Issue link: http://cp.revolio.com/i/855118
which contains, among other things, 50 g of sugar. Blood sugar level is measured 1 hour a er drinking the stuff. This test is not done fas ng. Women who screen posi ve go on to the second step, the glucose tolerance test (GTT), with either a 75-gram two-hour test or a 100-gram three-hour test. Again, Glucola is the vector for the sugar. This GTT is known to be imprecise with poor reproducibility. It has a 76% sensi vity (false nega ve) rate – which means that many women who do have gesta onal diabetes will be missed by the test (and thus may not receive appropriate dietary counseling to reduce their risks). It also has a similar poor specificity (false posi ve) rate meaning that about 25% of women who test posi ve do not have the condi on – but will be treated as if they have gesta onal diabetes – which puts them into a high-risk pregnancy category! Many European and other countries use a one-step test that's easier for women to tolerate, but also more sensi ve. This means that it results in higher rates of diagnosis. In fact, were European standards to be used in the US, as many as 15-20% of pregnant women would be found to have GDM. This might be a good thing allowing us to catch more women who are truly at risk of blood sugar problems that could impact their pregnancy health and their baby. But it also could mean that a lot more women – 2-3 mes as many, in fact – could be labeled with a condi on that changes the trajectory of their medical care en rely. When a woman is categorized as high risk, she then becomes subject to a host of medical restric ons and interven ons. Her place of birth may be curtailed to only the hospital (i.e. no birthing center, no homebirth). Her labor may be unnecessarily or prematurely induced. Percep ons of her risk status may lead to decreased tolerances in normal varia ons of labor, for example, her length of labor may be limited and her likelihood of cesarean sec on increased just because of a diagnosis. As we will see below, a diagnosis can also have a nega ve impact on her self-percep on of being healthy, and can cause anxiety and depression. Are There Risks to Testing? Aside from problems with food colorings and other poten ally unhealthy ingredients in the glucola, which are actually small compared to the risks of untreated GDM, we need to consider the mental and emo onal impact of a pregnant woman thinking of herself as having a "disease" rather than just emphasizing the importance of a healthy diet and appropriate follow-up, perhaps with the excep on of women whose blood sugar cannot be controlled with diet alone and who require medica ons. Michel Odent, the French obstetrician who is a champion of natural birth and respect for the capaci es of women's bodies, states: "Gesta onal diabetes is a typical example of a term with a strong nocebo effect. It has the power to transform a happy pregnant woman into an anxious or depressed one… One of the side effects of the term 'gesta onal diabetes' is to transform the interpreta on of the results of a test into a disease… The nocebo effect of the term 'gesta onal diabetes' is becoming a serious issue." For those of you unfamiliar with the term nocebo, it's a nega ve health outcome that is created by internalizing a nega ve health comment, told to you usually by a health professional. So here we are faced with a major dilemma – how do we address the poten ally significant numbers of babies growing up in what Michelle Williams, a GDM specialist at the Harvard School of Public Health, calls, "a metabolic toxic environment" due to true chronic maternal blood sugar problems, while also respec ng natural pregnancy, avoiding the over-diagnosis that might happen with the European tes ng standard, and the poten al for the nocebo effect? Nutrition Education and Individually Based Screening Decisions We know that obesity and inadequate nutri on are common problems for pregnant moms. We can't put our heads in the sand about this. We also know that what we eat in pregnancy is a set-up for lifelong health – or health problems – for our kids. So, we need to take this seriously. Knowing that you have a blood sugar problem and addressing this head-on can help you to have a much healthier, safer pregnancy and birth, and a healthier baby. A healthy Mediterranean-style diet adapted for pregnancy and moderate exercise is the op mal approach for both preven on and treatment of GDM. Tes ng for GDM is not necessarily problema c. It can be educa onal for women to see their blood sugar numbers and learn to adjust their diets accordingly. I've had many pregnant