to some 12 step meetings, or to an inpatient for a short time, but that is it. If you are lucky, you will get into some similar program where you get s counselor, but its not guaranteed or widely available.

            Use pot? LOL. No help for you.

      • Jenny_from_da_Bloc

        This could go back to autonomy issue as well. I don’t think anybody should be tested for anything without consenting to the testing. It could also deter pregnant addicts from receiving proper prenatal care based on them testing positive and the authorities getting involved. I think if they test positive the first time they should be given three UAs to test clean. Plus, drugs like marijuana stay in your system for 30+ days even if you have not smoked recently, so mom might have stopped smoking when she found out she was pregnant but will test positive for 30 or more days depending on her body chemistry and her percentage of body fat.
        If someone is a diehard cocaine, heroin, rx drug addict they are less likely to seek prenatal care anyways and will see any type of testing and counseling on the matter as judgement, making them less likely to come back for prenatal care. Addicts should have more access to drug treatment and counseling without the authorities getting involved in their pregnancies. Unless they refuse to seek help for the addiction or continue to test positive after the 3 UAs

    • Young CC Prof

      That’s why we test all pregnant women for HIV, and why the authorities are talking about testing all adults every 5 years, like cholesterol. Because it is stigmatized, and it can happen to you whether you’re “at risk” or not.

      • Trixie

        I am virtually positive I wasn’t tested for HIV either time. I was tested before I became a milk donor, though.

      • Renee

        I was tested for HIV, and was glad for it. You just never know.

    • fiftyfifty1

      ” Pelvic Floor Disorders.”

      Except maybe not because one of the rules of screening is that if you ask you better be prepared to offer a useful solution. When it comes to pelvic floor damage there are not a lot of really effective treatments so far 🙁

      ETA: although on second though, maybe even just sympathy and validation “yes this happened to you and you aren’t the only one” is a sort of treatment, at least for the emotional wounds of it.

    • Cold Steel

      These are universally tested for at the postpartum visit. You are asked about your mood and if you are concerned you have the ‘baby blues,’ or PPD. You’re asked specific questions on coping, sleeping and assistance. And you’re asked if you lose urine when you cough/sneeze (physical exam assesses for actual prolapse). If yes you follow up with a fun qtip-in-the-urethra test, and you’re prescribed some Kegels, a pessary, or various operations in order of severity.

  • Mariana Baca

    Don’t want to drink a drink? There is an easy solution to this: assume you have GD, follow the diet and test your sugar regularly.

    The wrong thing to do is to not test and not manage a potential condition.

    • fiftyfifty1

      Actually no. There is a downside to assuming yourself to have GD and following the diet guidelines if you don’t actually have it . For some women that will result in poor weight gain, which has its own set of risks. And GD pregnancies are managed somewhat differently at the end due to their unique risks. You don’t want that unless that’s right for you.

      Just do the test!

      • Mariana Baca

        I was trying to show that it was much easier just to drink sugar for one day than to try to do everything GD requires. I think people would rather be in ignorance, is all — the concerns about drinking sugar are a cover.

        • fiftyfifty1

          Got it! (frequently I am dense)

        • Therese

          Have you never heard of orthorexia? I think many of these people are genuinely freaked out about the drink.

          • Mariana Baca

            I have heard of orthorexia, and it seems like it could one day be considered a serious eating disorder. I don’t think *many* people have it to a degree that they can’t consent to a one-time medical procedure (like other OCD type conditions, there are degrees of severity and coping techniques). And the patient might have other dietary issues exacerbated by pregnancy if severe orthorexia is a concern, which might make testing for GDM even more of a priority. I would say the same thing about any eating disorder. An anorexic patient or bulimic patient might object to drinking that much sugar, too.

            Quack paranoia about artificial additives is not the same as orthorexia, however. Given there might be stipulations about the mode of birth with a GDM diagnosis, I think that is a much more likely reason to avoid an accurate diagnosis on record.

      • The diet sucks, testing your blood regularly sucks – but living with the more awful consequences of unmanaged GD would suck far more.

      • Therese

        Except you wouldn’t even need to follow the diet if you were testing your blood sugar regularly. If your blood sugars exceeded the limit on a regular basis, then yes, that would be an indicator that you would need to follow the diet.

      • rh1985

        Well, I would have loved to be offered an alternative test. But I was not so I had no test at all. I tried but could not get the Glucola down. I have severe taste aversions and a terrible gag reflex (this is something I have had my whole life, pregnancy simply made it worse). Literally all I could drink my entire pregnancy was milk, water, and if I was lucky, one flavor of juice. I luckily did not have GD as far as I know, my OB mentioned running some test when I was in the hospital after my delivery, which indicated I hadn’t had GD? Not sure what it it was. In my case following the diet if I did not have it probably would have resulted in my not eating nearly enough because I already was on a very limited diet due to the food issues.

        • fiftyfifty1

          Your pregnancy was very similar to mine. Glucola was not going to go down for me either!

          When I say “just do the test” I mean just do it if you can because that is a better option than acting as if you have DM2 (testing, following diet etc). I realize now that Mariana wasn’t serious about acting “as if” however.

      • Jessica S.

        What is done differently at the end of GD pregnancies? Just curious.

        • fiftyfifty1

          Since there is higher risk of stillbirth they do more testing and tend to induce earlier. Also lower estimated weight cut off to offer CS for macrosomia. More monitoring of baby for low blood sugar after birth.

          • Jessica S.

            Hmmm, I could see a few “pluses” there, if I do indeed have GD. Although I think I’d still take the misery of carrying a big baby all the way to 40wks and skip the diet and extra monitoring. Pregnancy is just a bear any way you slice it!

          • Yes, but the chances of morbidity and mortality are greater for the baby with uncontrolled GDM. It’s not just about the baby being very large.

          • Jessica S.

            You’re right. The more reading I’ve done on GD, the more I’m learning how serious it is for the baby, especially if undiagnosed/uncontrolled.

        • thankfulmom

          Another thing, the moms who decide to just test their blood sugar at home may not be diligent about it and stop testing after a few good readings. I had some of good reading with gd intially, but as my pregnancy progressed I needed up to 100 units of insulin a day. No, I’m not extremely obese either.

          • Jessica S.

            Ugh, that’s sounds like a lot to deal with! Did you feel “better” with it under control or was there no noticeable difference?

          • Diabetes is a “silent” disease in most of its forms. In fact, it has been postulated that most type 2 diabetics have had the disease for several years before diagnosis. since they don’t have noticeable unpleasant symptoms that send them to a doctor.

        • Do you mean the management of labor or the postpartum period? generally, FBS levels return to normal very fast– sometimes wthin a day or less of giving birth. Some doctors advise a 75 gm GTT at the 6 week PP visit, but most do not, in my experience.

          • Jessica S.

            I meant the management of labor, and even prior to that, if extra monitoring is done in the last month. But I didn’t consider after delivery. What sort of things do they look for with the baby immediately following birth?

          • Susan

            Main thing is we test babies blood sugar. The baby is at risk for hypoglycemia ( low blood sugar) because baby has been living with (possibly) a higher sugar level and it’s baby’s pancreas that has been kicking out the insulin to adjust to that “sweet” environment. Once baby is born he’s still going to make the insulin for that high sugar environment but no longer has that sugar source ( mom ) thus is at risk for low blood sugar.

          • First of all, uncontrolled GDM can result in macrosomia, with the baby too big to be born vaginally, or only with considerable trauma to both mother and baby [cephalopelvic disproportion is a reason for C/S]. Conversely, the placenta can begin to pack up, resulting in IUGR, with a low-birth weight and compromised baby.

            Following birth, babies born to GDM mothers can experience sudden, severe hypoglycemia and so have their blood sugar repeatedly checked for the first couple of days. This can cause seizures, during which the baby’s brain does not get enough oxygen, if not treated. [GDM mothers can actually have high insulin levels but their cells are resistant to it; therefore the baby is also born with insulinemia.]

            GDM is largely asymptomatic, in terms of the mother feeling unwell, so it gives a deceptive feeling that it isn’t serious.

          • Jessica S.

            Thanks for that explanation! Over the last few days, I have definitely gained a greater respect for how serious GDM is and why universal screening is a very good thing.

        • Susan

          I think what she may mean is that the guidelines for induction of labor are different. Also, diabetic moms often have babies whose lungs mature a little slower and a 36-37 week infant of a diabetic mom is more likely to have immature lungs. Sometimes doctors will do fetal lung maturity testing if they are contemplating induction of labor and the baby is in this range and the reason for induction is such that maybe they can wait a week or so. It definitely factors into decision making.

      • AmyP

        Yeah. I had GD my last pregnancy and wound up with a net 12 pound weight gain by the end of the pregnancy. Baby was 9 pounds. I was half-starved, I was so compliant.

        You don’t want to do that unless you need to.

  • Fertile Myrtle

    Oooh! Thank you Aviva! Here I thought I was going to take a very low risk test to screen for something that could be potentially harmful and dangerous to my baby when in fact my OB is trying to poison my baby. Phew. Glad she straightened me out!

  • Michele

    This might be a silly question, but can anyone tell me how often the gestational diabetes test gives a false negative? I’m 19 weeks pregnant and I’m wondering if I should start eating a GD style diet instead of waiting for my test in a month or two. I’m obese and have PCOS, in my last pregnancy I passed the GD test but I had a 10 pound baby. I’m concerned that maybe I really shouldn’t have passed it then and if I pass it this time I wonder if I should press my OB about making really sure. Or would that just make me an annoying patient? Not that I want a 3 hour OGTT if I don’t have to but I’ll ovary up and deal for the sake of the baby.

    • Susan

      Eating the GD diet in your situation would be applauded I suspect by any doctor! I don’t know the stats but that’s suspicious obesity and an LGA baby is sort of a trifecta of risk factors. I’d certainly ask your doctor at your next visit. You might want to start the diet pre conception. Not annoying but very smart!

    • Medwife

      If we all ate like we were diabetics, we’d all be healthier!

