Gestational diabetes mellitus (GDM) is one of the most common problems that can occur during pregnancy. According to the most recent available data, about 6 percent of expectant parents are diagnosed with gestational diabetes, which develops during pregnancy when blood sugar levels are high.

GDM has serious implications for both the pregnant person and the baby. Evidence Based Birth offers a summary of the problems the condition can cause, including:

• Pre-eclampsia

• Fetal high blood sugar

• First-time C-section

• Premature birth

• Higher birth weight/having a large baby

• Shoulder dystocia or birth injury

• Newborn intensive care

• Newborn jaundice

• Newborn low blood sugar

• The birthing parent developing diabetes and/or heart disease later in life

• The baby developing excess body weight and/or diabetes later in life

Birth center and home births are reserved for clients who are low risk and are expected to have low-risk deliveries. Therefore, we consider the potential complications of gestational diabetes adequate reason to mandate the glucose challenge test and that the mechanism of testing is based on standards of care grounded in research.

Who is at Risk for Gestational Diabetes?

Medical history and several other factors put pregnant people at a greater risk for developing gestational diabetes. These include:

• Being advanced maternal age

• Living in a bigger body

• History of gestational diabetes

• Having a large baby in the past

• Having a close relative with diabetes

• Belonging to certain ethnic groups

At Magnolia, the majority of our clients are Black and Latina, so we serve a South Florida population that’s at an increased risk for gestational diabetes. In order to remain in care at Magnolia, all clients must participate in the standard gestational diabetes screening process.

Why is it Important to Screen for Gestational Diabetes?

Because of hormonal shifts, all expectant parents experience some metabolic changes during pregnancy. Even during a pregnancy that’s not complicated by gestational diabetes, the pancreas has to work harder to produce enough insulin. Therefore, when a pregnant person does have gestational diabetes, there are notable problems with insulin resistance. This can lead to poor outcomes for both the birthing parent and the baby, especially if the condition goes undiagnosed or untreated.

When you come into care at Magnolia, we do a hemoglobin A1C test, which is a simple blood test that measures your average blood sugar levels over the past three months. The results can help us identify if you are at risk for prediabetes.

When it comes to gestational diabetes, the standard of care is to screen all pregnant people between 24-28 weeks. Often called the “one-hour screening,” this test involves drinking 50 grams of a glucose solution called Glucola. After one hour, your blood will be drawn. If the blood sugar result is greater than 135 mg/dL, you are considered at an increased risk for gestational diabetes and will be referred for an oral glucose tolerance test (OGTT).

This second part is a diagnostic test. (Remember, the first part was a screening.) Before the OGTT, you will fast for at least eight hours. Your blood will be drawn when you arrive at the lab, and then you will drink a 100-gram glucose solution. The technician will draw your blood after one, two, and three hours. Two abnormally high blood sugar levels lead to a diagnosis of gestational diabetes.

Does Magnolia Allow Alternatives Gestational Diabetes Testing?

The short answer is no. We realize there are some midwives who offer alternatives to the Glucola drink, such as eating candy or doing at-home blood sugar monitoring. However, using orange juice, a banana, jelly beans, or other real food options is not an evidence-based way to complete this test. Because those foods are not chemically analyzed in a laboratory, we don't know the precise amount of glucose in them. And we are testing how your body processes glucose specifically, not other sugars. We want to know with certainty that your pancreas is able to effectively discard excess glucose in a specific amount when it is introduced into your system.

Some clients have concerns and questions about the ingredients in the Glucola drink. These include water, dextrose, natural flavoring, citric acid, and sodium benzoate. Nothing on the label is controversial or any worse than what might be in other drinks that aren’t water only. The first two ingredients are water and sugar (from corn), while the third is the same kind of ‘natural flavorings’ that are in many packaged foods and drinks. Unfortunately, the FDA doesn’t require brands to explain what that means. The last two ingredients are preservatives.

We don’t offer an alternative to Glucola because we simply aren’t willing to risk the test not being accurate. Not completing the glucose challenge test in the evidence-based way of using Glucola is not an option if you want to remain in care at Magnolia.

Can I Continue My Care at Magnolia if I’m Diagnosed with Gestational Diabetes?

It depends. If you’re diagnosed with gestational diabetes, we will consult with a maternal-fetal medicine specialist. For clients with GDM that’s controlled with diet, not medication, it is safe to continue your prenatal care at Magnolia. To keep you and your baby safe, your care will include:

• Four times daily glucose monitoring

• Weekly biophysical profiles after 35 weeks

• Delivery by the end of the 40th week

Medication-managed GDM means that the hospital is the safest place to give birth.

Evidence-Based Care at Miami’s Premier Natural Birthing Center

At Magnolia, we are committed to providing evidence-based care that keeps you and your baby safe. One of the ways we do that is by requiring the standard Glucola screening for gestational diabetes. To learn more about prenatal care and birth services at Magnolia, fill out our form to set up a free consultation!