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In my post about the pregnancy and prenatal care options I chose, I mention that I don’t take the pregnancy glucose test that requires drinking glucola (that syrupy orange or grape drink) and that I use an alternate method of testing. I’ve gotten so many questions about this that I decided it deserved its own post, especially while I am still pregnant and the topic is fresh on my mind.
IMPORTANT: Please note that I am only writing about my own personal experience with this and the decisions I made after consulting with my OB or midwife (depending on which pregnancy it was). The information in this post (or any post I write) is not medical advice in any way… I’m just sharing my experience. Always consult with your own medical providers before making health decisions, especially during pregnancy, and make sure that you find providers who are willing to work with you to make the best decision for your pregnancy.
All that being said, here’s what I do when it comes to the pregnancy glucose test.
What is the Pregnancy Glucose Test?
This was one of the sections I found in all of the many pregnancy books I read when pregnant with my first child. Current guidelines call for a glucose challenge test somewhere between 24-28 weeks of pregnancy to test for gestational diabetes.
This test typically involves drinking a sweetened drink called Glucola that contains 50, 75, or 100 grams of sugar in different forms. In most cases, the first part of this test is an Oral Glucose Challenge Test (OGCT) that involves drinking the 50 gram solution and having a blood test exactly one hour later to measure blood sugar. If a woman passes this test, she typically won’t be given further testing for gestational diabetes. If a woman does not pass the test, a longer test involving a higher level of glucose consumption may be used.
It is important to note that for this test, it is the amount of glucose present, not the drink itself that is important for measuring blood sugar levels.
Why Test for Gestational Diabetes?
This was one of my original questions and one that I researched in depth. I didn’t have a personal history of diabetes or even a strong family history of it, so I wondered if the test was even necessary. I found that rates of gestational diabetes (a type of glucose intolerance that occurs during pregnancy that often resolves itself once the baby arrives) had risen dramatically in recent decades.
Gestational diabetes (GD) has its fair share of risks and is very important to be aware of and proactive about if a pregnant mom has it. Estimates suggest that 5-10% of pregnant women in the US may have some level of gestational diabetes and since it can increase rates of many pregnancy and birth complications, it is important to correctly identify these women. At the same time, it is important to note that a woman’s body does naturally become slightly more glucose intolerant during pregnancy as the baby needs a steady supply (though not a large supply) of glucose for development.
Managing Gestational Diabetes
Gestational diabetes can often be regulated by diet, though insulin is sometimes needed. Untreated GD can lead to serious complications like increased rate of c-section & shoulder dystocia, babies larger than they should be for their gestational age, higher rates of preeclampsia in mom and low blood sugar in baby at birth.
Certainly, gestational diabetes is a serious problem and one that I absolutely wanted to rule out in my pregnancies, I just wondered if there was a more effective way to test for it.
My Concerns with Glucola
While I agree that it is important to test for gestational diabetes, I had concerns with the glucola test itself, mainly that it contained ingredients I would not normally consume while pregnant (or ever!) and that it has a higher amount of sugar than I would consume at any one time. Most women describe this drink as tasting like an un-carbonated and syrupy orange soda. No thanks!
The ingredients in the pregnancy glucose test vary depending on the specific type of glucose drink consumed, but most that I was able to find a label for contain food dyes, brominated vegetable oil (BVO), dextrose from corn, and other substances that I consciously avoid.
At the very least, I was annoyed about the presence of food dyes (which give me a headache) as they are not needed for the effectiveness of the test and are merely there to make the drink look better (and hint: it doesn’t make it taste better at all!). Some women have allergies to corn and citric acid, so the glucola test is not even an option for them anyway.
What is BVO?
The added dyes and BVO are not needed for the effectiveness of the test as there must be a specific amount of sugar and blood tested at a specific time. With my first pregnancy, there was not a dye-free and BVO-free option, although there now is (it is not commonly used yet though).
I was surprised to find that BVO (and many food dyes) are banned in other countries but still consumed here. At a time when I am extremely careful about consuming only whole, natural foods, it seemed counter-intuitive to drink something with such controversial ingredients.
I’m also well-aware of the common objections that women get when they question the ingredients in the Glucola- mainly that a woman should “be no more concerned about this than a can of soda during pregnancy” (which I don’t drink) or any other sugary or dye-containing food (which I don’t eat). Yes, at the end of the day, it is not likely that a mom or baby will have a life-threatening or even life-altering reaction to the Glucola drink, but this test may not be the most effective option either (and certainly not the most pleasant).