    • Cold Steel

      Just theoretically, getting a false negative would be nearly impossible assuming you followed the instructions on timing. It’s meant to be a big slug of glucose to stress your pancreas as well as your peripheral tissues, to see that you can a) secrete insulin and b) use the insulin to push the glucose inside your cells. If you get your blood drawn after an hour, no longer, and the number is normal, it means your pancreas and cells are working properly.

      What is much more possible, though, is that you developed GDM *after* 28wks, and weren’t offered repeat screening. Not saying that’s what happened, but it’s a much more likely scenario.

      Eating a low-carb diet is a great idea. If you continue to eat 2000 calories a day, give or take, and make up the difference in fat and protein, you could go a long way to significantly impacting your potential insulin resistance. [The ADA diet is unfortunately not yet updated with the ACA’s new guidelines re: dietary fat, so it’s both low-carb and low-fat, which is very difficult to follow and potentially not so good for you].

    • Jessica

      My SIL passed the one hour test, and her doctor and the NICU doctors suspected she developed GD later in the pregnancy. She developed pre-e at 37w5d, delivered an 8lb,8oz baby at 37w6d, and he had respiratory problems and spent 11 days in the NICU (he’s doing just fine now). I understand he had some blood sugar issues right after birth as well. I don’t think she had PCOS, but she was a bit overweight.

      A good friend of mine delivered two weeks after me; she’d also passed the GD screening tests during pregnancy. Baby was 10lbs4oz at 41w2d and had some mild respiratory problems shortly after birth – but was discharged on time. I’ve long wondered if she had late-onset GD.

  • Renee

    Always focusing on tiny things, and missing the big picture.
    Because we all know that one drink, that has a tiny bit of something, that millions drink without incident everyday (in soda, the horrors!), is so horrible you should ask for something that is not meant for the test, or better yet skip that test!
    The QUACK FAITH BELTZ, killer of Aquila Paparella, told moms to eat about 20 jelly bellies instead. Close enough she said! Thats only if you bother with that dumb test anyway.

    Aviva is dangers because she did go to medical school, but is still a quack.
    I wish her admirers wold look into the industry she is in, its worth BILLIONS, and is completely unregulated. Quacks and snake oil salesman use typical projection- those evil docs want your money and will hurt you! They do it because it takes the focus off of what THEY are doing.

    DISPICABLE.

    • EmbraceYourInnerCrone

      Thank you!!

      I always wonder how they(CPMs/supercrunchy people) can believe that a) All interventions are bad for you and your baby! but at the same time b) inducing with castor oil is just fine, so is using blue and black cohosh and various other untested plants and herbs in unmeasured doses-it’s hard to know the strength of the active ingredient in an unprocessed plant.

      So the side effects of tested, studied drugs like pitocin given in measured controlled dosages to induce labor is OMG horrible, but using castor oil(which will give you massive diarrhea, but does not directly stimulate the uterus) is “natural/gentle”

      Blue and black cohosh is actually scarier because it does stimulate uterine contractions, can cause heart problems and raise blood sugar. Apparently they think because its a plant/herb/natural it can’t hurt you.

      From WedMD:

      “Blue cohosh is UNSAFE for adults or children. It can cause diarrhea, stomach cramps, chest pain, increased blood pressure, increased blood sugar, and other severe side effects.

      Special Precautions & Warnings:

      Pregnancy and breast-feeding: It is UNSAFE to take blue cohosh during pregnancy. Some of the chemicals in blue cohosh can cause birth defects. When taken by the mother late in pregnancy, blue cohosh can cause severe heart problems in the newborn baby.

      Many midwives still use blue cohosh to make childbirth easier, because blue cohosh causes the uterus to contract. But this is a dangerous practice, and it should be avoided.

      Heart conditions: There is some concern that blue cohosh might make certain heart conditions such as chest pain (angina) and high blood pressure worse. There is evidence that blue cohosh can cause blood vessels in the heart to become smaller and decrease oxygen flow to the heart. It might also increase blood pressure. Don’t use blue cohosh if you have a heart condition.”

      If a person doesn’t want to be induced , doesn’t want to have any pain killers or other drugs during labor that’s their call, always. However there are lots of things available to us now that make birth safer and more comfortable. Why not take advantage of them.

      • Renee

        Because web MD is written by pharma shills- duh!

    • Amy

      Jelly Bellies? Really? Because those are LOADED with artificial ingredients and food additives– colorings, flavorings, thickening and gelling agents. Is it because it’s something a CPM can get her hands on that makes it “better” and “more natural”?

      • Somewhereinthemiddle

        I think the upside for most women who want to do the jelly bean thing is that it is less offensive than the drink. I am a big believer in the screening, so I’m not arguing that at all. I’ve known women who have had such a hard time swallowing the Glucola drink that they vomited it back up. Having an alternative that may be more palatable is a good idea for those women. Someone correct me, but I *think* there was a study that supported the use of jelly beans. I haven’t personally looked into it because while I think it is pretty gross, I’ve tolerated the glucola well enough.

        • Renee

          The point is that this quack wasn’t using research to guide her. She was simply taking something she heard other quacks say, and because it was easy to obtain, and clients liked it, she made it sound official.

          I would have no problem with an alternative, but “jelly beans” are just not specific enough. They come in a variety of brands, sizes, and levels of sugar, and the variables can be different even within the same brand. (and this is ignoring all the additives and crap that is in processed candies- I am sure it worse than glucola.)

          Like all quack suggestions, it gives moms what they want, but not what they need.

          Jelly bellies (the brand FAITH the quack mentioned) just aren’t made for this test. I can see it now, a mom thinking- 20 or so? Is that 19 or 22? Or did she say 40? What flavor? Oh, these other ones are cheaper, maybe I will just use them….

          Drink the freaking glucola.

          • Somewhereinthemiddle
          • The Bofa, Being of the Sofa

            Isn’t it the case that every pregnancy is different? If so, then how does anyone know beforehand whether they can tolerate Glucola?

            OK, if someone exhibits a problem with Glucola, then find an alternative. But don’t just run to the alternative because some women might have a problem, or even if someone has had a problem in the past.

          • fiftyfifty1

            ” If so, then how does anyone know beforehand whether they can tolerate Glucola?”

            You just sort of know what things seem tolerable. For me it was a lot like having the stomach flu or being badly car sick. Nothing seemed truly appealing, but there were certain things that seemed so revolting that there was just no way. It was a really disheartening time.

          • rh1985

            I pretty much knew it wasn’t going to be tolerated. I was told to try it anyway. I didn’t even finish it before I got sick. I could not stop the uncontrollable gagging from the taste.

          • Jocelyn

            Yes, totally. Some things were instant “No, don’t get that near me” things, and others were “I can get that down if I absolutely need to.” And even thinking about “No, don’t get that near me” things could make you throw up, let alone trying to eat them.

          • Somewhereinthemiddle

            You don’t know until you are vomiting uncontrollably for an hour, piss yourself, pass out once you make it to the office, and have a migraine for the rest of the afternoon. Then the office tells you that you have to repeat the test until you keep down the entire bottle of drink until and hour has passed and they can test your blood.

            Is that something *you* care to run the risk of repeating with every pregnancy if there is an easy, inexpensive, widely available scientifically supported substitute?

          • fiftyfifty1

            As someone who asked to be exempted from the test myself due to pregnancies complicated by a lot of nausea and vomiting, I agree with you. I wish they would develop and market a standardized pack of jelly beans and offer a woman the choice. I have also wondered about a starch substitute test. I personally would have puked on the jelly beans as well, but did usually tolerate starch. I am thinking something like instant mashed potatoes.

            Hyperemesis in pregnancy is a real bummer, but until you’ve been there it’s hard to sympathize with.

          • Somewhereinthemiddle

            ^^^ Exactly. I know enough women who have experienced HG to realize just how horrible and life changing it is. That really, really sucks.

            A standardized alternative would be awesome. And to everyone poo pooing this, I really don’t understand why. It makes some women sick, wouldn’t it be great if there was something better. What is to argue about that.

          • Young CC Prof

            Does it make some women sick? Yes. Is it occasionally a real problem? Yes. Would it be good if those women had an alternative? YES!

            Does the fact that it can make you feel sick mean that it is “toxic”? NO. That’s what we’re making fun of, the idea that something making a pregnant woman queasy is evidence that it’s toxic.

          • Somewhereinthemiddle

            Right, but the comment I was responding to was talking about the “quack” idea that jelly beans can be a reasonable substitute, when there was a study done that supported it. I know the original post was about the toxicity and whatnot, but that wasn’t what I responding to.

            Obviously anything that is going to do what this test is intended to do isn’t going to be much in the way of healthy or natural. But that doesn’t mean that the Glucola should be the only option for folks who either don’t want to use it or can’t because they don’t tolerate it well, have HG or whatever. What in world is there to argue about in regards to having an alternative?

          • rh1985

            I could not get the Glucola down at all. I did not have hyperemesis, because I could eat some things without vomiting, but I had very very bad aversions and a bad gag reflex made worse by pregnancy. I could not force it down, I was not offered an alternative test, and therefore had no test at all. I wish they would have at least tried a food test for me. The jelly beans probably would have made me vomit as well, unless I could find a specific flavor I tolerated, but surely there is some kind of meal or juice out there that will at least give some kind of idea as to whether there is a problem.

          • Kq

            If by bummer you mean hell on earth for months with absolutely no sympathy. Hyperemeses sucks. 🙂

          • Jocelyn

            During my last (hyperemesis) pregnancy, I had a couple days where I could eat the mashed potatoes from KFC. (And that was the only thing I could eat.) I drove to KFC in the morning as soon as it opened, bought a couple, and that’s what I ate for days.

          • Becky05

            That’s an awfully small sample, far too small to show whether jelly beans are actually equivalent to glucola or not. The research we have on glucose levels and adverse outcomes are all done with some amount of glucola. It is the only standardized source that we have good data on.

