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Abby's Magazine - Volume 5 Issue 4| Page 49 Undetected and untreated, GDM poses poten ally serious consequences for the mother and baby both during the pregnancy and birth, as well as increased long-term health risks for the child. Even at levels lower than our current diagnos c threshold for GDM, chronically elevated blood sugar puts mom and baby at a higher risk of pregnancy and birth complica ons. Furthermore, elevated blood sugar creates a condi on in the body called "oxida ve stress," which causes chronic inflamma on in the mother. Chronic inflamma on in turn can lead to high blood pressure, preeclampsia, and preterm birth, as well as a higher life me likelihood of a child developing allergies, asthma, au sm, autoimmune disease, obesity, diabetes, and cardiovascular disease. One in three Americans is now overweight or obese. Women who enter pregnancy overweight are substan ally more likely to either have undetected blood sugar problems, or to develop diabetes. Even women who are not overweight can develop gesta onal diabetes. While pregnancy is a healthy and natural process, most women are not living close to the rhythms of nature, and are subject to stress, poor food op ons, and all of the other vagaries of modern life that can have an impact on an op mally natural pregnancy. The Obesity and Blood Sugar Problems In the past ten years obesity rates in the general and pregnant popula ons have skyrocketed. Sok have insulin resistance, pre-diabetes, and diabetes, all of which can also occur in women who are not overweight, and who eat what they consider to be healthy diets. As a midwife and medical doctor working with pregnant women for 30 years, I've analyzed the food journals of thousands of pregnant women. In fact, many of the food journals I've reviewed from "healthy eaters" were loaded with excess carbohydrates and sugar, for example, oatmeal with raisins and honey for breakfast, a natural energy bar for a snack, a fruit and yogurt for lunch – all high in sugar. There is a growing body of scien fic literature demonstra ng the serious short- and long-term health risks to the developing baby as a result of chronic exposure to excessively elevated maternal blood sugar. So, I am not sure that in this new milieu of rampant "diabesity," a term my friend Dr. Mark Hyman o en uses, that there isn't some possible benefit to women receiving glucose screening in pregnancy – but only if it serves as a catalyst for improved prenatal nutri on. However, I do not believe that all pregnant women must receive universal screening for GDM. We know that at least 30% of all GDM could be prevented if adults maintained healthy weight, and that as many as 93% of pregnant women will test nega ve. Most just don't have GDM. Therefore, it is quite reasonable for tes ng to be done based on an individual woman's well-educated preferences, risk factors, and ability to shi her diet and lifestyle to mi gate risks. I think we need to take the risks of high blood sugar in pregnancy seriously, and educate all women that a lower glycemic, Mediterranean-style diet is actually an op mal diet for all pregnant women. Tes ng is also not a subs tute for the lack of prenatal nutri on educa on, which should be provided to all pregnant women. So Why Not Just Test Everyone? According to a recent report by the Cochrane Collabora on, the value of GDM tes ng at all is ques onable. While treatment for GDM improves health outcomes, tes ng, according to the Cochrane review, doesn't change outcomes. A smart doctor should tell you that if a test isn't going to change the outcome, then it shouldn't be done. To me, this suggests that a strategy of op mal nutri on for all pregnant women is what should be rou ne, with tes ng done for those at higher risk. Further, within the medical community, there is a lack of clear evidence – and thus a lack of consensus – about the best way to test for and diagnose GDM. Current guidelines in the US recommend a "two-step approach." Step 1 is a glucose challenge test (GCT). Women are given a drink, "Glucola"