The Sugar Content
I also would not consume 50 grams (and certainly not 100 grams!) of processed sugar at any point during pregnancy and certainly not by itself. The test required fasting from midnight the night before the test and drinking minimal water during that time. Then, drinking what would essentially be almost my entire carbohydrate intake for an entire day in one sitting in processed form.
I questioned if this was actually a reliable way to test at all, since my body wasn’t normally dealing with these amounts of sugar. I realize that many people do consume this amount of sugar (and food dyes and dextrose) on a regular basis, but for me personally this test was not an accurate representation of the amount of sugar my body would have to handle normally.
Also, if the 50 grams of sugar was the important part of the test, why did it have to come from an artificially flavored and colored source? Couldn’t it come from another food or drink as long as it contained the same amount? Some research showed that not only was this possible, but it had already been studied. This study showed no difference in outcomes when subjects consumed 28 jelly beans instead of the glucose drink.
Bottom Line About the Glucose Drink & Test
It contains unnecessary additives for color/taste that, while not well studied in the US, have been banned in other countries. In the grand scheme of things, consuming a small amount of these ingredients in a single dose during a glucose test is probably not going to cause long-term health problems and may just result in a mom not feeling well for several hours.
Undiagnosed gestational diabetes is a potentially much bigger problem than the additives in the drink, but considering the additives are unnecessary for the effectiveness of the test, I hope that the medical community will continue to research these ingredients and develop a dye and BVO-free version.
Is the Glucose Challenge Screening Accurate?
I also had questions about the accuracy of the glucose challenge screening for the following reasons:
There is a high rate of false positives on the 1-hour glucose challenge test. In fact 15-20% of women will test positive on this test, but only 2-5% of women will test positive on the follow-up test or be diagnosed with gestational diabetes (though a positive on the 1-hour test can be a risk factor it itself). There seems to be a higher rate of this if mom does not normally consume sugar in these amounts.
Additionally, since pregnant women are not advised to fast or restrict water at any other point of pregnancy, this may be part of the problem as the test is often done after a long period of fasting. It is also important to remember that the OGCT is simply a screening test and not a true diagnostic test. A study found sensitivity and specificity of the 1-hour glucose challenge test were 27% and 89%, respectively, with a prevalence rate of 5%.
Could the test be wrong?
In fact, as “The Pregnant Mathematician” points out, when the test is evaluated mathematically, there is both a high rate of false positives and false negatives in women who may actually have GD. She breaks down the math:
Let’s assume we give the same 1-hour glucose challenge test to 10,000 pregnant women. With a prevalence rate of 5%, we would expect 500 women to have GDM and 9500 not to have GDM. Of the 500 with GDM, since the sensitivity is 27%, we know 27% of 500 would screen positive, for a total of 135 women. These are women who have GDM and whose screening will come back positive. Meanwhile, of the 9500 women without GDM, since the specificity is 89%, we would expect 89% of 9500 or 8455 women to have a true negative result.
According to this table, a total of 135+1045=1180 women would test positive. Of the women who get a positive result, only 135 of them really have GDM; this is the positive predictive value and, in this case, it’s 135/1180 = 11.44%.
Of the women who test negative- Out of 8820 only 8455 would actually not have GD. This gives a negative predictive value of 8455/8820 = 95.86%.
What does that all mean? If you aren’t into the math, it means that there is a decent chance that a woman who doesn’t have GD will receive a false positive and also a chance that a woman may test negative and actually have GD.
Differences Depending on When Test is Taken
Another study showed that results varied noticeably depending on when the glucose challenge test was given. Since glucose rises naturally as pregnancy advances, it is possible for a women to pass the OGCT if taken earlier (23-25 weeks) but fail if taken later in pregnancy (28-30 weeks).
Screening, Not Diagnostic
As this is just a screening test with room for error that is testing for a problem with the potential for big complications, I decided to find out if there was a more accurate alternative that could be used instead of or in addition to the 1-hour glucose challenge test.
Are There More Effective Alternatives?
Food and Drink Alternatives to Glucola
As I mentioned, there are dye-free and BVO-free alternatives to the drink, though they can be difficult to find and it seems that many doctors are not aware of them.