          • Somewhereinthemiddle

            Right, and I am not suggesting that the jelly beans are ideal or should be used as the standard. What I am suggesting is that there is a valid reason why women should be given an alternative that is standardized.

          • Jenny_from_da_Bloc

            That study only determined palatability, not accuracy of the test results, which probably included false negatives. Obstetricians are not pathologists or clinical chemists and cannot determine or decide significant changes to a laboratory test. These changes can only be made after consultation and approval of the laboratory’s directors, i.e pathologists or clinical chemists. Who would laugh at the suggestion that jelly beans would be a good clinical substitute to use from Glucola. Why would they laugh, because how can the amount of sugar in a jelly bean be determined and the same for each jelly bean? How many jelly beans would the patient eat, are the sugars as bioavailable as the sugar in Glucola? There are too many variables to give an accurate test result.

          • rh1985

            Yes, but shouldn’t they at least try to offer an alternative for women who simply can’t get or keep the Glucola down? I would have preferred a less accurate test to no test whatsoever.

          • Jenny_from_da_Bloc

            They do offer alternatives, I posted them above

        • Jenny_from_da_Bloc

          I thought the glucola did not taste so bad. It wasn’t great or preferable but it wasn’t totally gross and was tolerable. Seems like much ado about nothing from the quackers.

          • Somewhereinthemiddle

            I am not talking about whether or not people think it tastes bad. I am talking about reaction to it that includes vomiting, passing out, and migraine headaches. That sort of reaction isn’t “much ado about nothing.”

          • Jenny_from_da_Bloc

            Well, there are other alternatives and patients should discuss their alternatives with their doctors like the 50-100g dextrose and lemon juice preparation instead of listening to Aviva who offers bad advice and no alternative besides candy that contain the same type of ingredients she is “rising up against”. There is no guarantee or quantitative measure to determine the amount of sugar in jelly beans, which contain more additives and artificial colors than Glucola, to have an accurate or reliable result. Jelly beans are a ridiculous substitute for a proven method to determine diagnosis of GDM.

            The only thing the study determined was the tolerance for the jelly beans as opposed to the Glucola and it was only studied on 160 women. In other words, the advantages of jelly beans do not outweigh the risks of a false negative for GDM because jelly beans are more palatable. http://www.cap.org/apps//cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=cap_today%2F0610%2F0610e_cola.html&_state=maximized&_pageLabel=cntvwr

          • Jenny_from_da_Bloc

            *The AJOG study only determined preference and did not determine accuracy of the results or test enough subjects to determine if jelly beans are a reliable alternative. http://www.ajog.org/article/S0002-9378(99)70099-2/abstract

          • Somewhereinthemiddle

            I didn’t say that the study was ideal, but that it had been studied. I’ve never heard of the dextrose/ lemon juice alternative. Can you explain more?

      • Haelmoon

        There is actually evidence for the “Jelly Bean Test”. http://www.ncbi.nlm.nih.gov/pubmed/10561636
        Mind you, its not strong evidence, but at least someone has looked into this. Ironically, I suspect that there are more artificial additives in the jelly beans. Are there specific colours that should be avoided for food colouring?? 🙂

        **Oops, already posted below. Down side to be being on the West Coast, my contributions are always late into the conversation

        • Amy

          Personally, I don’t give a hoot what people are using for the GTT. I just find it completely ironic and hypocritical that a home birth advocate/CPM or whoever would eschew the standard drink because it’s “unnatural” in favor of Jelly Bellies.

    • Guest

      Yep. If it really worries you THAT much:

      1. Take the test.

      2. And then don’t drink soda ever again.

      Problem solved.

  • Chickenscratch

    This is interesting. I saw CNMs who supported/encouraged declining the GD test. I decided it made sense not to do it because my understanding was that: 1) I was low-risk, 2) The treatment for mild GD, if I did have it, was diet, and I already ate a diet that was similar to what would have been advised, and 3) because of my diet, Glucola would have been the least healthy thing I consumed during my entire pregnancy.

    Was I wrong? I thought GD was pretty strongly influenced by factors like weight/activity/diet, which essentially eliminated it as a concern for me. The CNMs seemed to agree. I’d certainly have done it if I’d been advised that it could still be a concern, and I hate to think I inadvertently put my kids at risk.

    • Irène Delse

      Out of curiosity, what were the reasons these CNMs gave for not getting a GD test?

      • Chickenscratch

        I don’t think there was a reason given specifically. It’s been a while, so I can’t remember exactly how the conversation went, but it was presented as a choice –“would you like to do this?”– and they explained that basically, you drink an extra-sweet soda, and they check to see how it affects your blood sugar. Based on diet, etc. we just agreed that I didn’t really need to do it. I certainly would have done it if I’d been told that there was still a chance it could be an issue.

    • Young CC Prof

      It’s still a good idea to test everyone. It can happen to anyone, and if you do get it, diet doesn’t always fully control it, so you need regular blood sugar checks to be sure. Even when reasonably well controlled, it can increase the risk of certain negative outcomes during delivery or in the last few weeks of pregnancy, so you’d need extra monitoring if you had it.

      When my mother gave birth with midwives in a birthing center, they were really insistent that she get tested, and they would have risked her out and sent her to the hospital if she’d tested positive. I can’t imagine why your midwives discouraged it.

      • The Bofa on the Sofa

        You don’t understand. Those women that get GD? It’s their own damn fault.

        • Young CC Prof

          Not enough kale. Should have stuck to the Brewer diet since before they knew they were pregnant. (Or in the case of my friend, been smart enough to keep that second embryo from taking root.)

          • Trixie

            Or the Weston A Price diet of raw cream, egg yolks, and liver.

          • araikwao

            😮 serious?? All that vitamin A that leads to birth defects?? Is that actually recommended by those people??

          • Alcharisi

            Having once been into that particular woo for a brief period, I can say so. These people actually have a recipe for baby formula based on raw eggs and raw liver.

          • Mishimoo

            I’m not sure who promotes this idea because I can’t find a source via Google, but I have heard followers of Mercola, Philip Day, and the Weston A Price foundation, all claim that large doses of natural Vitamin A decreases the risk of birth defects. They insist that the problem is ingesting the synthetic form rather than the natural form.

          • Young CC Prof

            Chemicals know where they came from, of course.

          • Mishimoo

            Yet water only has a selective memory.

          • Trixie
      • Chickenscratch

        I think it was a similar line of reasoning that Romm uses. Basically, why would you give this potentially unhealthy sugary thing to someone who is almost certainly doesn’t have GD? Based on my limited understanding of GD, it made sense to me at the time.

        • The Bofa on the Sofa

          Basically, why would you give this potentially unhealthy sugary thing to someone who is almost certainly doesn’t have GD?

          Because “almost certainly” is not good enough. You want to be certain.

          • Irène Delse

            Ah, yes, the bad, bad sugar! But a one-time test is not the same than doing a “Supersize Me” and gorging on sodas all day long. Too bad some CNMs don’t see that.

          • Chickenscratch

            I would have liked to know, but the possibility that I might still have GD despite not having any risk factors was not explained to me, so it seemed like an unnecessary test with a small but real downside for almost no return.

            It sounds like my understanding of GD was wrong in that you can still get it even if you’re thin, eat a perfect diet (whatever that is), exercise regularly, and have no other risk factors. I wish I’d known that.

          • guest

            I have a friend. She’s 5’3, maybe 100 pounds. Exercises, eats well. Massively failed her tests with both pregnancies. Her doc said she just has a not so great pancreas, which is not something you’d know just by looking at someone.

            And I agree. It’s one sugary drink. In the grand scheme of life, no big deal. Why take the risk?

          • Amy

            That was my reasoning. I eat a super-healthy diet, I’m tiny, and I do pilates and Irish step dance. The GTT drinks with my pregnancies have been about the only artificial things I consumed in years. One gross drink isn’t going to undo a regular diet of lean proteins, fruits, and vegetables any more than adding one raw carrot to your regular diet of fast food is going to make you healthy.

          • Young CC Prof

            I definitely blame your caregivers for misadvising you rather than you for not knowing everything about pregnancy.

          • araikwao

            Yeah, I’m embarrassed to admit that I declined testing in my first pregnancy because I thought I was low-risk, well, no family history. I can’t believe my hospital MW didn’t even try to convince me otherwise. Second pregnancy I had it, and maybe it was because I craved soft drink already, but I liked the drink – it was just like lime fizzy!! (undoubtedly different product in Aus, though)

          • Jessica S.

            A friend of mine considered declining the GD test, it’s her fourth pregnancy and she’s low risk, much of what you said about your case, but she did some reading and discovered that you can have GD and not have any symptoms. So she decided to take it.

            It’s really unfortunate that they didn’t give you all the information. It makes sense why you would have come to the conclusion you did with the information provided! It’s very cool that you can recognize their error – not many people like to admit they were wrong. Well, at least *I* don’t like to – it sets a bad precedence. Ha! 😉

        • Susan

          I think you can be forgiven for believing CNMs advice to you. It does sound believable. I don’t forgive the CNM for her fuzzy thinking though and putting her patients at increased risk because she’s too cool to let them drink an orange soda.

      • Irène Delse

        Indeed. Diabetes is a tricky beast, and health, weight and diet are not everything in that domain. Being seriously overweight, and having been that way from childhood, I know my doctor always worries about the possibility of diabetes, and each time we check, my blood glucose is not only normal, but near the lower end of the normal range. Still, I’m glad to know everything’s ok with my pancreas. Knock on wood. 😉

    • Susan

      I would say that when you weigh the small risk of one sugary drink with the small but serious risk ( even to very healthy mom ) of gestational diabetes that the risks of the sugary drink are theoretical and VERY small and the risks if you don’t identify a gestational diabetic are even if statistically small very serious risks. Let’s say even if they identified you and you successfully were diet controlled, then you would have started NSTs for further fetal surveillance at 32 weeks, you would even know you are at higher risk for type two diabetes later in life and you would be hopefully screen annually for that. And though MOST diabetics kind of “look like” diabetics there are lots of people who are thin fit but identified as GDM. You would have reduced your baby’s risk for stillbirth. The large babies are generally more associated with non compliance but my understanding, which could be wrong, is that tight control doesn’t completely eliminate the increased incidence of unexplained stillbirth in gestational diabetics.

