There is a summary and list of suggestions at the end of this page
The following description of gestational diabetes is reprinted from The Brewer Medical Diet for Normal and High-Risk
Pregnancy, by Gail Sforza Brewer [Krebs] with Thomas Brewer, M.D., published in 1983. While the standards recommended
by the Diabetes Data Group may have been revised in more recent years to yet another, possibly even lower blood glucose level,
which I will be researching in coming weeks, the principles advocated by Dr. Brewer in this reprint remain relevant.
For an additional source on gestational diabetes, please see "Gestational Diabetes: Myth or Metabolism?", by Joy Jones,
RN, which has been reprinted at the end of this page.
For more information on testing for blood glucose and proper nutrition for apparently elevated blood glucose levels, please
see Understanding Diagnostic Tests in the Childbearing Year, by Anne Frye, CPM, listed on our "Resources" page.
Perhaps you can obtain a copy of that book from your local public library, or through inter-library loan.
See here for "Gestational Diabetes: A Diagnosis Still Looking For a Disease?" by Dr. Michel Odent
See here for "The Emperor Has No Clothes", by Henci Goer, an article which includes information about the flawed studies which
contributed to the current standards of care for "gestational diabetes".
Click here to see the bottom of the "FAQ" page for suggestions on how to decline the Glucose Tolerance Test
See here for information about the Hemoglobin A1C test (remember that this source is referring to Type 1 diabetes, not "gestational
"Diabetes" (p. 211)
While there is general agreement among specialists about improving the outcome of pregnancy for the mother with insulin-dependent
diabetes, controversy rages about class A diabetes, that is, "gestational diabetes"--irregularities in blood glucose levels
that appear in an individual woman only during pregnancy. The problem stems, in our opinion, from a redefinition of what
constitutes diabetes in pregnancy, formulated by the National Diabetes Data Group in 1979.
Prior to that time, a blood glucose level of 140-150 milligrams per milliliters of plasma after fasting for twelve hours--the
level considered normal in the nonpregnant--was used as the upper range of normal in pregnancy, too. However, owing to new
research conducted on pregnant women in which blood glucose levels were measured over the course of thousands of pregnancies,
a new, much lower number--105 milligrams per milliliters was recommended as the upper limit of safety during pregnancy.
And this is the number now being enforced by many doctors who give a great deal of attention to diabetes screening in their
The difficulty with the new research is that, like almost all other research conducted in pregnancy, no attempt was made to
determine what is the normal blood glucose level in well-nourished subjects! That is, the research samples included large
numbers of women who had never been advised what a proper diet consists of in pregnancy, much less been carefully evaluated
for nutritional problems as pregnancy progressed. So, while 105 turns out to be the average number for all these women, it
is highly likely that it is incorrect for the well-nourished. The reason: Well-nourished women who have adequate protein,
calories, vitamins, and minerals keep their blood glucose levels normal and even maintain an energy supply reserve (glycogen)
stored in their livers. This glycogen reserve is called upon to keep blood levels of glucose within normal ranges, should
you go for a few hours without eating.
In the well-nourished woman, these glycogen stores are good for about twelve hours. But in the poorly or marginally nourished
mother, the glycogen stores are minimal or even non-existent. So the blood level of glucose falls soon after eating and scrapes
along until the next meal. We are certain that 105 milligrams per milliliter is an artificially low level for pregnancy
blood glucose, a determination that was heavily weighted with results from women whose pregnancy diets simply were not adequate
for the nutritional demands pregnancy imposes.
We are making a big point of this because of the intense anxiety produced in the mother who is told not only that she is diabetic,
but that even with minor elevations of glucose she is likely to experience the full gamut of disastrous pregnancy outcomes
associated with full-blown, out-of-control diabetes. Furthermore, as calls to our hotline indicate, many women are not
being couseled properly about the dietary and exercise aspects of diabetes when their "gestational" diabetes (according to
the new criteria) is diagnosed. Instead, they are hurried directly onto insulin therapy--and ordered to check their glucose
levels at home every hour to keep it between 100 and 105!