Some doctors provide alternatives to glucola and I have friends who (at the advice of their doctor) instead consumed things like:
- 6 ounces organic grape juice + a banana
- 1 cup milk + 1.5 cups cereal
- Pancakes with 1/4 cup maple syrup
- 28 dye-free jelly beans
- Natural soda with 50 grams total sugar
- 16-ounces orange juice
These options are not as well-studied as the glucose drink but are often much more palatable to a pregnant mom. It is important to note that these options are not straight glucose but contain a mixture of glucose and fructose (and other starches/sugars).
Even if effective, these options will also have the same statistical problems as glucola for the screening test and may miss women who have GD or falsely identify women as positive who actually do not have GD.
Blood Sugar Monitoring
After much researching and talking to my doctor and midwives, I eventually chose what I found to be a more effective and accurate way to test my blood sugar: blood sugar monitoring.
In fact, this is considered so effective that it is part of a regular monitoring program for people who have diabetes and women who are diagnosed with gestational diabetes are often required to monitor their blood glucose anyway.
At-home glucose monitoring is also used to help identify if a woman has GD after receiving a positive on the OGCT, so I skipped the screening and went straight to the diagnostic/monitoring with blood glucose testing.
Sure, the finger stick isn’t fun (though I’d argue it is more fun than drinking syrup), but it provides a much more accurate look at the body’s response to glucose on a daily basis. Additionally, this option can be easily done at home and once I received the “ok” from my doctor/midwives, I was able to get the supplies for at-home monitoring for less than the price of the OGCT with our insurance.
Here’s Why I Chose Blood Sugar Monitoring
It provided a more long-term view of what my glucose levels were doing and more insight into how individual foods affected by blood sugar on a daily basis. Additionally, it let me monitor throughout pregnancy, not just in a one-hour window at 28 weeks, and adjust my diet based on my personal readings.
In fact, after talking with my doctor, this is an option I would personally choose in addition to taking the 1-hour glucose challenge test if I was going to take it. Given the high rate of false positives and negatives on the OGCT, actually monitoring blood sugar is a more accurate way to keep an eye on blood glucose levels throughout pregnancy.
Many women who do have GD are able to manage their condition with diet alone under the guidance of a doctor and nutritionist by consuming whole foods and reducing processed carbohydrate intake. I already consume a real-food diet and limit all processed foods, so I found that monitoring my blood sugar at home was a fascinating glance into how my body handled different foods.
In fact, I was surprised to find that white rice didn’t affect my blood sugar as much as I expected, but certain fruits did.
For glucose monitoring, I use Levels and highly recommend them. They make continuous glucose monitoring mainstream for the first time ever and the data is fascinating! In addition to providing you with CGM sensors, the Levels app interprets your data, scores your individual meals, and allows you to run experiments across different inputs like diet, exercise, and allows you to see your glucose levels with one touch of your phone.
What I Did
At around the 28-week mark of pregnancy, I always tested my blood sugar for about a week at the following times:
- Fasting reading as soon as I woke up
- 1-hour after each meal
- 2-hours after each meal if reading was not below 120 at 1-hour
- Several times after purposefully consuming a really high-carb meal
- At other times just out of curiosity, including a few times after purposefully eating about 50g sugar just to see how I would have done on the OGCT
At my doctors recommendation, these were the ranges I was looking for to make sure my blood glucose was in a healthy range:
- Fasting blood glucose (first thing in the morning) of 86 or lower (Mine ranged from 81-85)
- 1 hour after eating= 140 or lower (mine was always below 120)
- 2 hours after eating= 120 or lower (mine was usually around 100)
- 3 hours after eating= back to fasting level (yep)
There can be some variation in this, but the majority of my readings should be in these ranges. I do this at 28 weeks and 33 weeks (my preference) and also throughout the last trimester to make sure my levels are good.
Hemoglobin A1C Test
I should also note that in regular blood testing and monitoring with my doctor for my thyroid during this pregnancy, I also had my Hemoglobin A1C tested at several points. This test is run as part of the regular panel at my local lab and it is also a test used in monitoring and controlling diabetes as it measures average blood glucose over a period of 3-months. It has been used as an alternative to oral glucose testing in some patients and is routinely used for patients with regular (non gestational) diabetes. I didn’t specifically use this test as an alternative to other forms of GD testing but considered it good insurance since my levels were well within normal.
Bottom Line: My Hope for The Future of GD Testing
I share this information just as a mom who has been through it six times and not as a medical professional of any kind. Any pregnant woman should absolutely work with her doctor or midwife to determine the safest and most effective form of testing for her and her baby.