      • Chickenscratch

        Thank you for the information. I wish it had been presented to me this way because I probably would have made a different choice.

        Just out of curiosity, does anyone know approximately how much of GD is related to modifiable risk factors like diet, weight, etc.? Or how likely it is that you might develop it in the absence of risk factors, with a healthy diet, etc.? Maybe I’ve been brainwashed by the healthy-lifestyle obsession that pervades everything these days, but I’ve always had the impression that you could pretty much completely prevent type II diabetes with lifestyle modifications, (and so, by extension, probably also GD).

        • Young CC Prof

          My MIL is quite thin and has Type 2. (She also produced giant babies.) My oldest brother-in-law was identified as borderline and managed to reverse it with diet and exercise, although he has to continue to be careful and get tested.

          It’s a combination of factors, some lifestyle, some genetic. Like heart disease. You can reduce your risk a lot with healthy lifestyle, but it isn’t always enough.

          • guest

            Two neighbors pregnant at the same time. One was slender and fit as can be; she had GD and I’ve never seen anyone so careful with her diet. Another started out looking like someone fed the standard Amish diet, but without all the Amish exercise. No GD for her.

          • Irène Delse

            Isn’t it also one of the conditions for which old age is a factor? I know a few people who diagnosed with type II diabetes at around 65 years or older, even though they were not fat and had balanced diets.

        • Susan

          I would have to look up the statistics. I suspect you could too. I have worked a lot with Sweet Success in California they have really good info if you google that. I think the problem here is that yes, lifestyle things have huge importance and impact. But it’s not the whole story. So it’s easy to see how someone could think this way.

        • yentavegan

          My beautiful, always healthy , always in top physical shape, never ate processed foods sister in law had gestational diabetes. She was on medication during her pregnancy. She was off the medication with in days of giving birth..

          • MaineJen

            The only person I ever knew to have GDM was a thin, super-healthy vegetarian. Low-risk as they come. She developed it during both pregnancies. Go figure…

        • Medwife

          There is a HUGE impact from genetics. If you are of Asian, African American, or Hispanic decent and/or you have a strong family history, you’re at higher risk no matter what you eat.

        • attitude devant

          I’ve picked up full-blown diabetes in pregnant women who were thin, ate right, and had NO CLUE they had it.

        • Cold Steel

          The reason is that estrogen itself induces insulin resistance. Since estrogen levels are massively, massively increased in pregnancy even women without traditional risk factors can develop GDM. Women who are obese are more prone to it since fat tissue itself also impairs insulin’s function, so they have a double whammy. But it’s the estrogen that’s the tipping point.

        • Alexicographer

          I believe maternal age is also a pretty significant risk factor, and only “modifiable” in a big-picture, plan-far-ahead kind of sense. Certainly not modifiable in any given pregnancy.

      • Haelmoon

        The increase monitoring is for moms who are poorly controlled with diet. If you are well controlled with diet alone, the evidence for increased monitoring is not strong. There is not clear benefit to induction of labour in this group.

        • Susan

          Maybe that’s regional because here were do it either way. I am sure tight control reduces the risk but my understanding is these patients are still at increased risk. Can you point me toward the research that says they don’t need NSTs?

    • Becky05

      Treatment for mild GD wouldn’t only be a good diet, but would be a good diet while monitoring blood sugar levels several times a day.

    • It don’t think this is necessarily true. I’ve seen so many otherwise healthy, low-risk women who did develop GDM, and there also seems to be a spike in GDM here during the summers (Israel has tons of luscious fruit and Israelis love it in the hot weather), that I don’t think it is a safe assumption to think that food or lifestyle habits necessarily determine who develops it.

  • lawyer jane

    Anyone else have blood sugar that was actually controlled better during pregnancy? Before getting pregnant I regularly had borderline “prediabetic” levels, but I passed all my prenatal GD tests with flying colors, actually lower than when not pregnant.

    • Jessica

      I don’t really have a baseline to compare it to, but while I failed the 1 hour test, I passed the 3 hour test with flying colors. Pregnancy and the immediate postpartum period was the only time in my adult life that gaining weight was hard. I am very overweight to begin with, and was very concerned that I’d be unable to limit my weight gain to the 20lbs or so my OB recommended (which was higher than what ACOG recommends, IIRC). As it turns out, I gained 12 pounds during the entire pregnancy. Went back for my six week checkup and I’d lost 36 pounds since delivery. I maintained that weight loss for months, until my milk supply regulated and my period returned. Boo.

  • theadequatemother

    Every week at work I give anesthesia for at least one procedure related to the effects of diabetes. From amputations of ischemic limbs to creation of av fistulas for dialysis, even hohum sedation for cataracts and retinal procedures, and of course, the treatment of chronic neuropathic pain. GD has health implications for the fetus and that was enough for me to take the inconvenient and unpleasant two hour test, but I also know that women who develop GD are more likely to go on to develop adult onset insulin resistance and type two diabetes. It’s not 100% of course. I wanted that information because had I ended up with GD I would have the chance to make some lifestyle changes that could delay the onset of type II diabetes and a reason to make sure I was screened regularly.

    With kiddo number two, the yucky drink was 100% offset by the bliss of siting in a lab for two hours by myself reading a book. Cos that hadn’t happened for two years….

    • Young CC Prof

      My husband and his brothers were born slightly before GD testing was a thing. All three of them were large at birth, one was over ten pounds, even though everyone in his family is small and lean. And, yup, his mom now has diabetes. Though she insists that her babies were “not fat, just big.”

  • The Computer Ate My Nym

    side effects including nausea, vomiting, bloating, and diarrhea, as well
    as other adverse reactions including headache, dizziness, and fatigue.

    Aren’t those all the side effects of pregnancy? I threw up during my GTT but I was more inclined to blame the pregnancy than the drink, especially given that I had already been nauseous for about 2.5 months before that. Felt fatigued after taking it too. Ditto.

    • Therese

      Most of the time nausea ends once you’re out of the first trimester.

      • The Computer Ate My Nym

        I was one of the “lucky” women who had nausea the full 9 months. It did let up a little by the end of the second trimester, but it only ended after the pregnancy did. I made up for it by eating everything in sight while nursing.

        • UsernameError

          I’m one of those, too, with nausea the entire pregnancy. It eases up in the second trimester, and them comes back in the third. Which is always a site to behold since you aren’t exactly at your most graceful at 8 months pregnant.

          • Young CC Prof

            Yeah, I also had it come back 3rd trimester, though fortunately not as bad.

    • moto_librarian

      I felt queasy during the test, but I figured that was because I was drinking a bunch of sugar on an empty stomach.

    • me

      My biggest worry in doing the test was reactive hypoglycemia. I “passed” with flying colors all three times, but I made damn sure to bring a snack to consume immediately after the blood draw so I wouldn’t pass out (I have a history of passing out from low blood sugar).

      I suppose I could have refused the test, but to me it seems no different than me eating too many carbs at any meal: you know you’re going to feel like a$$, then get crabby, then dizzy, then (if you manage to ignore all those things) the lights go out. So I brought a granola bar (so I could drive home without killing myself) and then ate a proper meal once I got home.

      It’s not that complicated really.

      • me

        Oh, and FWIW, I found the drink delicious. I could feel myself crashing near the hour mark, but no different than having a large slice of chocolate cheesecake.

        There’s a reason I need to cut carbs to lose weight – I’m a total sugar junkie. Paying for it later helps me to avoid it….

  • Sue

    If this person is a registered medical practitioner, can a complaint be made about her public misinformation?

  • S

    She knows you’re not supposed to drink it every day, right?

    • Young CC Prof

      It’s like vaccines, the homeopathic doses of toxins administered once do catastrophic damage. (But shouldn’t homeopathic toxins make you healthier?)

      • sdsures

        They should! *giggle*

    • Mel

      I snorted my bromated vegetable oil fav Diet Squirt when I read that.

      • The Bofa, Being of the Sofa

        One of my favorite demos to do in organic chemistry is the “bromination of bacon grease.” It works slickly, and I get to fry bacon in class (you don’t have to, but it’s more fun that way)

        Whenever I do it, one question that always arises is whether you could eat the bacon afterward. I tell them, with this, of course, I wouldn’t advise it (mostly because I usually use spoiled bacon, for starters) but I do point out that BVO is actually a common ingredient in citrus drinks. Mountain Dew is the best example, but it’s also in Squirt.

  • Captain Obvious

    I use bromine in my hot tub, and I feel wonderful in my hot tub. Therefore bromine must be good.

  • Elaine

    This won’t make me popular here, but I didn’t drink glucola in either pregnancy for reasons that had nothing to do with BVO (though I don’t eat many processed foods or drink much soda, I am unimpressed by the anti-BVO hysteria). In the first part of my pregnancy with my daughter I was constantly ravenous to the point of feeling weak or dizzy; with my son I got a horrible stomachache from even a little bit of sugar. In both cases these issues had somewhat decreased in magnitude by the third trimester, but I still didn’t want to undergo this lab test that had the potential to make me feel awful when there were other alternatives available. My midwife drew an A1c the first time (which is not the best choice, as it turns out); the second time, I did fasting and 2-hour post-prandial readings instead. I certainly wasn’t going to blow off a concerning reading, but I was well within normal limits.

    • GuestK

      I’m surprised by the A1c – that’s going to give an idea of the average glucose over 3 months, so will tell you next to nothing if you’ve developed gestational diabetes recently. The 2 hour post-prandial is really what the test is getting at anyway, the glucola just gives a way of standardizing the amount of glucose ingested.

      • Elaine

        I agree. In hindsight I am surprised she allowed/suggested that too.

      • araikwao

        Yeah, that’s what I thought when I read Romm’s silly article, too

    • Anna T

      I never drank Glucola (or whatever it’s called here) either.

      I figured I’m low-risk for gestational diabetes (and no, I’m not a doctor, but I *am* a dietitian with a university degree and clinical internship under my belt). I mean, I was 23 (and 25 with number 2), healthy, lean, fit, with no history of diabetes for anyone in the family. I thought that qualifies me as low risk, and told this to my doctor.

      She scowled, looked me in the eye and said, “there is no such thing as low-risk or high-risk for GDM. Everybody has an equal chance of getting it.”

      I thought I must have misheard; but no. She wasn’t saying, “you might still get it if you’re low-risk.” She was actually trying to convince me that there’s no difference between me and an obese, over-35 woman with a history of diabetes.

      Whether she really believed that, or she was just trying to convince me to take the test, I do not know – and I’m not sure which option is worse.

      Even if you think everyone should follow a certain procedure, you do not tell falsehoods to promote it.

      • Therese

        Around 40-60% of women with GD had no risk factors for it, so maybe that is what your doctor was saying and you misunderstood.

        • Anna T

          Maybe that was what she meant, but it certainly wasn’t what she said. I did not misunderstand. She was either misinformed or was trying to add a healthy little dose of fear. No doubt she felt it was for my own good.

          • Stacy21629

            So you were both “misinformed” but she chose to err on the side of caution where your baby’s life was concerned and you chose to err on the side of risk.

            Gestational diabetes is due in part to progesterone antagonism of insulin meaning EVERY pregnant woman is at risk simply by virtue of being pregnant. It’s a sugar drink and a blood draw. What is there, really, to be against, except to be “against”.

          • Anna T

            Well, obviously if you’re not pregnant your risk of *gestational* diabetes is zero…

            I don’t think I was misinformed. I knew it was not *impossible* for me to have GDM, even without risk factors. I did, however, think it was unlikely, and I was not wrong.

            What my doctor SHOULD have said to me was, “yes, you are right. It is unlikely that you have GDM. However, since the test is easy and safe, and the information is so important, I still recommend that you take it.”

            As soon as she said something that was just plain wrong, it created a huge turn-off.

            Also, I realize this should not be a consideration, but it was for me: I have no car and live in an area with next to no public transportation. This made arriving for any routine test or scan a project, even more so when I already had a child at home. I did make it for the necessary milestones, but I simply could not make arrangements for “just in case” appointments and extra scans.

            So, the GDM test was among those I refused, as was the early all-inclusive scan, the genetic testing and the amnio.

            Before you condemn me and say “oh, I get it, you just didn’t go to the clinic because you were lazy,” consider the following situation. I was once sent into town for a test our little local clinic couldn’t perform. I spent the whole morning and noon on the commute and test. Then I stood waiting for the bus to take me home.

            The bus was late. I ran out of water. There was no shop in the bus stop’s vicinity. I had my toddler with me because there was nobody else to watch her. It was summer (in Israel) and the heat was glaring and I very nearly passed out. I don’t know what would have happened to my child in that case, there were no other people nearby.

            So, I repeat, ideally this should not be a consideration, but for women who live in very remote areas, just making it to the test might take a real toll, and one must consider whether the appointment really is necessary. You would, I hope, think twice before making a possibly dispensable appointment for a woman who has to take a helicopter to make it to the clinic…

            Perhaps I *should* have taken the GDM test. Perhaps next time I will. But my point is that doctors are supposed to give correct information and statistics, not exaggerate risks in order to make patients consent to a certain procedure.

          • Mel

            When I was in the NICU 30 years ago and weighed under 3 pounds, the little girl in the bassinet next to me weighed 14 pounds. The OB had had to shatter her collarbone and humerus on one side and she had Erb’s palsy on the other side from the severe shoulder dystocia.

            Her mom was my mom’s age (24-ish), fit and appeared healthy, but her untreated GD nearly killed her daughter.

            That’s what your OB was trying to prevent.

          • lawyer jane

            Yeah, it makes no sense to reject a procedure just because you didn’t like the way your doctor explained it to you … Clearly what she was trying to convey was that there was some risk for everyone.

          • Stacy21629

            Many drunk driver s were “right” that they wouldn’t crash on their way home – doesn’t mean it wasn’t a risky thing to do.

            did you explain your transportation and child care difficulties or was the doctor to know by telepathy? I have a car but lived about an hour from my cnms office last pregnancy. I drank the glucola at home (given to me at a prior visit) left for the appointment, had a blood draw as soon as I walked in the door. Saved waiting around. No separate visit – combined with routine prenatal.

            Glucometers work at home too. While not ideal you could have drank the drink and pricked your finger at home. Anything abnormal warrants further testing.

            GD carries tremendous risk to your baby and is relatively easy to screen for. Make your providers aware of your situation an hopefully they will work with you.

          • Mariana Baca

            You had a *lower risk* of developing GDM than an older, obese woman. All pregnant women are at risk for GDM, however. She is probably saying that there is no truly “low risk” category for a disease that affects anywhere from 1 in 30 or 1 in 10 pregnant women. 1 in 30 is not low risk.

            If there is hardship making it to a hospital, hopefully the test can be combined with other exams or administered at a more local clinic since it doesn’t require fancy equipment.

          • Irène Delse

            You know, it’s difficult to remember word for word what someone told you at a precise time, so maybe what she said was more on the lines of “even women with no apparent risk factors can have GD”. Who knows? Note that this is not a criticism of your intelligence or capacities, just a fact of life: memory is graven in wax, not bronze.

      • Babydoc Mom

        If you put 100 women who are over 30, obese and with a family history of diabetes in a room, more of them would have GDM than 100 people who were 23, healthy and fit with no family history. That is a fact.

        Could your doctor tell by looking at you if you were going to have GDM? No. There was no way to tell by looking at you nor by taking a history. You would either have it, or not. Statistics apply to populations, not individuals.

        As a dietician, I would hope that you would be aware of the risks to both pregnant women with GDM and to their babies. Including increased risk of stillbirth, macrosomia, shoulder dystocia, surfactant deficiency, neonatal hypoglycemia…..

        So you put yourself and your baby at increased risk to prove a point?

        Glucola is an awful tasting substance, and not throwing up afterwards was difficult, but it is a small price to pay for the information that benefits both the pregnant woman and her unborn child. I have treated (too) many babies who have suffered the effects of undiagnosed (until after delivery) GDM. Most of them had slim active young mothers who felt that THEY weren’t at risk. They gambled and lost, some losing their children in the process. Maybe you gambled and won. Was still a gamble. That was what your physician was trying to tell you.

        • Anna T

          I wasn’t trying to prove a point or bash my doctor; I genuinely didn’t think I needed the test at the time. I might reconsider for future pregnancies, though, because I’m older now.

          No, it was not a gamble; I was keeping a watchful eye on myself and my tests and scans. If any of my blood tests had been off, or if my babies had measured larger than normal, or if I had experienced any suspicious symptoms, I would have taken the GDM test and acted appropriate to its results. None of this ever happened and I had healthy, average-weight babies.

          • Irène Delse

            It’s interesting that you don’t think you gambled, when in fact you did play the odds. Better odds than if you hadn’t been young, thin and healthy, sure, but still a non-negligible risk. You were lucky: it’s not an accusation, just a statement of fact.
            It’s human to think you are different and can bend the rules a little to avoid things you don’t like or find inconvenient. It’s human to be peeved by a pushy doctor and to dig in your heels rather than do what she says. But next time, maybe think about being safe more than being right, eh? And if you can, go see a doc with with better bedside manners.

          • DiomedesV

            You accused your doctor of lying. That’s not bashing your doctor?

          • Susan

            I don’t know, I have heard patients consistently say a certain doc says “x” that I am confident this doc is saying “x”. Explaining some of this stuff is time consuming. I can see the temptation to simplify the explanation. But, It is lying. I know some doctors do it. Most don’t but I find her story believable. The doctor probably doesn’t see it as lying but technically, as presented, her doctor was lying.

          • Jessica S.

            Again, it’s too bad your doctor didn’t instead tell you that even in lower risk patients, there are rarely any symptoms that present with GD. Thus the screening. I understand it’s a hardship, but it’s one that could prevent an onslaught of much worse.

      • Israel doesn’t use Glucola — it provides the 100 gm dextrose and the patient is told to bring a lemon, which is very easy here [sez moi, looking at my lemon tree]. The resulting lemonade is sweet, but drinkable.
        It has nothing to do with possible additives or side effects: it’s just much cheaper for the health funds this way.

        • TG

          the clinic added their own lemon to mine!

        • Susan

          I like that idea!

      • Young CC Prof

        Yes, there are risk factors. Your doctor should understand that and tell the truth about it. HOWEVER the incidence of gestational diabetes in women without risk factors is still high enough to make it worth screening everyone.

      • Ob in OZ

        Agree. You were low risk, not no risk. I’m not liking the current recommendations of diagnostic testing (2 hr gtt) everyone , but it seems to be the new standard of care.

      • Trixie

        So you ignored her advice even though she had superior education on the matter? It’s one simple test, it’s not like she wanted to hack your leg off.

      • lawyerjane

        Huh. The only mom I know who got GD was a super-thin marathoner.

      • DiomedesV

        “(and no, I’m not a doctor, but I *am* a dietitian with a university degree and clinical internship under my belt”

        In other words, you know next to nothing about pregnancy and obstetrics. Moreover, whatever your doctor did or didn’t say (and I think the term “falsehood” is more reflective of your need to defend what was clearly a poor decision) you clearly don’t understand the difference between low-risk and no-risk.

        Plenty of women without risk factors go on to develop GD. Unfortunately for people who believe that being thin, fit and young means they are morally superior beings to the pregnant obese, GD is not a simple consequence of being fat, lazy, and old. Like pre-eclampsia, it is a multifactorial illness that is caused by the complex hormonal and immune interactions that inevitably occur during pregnancy. As yet, these interactions are poorly understood. In addition, women who go on to develop GD, no matter what their obvious risk factors, are at greater risk of developing type II diabetes, which is an illness that is sufficiently awful that I would think you would be willing to take the time to take a 2-hour test to avoid it, even if you weren’t motivated by concern for your baby.