My hope is that as more women question the need for unnecessary ingredients in the glucose drink, dye and preservative free options will become more common and easy to find. Yes, the levels of dyes and preservatives in current options are pretty low, especially if it is only consumed one time, but this drink is routinely given to all pregnant women and there is absolutely no medical reason for the additives and no reason to expose unborn babies to them, no matter how small the risk!
There are also some concerns with the rates of false positives and negatives with the 1-hour oral screening test, and it is simply that: a screening test and not a diagnostic one. As I said, I don’t think that women should refuse the test and do nothing, but I have my doubts about the accuracy of the test and think that there are potentially much better options to a one-hour glance of blood glucose at 28-weeks.
I hope that more women will question the presence of these additives in the glucose drink and take a more active role in working with their healthcare providers to decide if the current OGCT is the best option for them. Many doctors and midwives seem to be open to alternative testing measures like dye-free glucola and at-home blood sugar monitoring.
What I did:
My personal choice, after consulting with my own health practitioners, is to focus on a very nutrient-dense whole-food diet that contains enough protein, healthy fats and vegetables throughout my pregnancy (which is similar to the diet recommended for a woman with gestational diabetes anyway) and to test my blood glucose at home throughout pregnancy as a more accurate way of accessing my risk of GD.
I didn’t “refuse” the OGCT (as I wasn’t asked to take it) but chose a more involved method of testing and monitoring that I felt provided a more accurate picture of blood glucose levels and actual risk of gestational diabetes. (And my results were normal with all of my pregnancies and my babies ranged in weight from 6.5 to 7.5 pounds).
Did you drink the glucola? What were your results?
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Discussion (57 Comments)
My Dr said not to drink that stuff, but go out for a big breakfast with pancakes, syrup, bacon, etc… Whatever you wanted, then tell them you want to challenge the test and not drink the gross liquid. Sorry I can’t quite remember all the details. But yes, for someone who never eats sugar or processed food that orange stuff can be quite a shock! I did do the test with my first child and it was not pleasant.
I was diagnosed with gestational diabetes in my first two pregnancies. I monitored my glucose through both and my glucose readings were always within normal ranges (mostly under 120 mg/dL 1 hour post-prandial). I highly recommend finger-prick testing at regular intervals instead of any of the glucose challenge tests. I was very frustrated that I got the label of being higher risk. I was constantly paranoid about my weight. I gained about 27 lbs. with my first, 32 lbs. with my second and was always, but for some reason during the fifth month, my weight jumps 7-9 lbs instead of the text book 4 lbs–at that point, I felt guilty like I was eating too much or causing my baby harm. I am currently pregnant with my third and because of being diagnosed the first two pregnancies, they already assume I have GD for the third, so I don’t have to take the test. However, I do think that I fall into the false-positive category, or that I simply do not have a tolerance for 50 grams of glucose first thing in the morning after fasting. I think that’s about all the insight I was able to glean from both pregnancies and a lot of glucose testing! No, I am not the type who should eat powder-sugared jellied donuts for breakfast–but my eggs/kale and sauerkraut are likely not doing much harm. I just don’t eat a lot of carbohydrates usually, so those tests are just a shock to my system. I have found (more through testing than the glucose tests themselves), that I do not tolerate starches well later in pregnancy. No sweet potatoes, and definitely no white potatoes. Short of the starches, I do fine with other fruits and foods–but it’s really handy to have this information. My highest glucose reading in all of my pregnancies came from eating a sweet potato, adzuki bean, kale casserole. Starch anyone?! This article is great–thanks! More moms need to know their alternatives!
I took the test and was slightly above the normal range. My OB wanted me to take the second test, which was a much longer fast. I refused. I wasn’t eating super crunchy at that part of my life but I knew that I didn’t want to drink another one and fast again. It was really hard on my body, my mental attitude, and I had to take the morning off of work for it! I said that I’d rather treat my body as if I had it and follow the special gestational diabetes diet than take the test again. I ended up doing neither, with my OB’s approval, though my OB’s partner gave me an irritating lecture while I was in labor about it which was irritating as that ship had sailed! But I was that natural laborer who went 42 weeks before allowing an inducement. Yay for doulas and supportive husbands!