        Your doctor has probably seen many patients with no apparent risk factors go on to develop GD and has no a priori reason to think you will not be one of them.

        You got lucky. The end.

      • DiomedesV

        “Statistics apply to populations, not individuals.”

        Exactly. What kind of dietician doesn’t understand that?

      • UsernameError

        The thing is, the majority of the risks are conferred to the baby, not to you. Why anyone would be willing to put their newborn at risk of low blood sugars, seizures, and heart problems just to avoid a yucky drink is beyond me.

        We test for a lot of things we are low risk for, because low risk doesn’t equal no risk. For instance, my kids are at a low risk for the myriad of disorders that are tested for during the newborn screen. But I still make sure all of my kids get this test, because it is so important.

        • Young CC Prof

          The newborn screen is an awesome thing, one blood test to check for dozens of different metabolic disorders before permanent damage can be done.

      • Susan

        I think you are right that certainly some people are at higher risk than others. If the doctor really wouldn’t take the time to explain why you should be screened even though you are at very low risk than that’s a shame. I would have started to mistrust my doctor if she was blowing off patient education that way or worse telling the patient a lie.

      • Jessica S.

        I think she may have been trying to tell you that it usually presents with NO symptoms, so there isn’t going to be much to tell you there’s a problem until the problem is already had – for you and the baby. And if she wasn’t, then that’s what she should have presented to you, instead.

  • Petanque

    ” I got the science thing down tight in my medical training” – cringeworthy!

    • Guesteleh

      I wprk with doctors and I can’t imagine any of them speaking like this. Gives me major fontrum.

      • Petanque

        I just googled Fontrum – thats hilarious! And appropriate.

        • NoLongerCrunching

          For the lazy:

          Fontrum, n. Feeling embarrassment for someone that doesn’t have enough common sense to feel the embarrassment that they should be feeling for themselves for their actions.

          • Ob in OZ

            The lazy thank you. I must use fontrum in a sentence within 24 hours. Opportunities abound.

          • attitude devant

            I’m busily considering how to turn it into an adverb and an adjective.

          • attitude devant

            cousin to ‘cringeworthy?’

          • araikwao

            Oh that is the best word ever!!

          • Jessica S.

            Thanks, it wasn’t in my Apple dictionary apparently – I was lazy enough to benefit!

    • Yes, her writing style hardly seems worthy of Yale.

      • The Computer Ate My Nym

        Didn’t GW Bush go to Yale? Whatever one thinks of his politics, his writing and speaking style was easily…misunderestimated.

    • araikwao

      Clearly she is mistaken..

  • Stacy21629

    “The medical community considers this “drink” harmless though it is well
    recognized that some women just can’t tolerate it due to digestive
    system side effects including nausea, vomiting, bloating, and diarrhea,
    as well as other adverse reactions including headache, dizziness, and
    fatigue.”

    Also known as “how I feel most days of my pregnancies”.

    Give me a break. What a load of unscientific nonsense. Anyone immature enough to call me a “momma” I do not want handling my medical care.

    I’ll drink the drink.

  • Captain Obvious

    I believe every other country but the USA uses the 2 hour GTT to screen for GDM. Wasn’t a study done out of Canada that demonstrated the benefits of the 2 GTT against outcomes? I believe the glucola followed by 3 hour GTT have arbitrary cut offs decided by expert opinion without any studies ever proving benefit.

    • Young CC Prof

      My OB had me do the 2 hour. I think it’s gaining popularity in the US.

      • Klain

        I’ve only done the 1 hour GTT in Australia, with the understanding that if the ob didn’t like the readings then I would have to do the 2 hour test.

    • In Israel we do a 50gm test with blood drawn at 1 hour after ingestion. If that is abnormally high, then we send the woman for a 100 gm 4 hour GTT.

      • Jenny_from_da_Bloc

        Is that the 50g dextrose test?

        • Yes. You do not have to fast for it.

          • Jenny_from_da_Bloc

            Do you have any additional information on the dextrose test and what product and method is used to perform the test? I heard about a 50g dextrose and lemon juice mixture used in Israel that is as effective as Glucola, is this true?

          • Now that I think about it, I think glucose is the sugar used. Not that it matters all that much, since the main difference is that different sugars taste sweeter/less sweet [using a very “sweet” sugar in recipes means more “bang for the buck” — a smaller amount [i.e. less calories] will give the same sweetening effect as a less sweet sugar. Energy foods tend to use sugars which taste less sweet, and therefore they can ADD calories by using more.

            Back to the test. You don’t need a commercial preparation at all — any pharmacy can make up a package containing 50 gm glucose powder by weight. It is dissolved in water, and the juice of a lemon added for palatability. The person tested eats her normal breakfast, takes the drink within 2 hours of breakfast, and one hour after drinking, has blood drawn. Not a complicated business at all.

            The three or four hour GTT is a bit more complicated. For one thing, the patient fasts [water is allowed] for 8 hours prior to the test. Fasting blood is drawn, the patient drinks her drink –again, it doesn’t have to be anything more than 100 gms of glucose in water [and within reason, the amount of water is irrelevant, but it should be drunk within 10 or 15 minutes]. The lemon is optional, but preferred, as that is a very sweet drink. 1 hour after ingestion, blood is taken, then again at the 2, 3, 4 hour marks. When possible, urine is also collected. If two or more blood results are abnormally high, the patient is assumed to have GDM. FBS should not exceed 110; results at 1 hour should be 140 or less, and the following results should not exceed 120, IIRC. [these values are somewhat arbitrary; different doctors may have different standards]

    • Jessica S.

      I thought it was curious that my sister in law, due two weeks after myself, took the 2 hr GTT, where as I did the one hour screening, which is followed by the 3 hr GTT if the screening was positive. I wondered if her clinic if following different guidelines? Perhaps better, in the long run? I have no clue. Is the two-hour also diagnostic? I understand that the one-hour is not to be used as a diagnostic tool.

      Incidentally, my one hour screen was fine when I took it at 28 wks, but now, at 32 wks, after a ultrasound this week showed baby at three weeks+ ahead of dating, I have to do a three hour GTT tomorrow. It will be interesting to see if the GD developed somewhere between 28 and 32 weeks.

    • Becky05

      There is controversy here, with some organizations recommending the 2 hr and others recommending the 1 screening then 3 diagnosis. There was a large convention on it recently, last year I believe, and the ACOG still strongly recommends the two step process. It is quite wrong to say that there is no evidence for that option.

      This article has links to sources: http://www.medscape.com/viewarticle/808409

      • Jessica S.

        What’s their reasoning with the two step, as opposed to the two-hour? I tried to search on their website but the majority of the applicable results were for member only.

  • Amy Tuteur, MD

    Aviva “responds”:

    • Young CC Prof

      I’d rather have a doctor who reads not only the label, but the latest research and medical association recommendations on the product. Especially for products that are decades old and have been studied quite a bit since.

    • Captain Obvious

      So she is trained to care for obstetrics. but doesn’t do so.

      So many progestin products site VTE risks, but evidence based medicine demonstrate its really the estrogens that are associated with VTE.

      Bendectin was taken off the market despite not really causing any problems.

      Silicone breast implants had warnings for years, yet are now found to not have caused any real problem.

      HRT was thought to cause breast cancer, but the final analysis shows HRT was only associated with a 8 more per 10,000 women risk of breast cancer. But ERT actually showed a decrease of 6 per 10,000 women risk for breast cancer.

      Vaginal mesh may have a 7% erosion risk, so lets ban that for everyone, despite it helping 97% of women.

      Lets put warning on yaz, Yasmin, and Ortho Evra, that it may cause VTE? Duh. All estrogen based BC does.

      And now lets put a moratorium on morcellation of fibroids that can reduce recovery and minimize incisions because of the rare occasion of 1/350 to 1/1000 risk a sarcoma may actually be there.

      Product labels speak the truth Dr Amy!

      • The Computer Ate My Nym

        Yaz and Yasmin do seem to have higher rates of VTE risk than other OCP, for whatever reason. It’s in the prescribing information, which is far more complete than the label and what I’d suggest a doctor planning to prescribe a medication she or he is not very familiar with read.

        • Captain Obvious

          Only two studies showed a small increased risk. Other studies did not show any increased risk. So of course the labeling states there may be some increased risks and the lawyers are going to jump on the band wagon with those two studies looking for cases.

          YAZ

          VTE Risk
          Drospirenone:
          23/100,000 women years
          Levonorgestrel :
          9.1/100,000 women years

          Drospirenone:
          30.8/100,000 women years
          Levonorgestrel :
          12.5/100,000 women years

    • Stacy21629

      Enlighten us, Aviva. How many babies a year do you deliver as an MD?

      • Young CC Prof

        She’d deliver them every day, but her insurance company won’t let her. (Because then she’d have to pay them more money, like the real obstetricians do.)

        • Stacy21629

          The point I’m making then is her claim to “provide the full scope of care to women from cradle to the grave” is a complete lie if she hasn’t actually delivered any babies.

          • Certified Hamster Midwife

            To be fair, if she’s caring for infants as a family doctor, that’s cradle. If she delivered babies, it would be cervix to grave.

    • Stacy21629

      Reading drug labels has serious limitations with regards to making medical decisions. Labeling is a complicated bureacratic red-tape mess designed to cover the drug company’s butt. Often new uses are tried and studied that are not added to the label simply because it takes too much time and money to change the label. Or the drug might be 89% effective at treating X disease but labeling for that requires 95% efficacy so it’s left off. It’s the medical studies published in journals that are actually worth something to me. And I treat dogs and cats, not pregnant women and babies!

      The fact that this woman practices medicine now scares me. She walks, talks and acts just like the CPM she was.

      • lawyer jane

        Exactly. Not only to labels not tell you about additional uses for the drugs, but they also tell you nothing about post-market risks that have emerged (or been covered up by the drug co in the FDA approval process). I would be shocked if any of my docs relied solely on a drug label, especially during pregnancy!

    • Bombshellrisa

      Well, that is exactly what I want my doctor to be busy doing-reading labels. Not attending grand rounds, not being involved with post clinical conference for nursing and medical students and certainly not actually caring for patients. I want my doctor stuck in front of a computer, blogging about labels.

    • NoLongerCrunching

      I think saying people shouldn’t read the labels is going to trigger some outrage. I know what you mean about the uselessness of the labels, but the paranoid types are going to have a field day about Dr Amy trying to take away womyn’s access to informashunz!!!

    • Sue

      “Now, would you rather have a doc like me who spreads populist paranoia and pretends to be more caring, or a doctor like Amy, who is actually trained in obstetrics and knows the literature better than anyone?”

      Fixed.

    • The Computer Ate My Nym

      I’m…confused. She’s claiming superiority because she read the label on glucola? Um…how about the PDR entry or the prescribing information or up-to-date or medline? And what safe alternative to GTT based on the medical literature is she offering anyway?

    • araikwao

      Completely sure I wouldn’t want a doc who is busy reading food labels rather than literature, and quotes vapid sources such as “Food Babe” rather than, well, literature.

  • baileylamb

    I ate a half of bagel with butter and a big heap of cream cheese before my glucose test, I wanted to be sure. A lot of folks on the baby boards talked about eating different the night before, so the wouldn’t get a false positive. I took the opposite approach.

    No GD but my son does hate anything on his bagels.

  • Trixie

    And I can’t believe she quotes Food Babe as a reputable source. This is what Food Babe has to say about microwaves: http://foodbabe.com/2012/07/30/why-its-time-to-throw-out-your-microwave/

    “Last by not least, Dr. Masaru Emoto, who is famous for taking pictures of various types of waters and the crystals that they formed in the book called “Hidden Messages in Water,” found water that was microwaved did not form beautiful crystals – but instead formed crystals similar to those formed when exposed to negative thoughts or beliefs. If this is happening to just water – I can only imagine what a microwave is doing to the nutrients, energy of our food and to our bodies when we consume microwaved food. For the experiment pictured above, microwaved water produced a similar physical structure to when the words “satan” and “hitler” were repeatedly exposed to the water. This fact is probably too hokey for most people – but I wanted to include it because sometimes the things we can’t see with the naked eye or even fully comprehend could be the most powerful way to unlock spontaneous healing.”

    • Young CC Prof

      Too hokey for most people, but not for her customer base.

    • The Bofa on the Sofa

      You’d almost think it has to be a Poe. No one can be this idiotic, can they?

      • Trixie

        Food Babe can!

      • Irène Delse

        Bringing in the Food Babe as an expert on anything related to nutrition or medicine should be its own internet law.

        • The Bofa on the Sofa

          Ah, just a variation of Scopie’s Law.

    • Leslie

      This really, truly may be the stupidest thing I have ever read. I’ve read some really stupid things in my time, but this simply takes the cake.

      • The Bofa on the Sofa

        Exposing the water to the word “hitler” does bad things. Although, it appears that they have to be exposed _repeatedly._ Just showing it once is not enough.

        • Leslie

          What if i just whisper it? What if I yell H-I-T-L-E-R , repeatedly? Can water spell???

          • The Bofa on the Sofa

            SATAN? Or SANTA?

          • Amy M

            Well the letters are the same….what if you threw in Scrabble tiles? Would the water know what you intended to spell or would it assume the worst?

          • Trixie

            Water’s such a pessimist sometimes.

          • Bombshellrisa

            What if I yell three bad things and then a good thing? Would that make it neutral?

          • Leslie

            I think we just came up with a perfect idea for my kid’s next science fair project! Whoo-hoo! I can’t wait to see his crunchy teacher’s face when he proposes this!

          • Young CC Prof

            Only the water in homeopathic remedies can spell.

          • Trixie

            It’s all the banging over horsehair blankets that lines the letters up.

          • The Bofa on the Sofa

            A check + to those who understand this reference.

          • The Computer Ate My Nym

            Yell it three times and…Dr. Amy Satan appears!

          • Alcharisi

            If you shout “Blucher!” at it, does it rear up and whinny?

        • Trixie

          The only question left, and I think we all know the answer already, is whether Glucola is really made of…Hitler water!!!

    • Jenny_from_da_Bloc

      Evil science ovens!

      • Trixie

        I wonder if microwave radiation from space causes Satan water also, and if so, how do you control for that?

        • Captain Obvious

          Day to day radiation exposure is about 100 mrad.

          • Amy M

            Seriously. I have to take radiation safety refresher every year because of what I do at work, and they always go over what we are typically exposed to just by living day to day, and what is considered safe. There’s way more natural radiation around than most people realize.

          • Trixie

            And yet you never see Food Babe advocate for something sensible, like testing your home for radon.

          • FormerPhysicist

            My dentist was a little surprised when I was so cavalier about my kids getting dental x-rays. But if I don’t think twice about flying … (well, at least not because of the radiation. I hate flying with kids for other reasons.)

          • Irène Delse

            My mother once asked the dentist why he stood on the other side of the room while he remotely operated the X-ray machine, but the rays were deemed safe for the patient. He told her that he didn’t want to get a patient’s dose of radiation twenty times a day, five days a week. She understood, and laughed.

      • Certified Hamster Midwife

        Don’t put metal in the science oven!

      • Mishimoo

        …I’m going to write that on a post-it note and stick it to my microwave.

    • Jennifer2

      “Live, healthy, and nutritious foods can become dead in a matter of seconds when you use a microwave.”

      I really, really hope that most, if not all, of my food is dead when I eat it. I might start microwaving everything I eat for at least 5 seconds just to make sure it’s all dead. I don’t want to eat a turkey sandwich and have the turkey be alive. Or see the tomato staring back at me with its sad little tomato face saying “please don’t eat me! I’m alive!”

      • Trixie

        There’s an Isaac Asimov short story about a guy who develops the ability to hear plants screaming in pain when they’re hurt. He can’t walk on grass or pick leaves. He tries to survive on windfall fruit but that’s tough going.

        • Amy M

          There’s also a Roald Dahl story about plants screaming in pain, but I think in that one, a scientist develops a tool to hear them, and deliberately pulls leaves off to test his equipment or something. It’s creepy.

        • Mel

          There’s a whole play on that in “The Restaurant at the End of The Universe” by Douglas Adams. Cows have been bred to be suicidal and the plants have started communicating that they don’t like being eaten either…. It’s a hoot.

        • The Computer Ate My Nym

          There apparently was an idea that this happens in real life at one point. The Mythbusters tested it and didn’t find any evidence. Which is unsurprising given that plants don’t have neurons.

      • Young CC Prof

        Microwave hysteria is culturally interesting. It’s a perfectly good way to cook, conserves the nutrients of veggies better than most other methods, and, if you’re cooking small quantities, is more energy-efficient. Obviously there are quite a few dishes that can’t be made properly in a microwave, but there are plenty of tasty ones that can.

        Why are they so scary? Is it pure technophobia? Is it because people don’t understand what’s really happening, or because it uses the dreaded radiation? Or is it part of the artisanal housewife phenomenon, or the good old-fashioned Puritan ethic that it must be sinful because it makes cooking too easy? Or is it all of the above?

        • Jocelyn

          I think it’s because people don’t understand the electromagnetic spectrum. They don’t understand the difference between ionizing and non-ionizing radiation.

          • Amy M

            They don’t know how microwaves work, and can’t understand enough even they tried to learn. I have no patience for that kind of idiocy.

          • Mel

            I have spent years (literal years) of my teaching career explaining why those two are different to teenagers.

          • Young CC Prof

            I also find time to explain that in any math class that touches on radiation in any way.

    • Carrie Looney

      Not only is the Food Babe a bona fide nitwit, but her writing style really grates on my spine. For the life of me, I cannot understand her popularity. I saw a lot of her ‘OMG Subway bread has a chemical in yoga mats’ crap posted on my FB a little while back.

    • Irène Delse

      Oh yes, when I saw she was quoting the Food Babe, I just rolled my eyes in disgust. In addition to her microwave nuttiness, the said FB is known for scaremongering about vaccines. There’s a hilarious take on her exploits at the Science-Based Medicine blog:
      http://www.sciencebasedmedicine.org/scam-stud/

    • Siri

      Water speaks English?

      • Young CC Prof

        Only if it’s been inside the brain of an English speaker. This only works in English-speaking countries, and if there are too many people speaking other languages around, that contaminates the result.

        • Siri

          So if I’m bilingual, is my water bilingual too? If I say horrible Norwegian words to it, will it be more or less upset than if I say them in English? What about neo-Nazi water, does it enjoy the sound of the word Hitler? I’m reaching out to you here, YCCP; don’t fail me.

          • Young CC Prof

            No, it doesn’t depend on the speaker’s native language, it depends on the drinker’s native language. See, water molecules are recycled, they go in and out of people’s bodies, and naturally water molecules have memory, so it depends on the linguistic alignment of the most recent drinker (or inhaler) of the largest number of atoms in that particular container of water.

      • The Bofa, Being of the Sofa

        Good question. For example, will it have the same response to el Diablo as it does to Satan?

        • Siri

          I just yelled EL DIABLO at my drink, and it froze in terror.

      • LibrarianSarah

        Not only does it speak English but it apparently has at least a basic understanding of Christian theology and world history.

      • The Computer Ate My Nym

        Of course. Everyone speaks English. Anyone who appears not to is simply trying to fool you. Didn’t you know?

      • Trixie

        If English was good enough for Jesus, it’s good enough for water.

        • attitude devant

          Oh, Trixie, I grew up in the Bible Belt, and I KNOW people who assume Jesus spoke English.

          • Trixie

            Of course he did. King James English, to be exact.