Just to comment from my experience – I do think the dye-free/BVO-free alternatives are becoming more-readily available. I’m currently 35 weeks pregnant, and I did do glucola screening at 28 weeks. The sans-additive version was the only glucola option that my birth center offered. Also, I wasn’t required to fast; I was told to stay away from simple carbohydrates the day of the test. I agree with your observations on false positives, and it’s probably not fantastic for the baby to be intentionally spiking your blood sugar for just testing, but for the majority of pregnancies, I understand why the 1-hour screening is the go-to test. I respect your choice to go through testing yourself for the increased accuracy (I might consider it for my next pregnancy), but I also understand why a doctor/midwife might be hesitant to recommend testing that requires on-going independent monitoring on the mother’s part. It’s great to hear about another alternative for motivated moms though!
I did blood sugar testing at home with my second pregnancy. Since I don’t consume a lot sugar on a normal day it didn’t make sense for me to do the glucola test. Luckily, I had a midwife who wanted to work with me and what I was comfortable with.
With my second pregnancy I knew I was allergic to preservatives and additives and so I shared my concern with that drink with my Dr. She allowed me to look at the ingredients and sodium benzoate was listed (its one of my worst offenders). She offered instead to allow me to pick out a candy bar for the test that had the same amount of sugar; which wasn’t healthy but sadly better than the drink. She told me how far timewise before the test to eat it and it all worked out fine. I am going to try and get a healthier alternative this time around.
My midwife group let me do the Red Machine Naked juice. Although it shows you that we don’t need that much sugar even from natural forms in one sitting, I felt better that it wasn’t processed and with food dyes (and it tastes much better)! Thanks for this post!
Katie – could you please tell me, can these monitors be used to check for non diabetic hypoglycaemia? Thank you.
I don’t know… I would recommend asking your doctor.
Hi Trudy–You can use your monitor to check your glucose 1 or 2 hours post-prandial and it will help give you an idea if you are adjusting your carbohydrates/starches well enough to keep high or low glucose levels in check. Sometimes in early pregnancy, I feel like my glucose will be lower than normal, even after a full meal. You can’t really use it as a self-diagnostic tool (your doctor will have better tools to find out what your glucose is doing on a longer term scale (Hba1c)), but you can use it to guide what you eat to help you manage your glucose levels on a daily level. To get a general read, I usually test four times a day over a three day period–fasting (right when I wake up), 1-hour after breakfast, 1-2 hours after lunch, and 1-2 hours after dinner (usually 1 hour during pregnancy). Then I’ll take a break for a few weeks and try again, or test once in a while if I think I ate a larger than usual serving of starch or carbohydrates. I do not have diabetes, but my glucose levels are more sensitive during pregnancy than they are otherwise, and given my family history, I am already at higher risk for developing diabetes, so it’s good for me to keep tabs on it on a regular basis without getting obsessive about it!
Very informative and enjoyable! I’m old enough I only had to do this with the youngest of my daughters. A point I had never thought of, tho, I encountered with my youngest daughter’s first pregnancy. She had hyperemesis. At one point I took her to her regular checkup and we admitted her immediately for IVF and electrolyte replacement. Her test results were all over the board, naturally, but it hadn’t been brought up to her that if she couldn’t keep anything down it might not be the best idea to do this test. Lol! Poor angel! She wouldn’t tell me how bad it was, altho I am a nurse, or maybe because I’m a nurse. I don’t know. But this time she’s doing better and I’m hoping she’ll listen to you! Cause she sure don’t listen to me!
Very insightful article, thank you! I did not take the Glucose test. I was 19, seeing a conventional nurse midwife, and already had many questions that she couldn’t answer as well as several downright scare tactics used on me since I expressed my desire early on to have an unmedicated birth. I also felt bullied, likely due to my age and looking even younger. I was very fit, healthy, already eating a whole food, plant based diet, and a very healthy weight. My mother was diagnosed with GD with both my brother and sister, toxemia with my sister. She was also very overweight, ate poorly, had high blood pressure, and stress. I asked how I could possibly be destined (as I was told) to expect a pregnancy like my mother’s when my lifestyle was so different and my body was much healthier. And it was far different and rather enjoyable. So, after having so many of my questions left unanswered, I transferred care to the local midwife and was by this time, 28 weeks. I had my blood tested over the course of several days and it was very normal and as it should be. Back when I was given the bottle of Glucola, I just looked at it and had a disturbed and rather uneasy gut feeling about it too. Now, I am so happy I didn’t. My personal experience!