    • attitude devant

      Oh dear god. This stupidity gained cultural currency when that idiotic movie “What the do we know?” was in the theaters.

      I’m sorry if any readers don’t have enough sense to realize that this is patently ludicrous, then they deserve the Food Babe.

  • Leslie

    And, why, pray tell, isn’t Dr. Romm weighing the “risks” (sarcastic quotes) of Glucola against the very real risks of undiagnosed — and hence uncontrolled — GDM? Real doctors weigh the pros and cons of medical tests. Women who don’t regularly have a trace of diabetes or any history of diabetes in their families can get severe GDM requiring four insulin shots each day. I should know — it happened in all three of my pregnancies. Thank goodness I drank the Glucola and found out that I needed to protect my and my babies’ health!

    • Certified Hamster Midwife

      Uncontrolled blood glucose is a variation of normal?

      • Leslie

        Well, er, yes, in the sense that EVERYTHING is a variation of normal — um, I mean except for things that ARE normal. Tell you what, let’s call everything that is NOT normal, oh, I don’t know, how about “abnormal”? What do you think?

        • Young CC Prof

          That sounds so judgmental! I don’t want to be abnormal. Stop criticizing my health status, I take it personally.

        • Certified Hamster Midwife

          Abnormal is just a variation of normal.

          • Yes, because the word “abnormal” has “normal” in it. QED

      • Petanque

        Trust pancreas.

        • Mishimoo

          Sing a love song to them!

          • The Bofa on the Sofa

            But don’t expose it to the words Hitler or Satan repeatedly (the body is made of water)

          • Mishimoo

            You’ve finally explained my joint pain! Clearly, I have read too much about too many bad things.

          • Mishimoo

            I just noticed your name change, it made me actually laugh out loud. I love it!

          • Michele
          • Mishimoo

            Exactly! 😀

        • The Computer Ate My Nym

          Never. They’re inherently untrustworthy little bags of enzymes.

  • Trixie

    Can Aviva please pick between “mommas” and “mamas” and stick with one?
    What an arrogant, dangerous hack she is.

    • “Momma” is Ashkenazic, “mama” is Sephardic*, and “ima” is Israeli.

      *Israelis and other Hebrew speakers will understand this joke.

      • Young CC Prof

        Oh, yes. I especially like the way so many Hebrew words known to English speakers have resisted a standard Latin spelling and are transliterated pretty much any way the writer pleases.

  • Bombshellrisa

    I asked the diabetic educator (she is an ARNP) about the jelly bean test when I went in for my initial consult about gestational diabetes. She said that many midwives don’t use the right type of jelly beans and don’t verify that there is indeed 50 grams of sugar in the 28 jelly beans that their clients are using (she said she gets this question a couple times a day!).

    • Young CC Prof

      And obviously jelly beans are a natural solution! (Why not just drink some corn syrup? It’s easier to measure, surely.

      • Bombshellrisa

        Only if it came from non GMO corn though, right?

      • Therese

        How often does a natural, hippy woman get the chance to eat jelly beans, guilt free? Somehow the idea of drinking corn syrup is just not as appealing.

      • The Bofa on the Sofa

        It’s not the corn syrup the problem, it’s the artificial dyes. Thus, jelly beans…

        oh wait..

  • Cold Steel

    As a very minor quibble, I will say that as a boarded & trained FP it’s well within her specialty to provide routine prenatal care, so she might have thought just as much about Glucola as the average obstetrics resident.

    My very favorite part was when she said “we [me + ‘food activist,’ whatever the hell that person’s qualifications are] both agreed that this toxin should not be given to pregnant women!” And like that, done. No evidence, no mechanism, just bam! conclusion reached. In logic I believe this is called affirming the consequent.

    There is a growing trend in out-of-hospital birth circles to offer a spot glucose– like a fingerstick– as a means of screening for gestational diabetes. If it’s high, they say “oh, you just ate a doughnut, it doesn’t mean anything.” If it’s low, they say “you’re normal! No need to stress your pancreas and actually assess for insulin resistance!” It’s like the q3hr doppler checks in labor: the trappings of respectability with none of the scientific understanding or efficacy actually underpinning the practice.

    • fiftyfifty1

      “I will say that as a boarded & trained FP it’s well within her specialty to provide routine prenatal care, so she might have thought just as much about Glucola as the average obstetrics resident.”

      I’m going to weigh in here as a boarded and trained FP myself. It is true that in residency we do provide some obstetric care. But many, if not most of us graduate ill prepared to provide obstetric care unless we add on a family medicine obstetric fellowship afterwards (which Aviva chose not to do). From adenomyosis to glucola to zofran, I’m pretty sure that if it has something to do with obstetrics, the average OB resident has thought about it at least 10x more than a recent FP grad. Most FP residents realize that they don’t know enough and either go on to more training or give up obstetrics altogether.

      I love being an FP. But one thing that makes me uneasy is the insistence that “what we do is a specialty too”. We are generalists. Our knowledge is broad but *shallow*.

      • Gene

        There are plenty of FPs who will provide obstetric care. But, to be fair, emergency medicine docs are also trained in emergency prenatal care as well as in delivery (usually vaginal, but in theory, we can also do peri-mortem c-sections). I’ve delivered several dozen babies as part of my emergency medicine training. But I’m much better qualified to take care of the product of delivery as opposed to the vessel, shall we say.
        Broad and shallow works for EM as well (in some cases). We are experts in emergent and urgent conditions, less so in chronic care.

        • Mel

          A peri-mortem CS in cattle (we call it a terminal CS because the dam has suffered some massive collapse that she is unlikely to recover from and will most likely die at some point while under anesthesia) is the one medical procedure I haven’t seen on the farm yet.

          It’s also the one I fear the most because it’s emotionally crushing on everyone. My husband almost never talks about the few he’s assisted on and generally tears up when he does talk about it.

  • Young CC Prof

    “…digestive system side effects including nausea, vomiting, bloating, and
    diarrhea, as well as other adverse reactions including headache,
    dizziness, and fatigue.”

    In other words, the way pregnant women react to normal food items and/or daily life.

    • The Bofa on the Sofa

      Moreover, who ever said otherwise? Does any OB actually deny that the stuff has potential side effects like these?

      I’m trying to find the part about where anyone is “hiding” this information?

      • Young CC Prof

        It was cleverly hidden on unsecured websites and on the product packaging. Only people with degrees from Google U can find it.

        • Mishimoo

          And it’s only on the information sheets we’re given prior to consenting to the test! Not to mention discussing it prior to the check-up where it’s offered.

          From my experience, it seems that some women in my local area are avoiding or arguing about being tested for GD, as my CNMs were very happy/relieved when I said “Of course I want the GD testing done. I’m probably low-risk, but I’d rather be safe than sorry.”

        • Bombshellrisa

          And CPMs too, so it must have something to do with what Missy Cheyney calls “other ways of knowing”

        • Petanque

          So you can find it if you “really” do your research!

      • Bombshellrisa

        I do remember the handout about what to expect at each appointment and it very clearly stated that nausea, headaches and dizziness were common side effects. It had to talk about vomiting too because if you throw up between drinking the stuff and your blood test, you would have to repeat the process

        • Jessica S.

          If I end up throwing up, my doctor will have to find another way to figure it out. There is no way in hell I’ll subject myself to that twice. However, since I had no problems with the one hour (heck, I went shopping while waiting for the blood draw), I’m hoping the three hour won’t be drastically different. I know the fasting will make things tricky.

          • Jessica S.

            I say “no way in hell” b/c I rarely throw up so when I do it’s a very long and torturous process that my body fights the entire way. I’d much rather be dead. :/

    • The Bofa on the Sofa

      I think you missed an important part of the quote…

      some women just can’t tolerate it due to digestive system side effects including nausea, vomiting, bloating, and diarrhea,

      Now, to your comment: what DOESN’T cause “digestive system side effects” in “some (pregnant) women”? Jeez, with severe hyperemisis, even water will cause nausea and vomiting.

      Ooo, it causes “fatigue.” In pregnant women. The hell you say? You know what else causes fatigue in pregnant women? Pretty much everything. Getting up in the morning is enough to wear you out.

      My wife got headaches and dizziness riding in a car while she was pregnant. Does that mean that no pregnant women should ride in a car? Shoot, it didn’t even stop HER from riding in the car, because that was something she needed to do.

      (although it helped if she drove)

    • Trixie

      Glucola *is* gross though. Like especially.

      • Leslie

        Grody to the max!

        • Young CC Prof

          Like drinking bad candy.

    • Jennifer2

      Even if it’s a significant reaction, I would much rather suffer even a few hours of nausea, vomiting, bloating, diarrhea, headache, dizziness and fatigue than have a macrosomic baby or a calcified placenta that I didn’t even know was a risk because I had completely uncontrolled GDM.

      For the record, I thought the glucose drink (not sure if it was Glucola or a different brand) tasted like medicinal Sprite. It wasn’t tasty, but it wasn’t awful, and I felt zero ill effects from it.

      • Medwife

        Oh, I loathe Glucola. I barfed it up on hour 2 of my 3 hour GTT but did manage to complete it the second time (and did not have gdm). But I was a puker, that’s pregnancy for me. Tomato soup made me vomit too. Doesn’t make it a “toxin”.

        • fiftyfifty1

          I was a puker too. I actually asked to be exempted from the test for that reason and they allowed it both times and substituted some spot blood sugars instead. I had fully planned to do the test, but by the time testing rolled around I was still puking lots and was struggling with poor weight gain due to that. I also felt that I didn’t even want to know because then I would have to try to limit carbs which seemed impossible because the only foods which seemed even remotely acceptable to me with all the nausea happened to be carb-rich. I just couldn’t face it.

          I realized it was a risk (although small) but I took it anyway.

      • Mishimoo

        I hated it because it made me feel nauseous*, but it’s better than the risks associated with GD.

        *which could also be a psychosomatic reaction in my case because it reminds me of the watered down Sprite that I drank loads of when I had gastro as a kid.