All too often, the physician who has ordered this form of treatment also sends the mother home with one of the old, hazardous,
restrictive diets or just tells her to "cut out all carbohydrates." Calls from all over the country indicate to us that this
is not an isolated phenomenon, but a growing trend in diabetes management that bodes ill for the health of the many thousands
of pregnant women who will be falsely diagnosed as diabetic and then be further mismanaged in terms of their nutritional needs.
You may find yourself in this predicament if:
If you and your doctor disagree on what is to be done about your pregnancy care, you may have to search for someone whose
philosophy and practices are more in keeping with your own. Before taking any glucose tolerance tests, inquire about the
doctor's proposed plan of therapy, should you turn up as a "gestational" diabetic, and ask what level of blood glucose the
doctor uses to decide if you are well or not. If you don't like what you hear, call the medical school nearest you for referral
to a diabetes specialist who might, at the very least, be able to send you reprints dealing with the dietary management aspect
of your care that you could then bring in to the doctor on your next visit. Some physicians are open to discussion with their
patients; others discharge you from their practice if they feel you are unwilling to comply with their way of doing things.
Regardless of what you decide to do, keep your nutritional needs clearly in mind and meet them every day. Our diet is well
suited to the needs of the diabetic mother, with additional protein intake in the form of between-meal snacks to achieve the
1-gram-per-pound ratio that the best research advises.
See this article regarding the risks of ultrasound in pregnancy, and others on my "Other" page
See here to better understand the evolution of the mainstream medical perspective on nutrition and salt in pregnancy
The following has been reprinted from Mothering magazine, #50, Winter 1989. There will be an updated version
of this article, in the same magazine, sometime in the next few months. Even 20 years later, the basic principles remain
"Gestational Diabetes: Myth or Metabolism?" by Joy Jones, RN (p. 59)
With increasing frequency, birth practitioners are recommending glucose screening tests for pregnant women. They are telling
women that the health of their pregnancies and the lives of their babies are in jeopardy if they refuse testing. As a result,
many childbirth educators, birth practitioners, and pregnant parents are having to answer some probing questions: Do I really
need this test? What can I do to pass the test? Could I take another test instead? Is there such a disease as "gestational
Several professional organizations have published testing guidelines. The American Diabetes Association recommends that all
pregnant women take a one-hour glucose test.(1) The Centers for Disease Control advise that preferably all pregnant women,
but definitely those with diabetic risk factors or over the age of 25, take a one-hour glucose test.(2) The American College
of Obstetricians and Gynecologists recommends that women who have indications of diabetic risk or who are over the age of
30 have glucose screening.(3) The American College of Nurse Midwives has not yet published any guidelines [as of 1989], since
research on the subject is still incomplete, and its members usually follow the protocols of their medical backup.
Not only do the guidelines vary, but the test results themselves are questionable. And yet these results can signify the
difference between a low-tech or high-tech pregnancy and birth. Moreover, some birth practitioners do not feel that "gestational
diabetes" is an illness requiring treatment. The controversial nature of "gestational diabetes" becomes clear when it
is distinguished from the clinical picture of diabetes in individuals who are not pregnant.
Clinical Diabetes in Nonpregnant Populations
What happens when you eat carbohydrates and sugars? Enzymes convert the food into simple sugars, some of which are digested
and used immediately and some of which are stored for future use. Glucose, the most important sugar, enters the tissue cells,
where it combines with oxygen to form carbon dioxide and water. The energy released by this chemical reaction is used for
muscular work and for maintaining bodily temperature. Insulin, a hormone secreted by the pancreas, promotes the transport
of glucose across the cell wall.
Diabetes is often thought of simply as a lack of insulin. However, according to Foster in Harrison's Principles of Internal
Medicine, the term diabetes can refer to many different syndromes.(4) The symptoms of diabetes mellitus, one of
those syndromes, include the presence of sugar in the urine, excessive thirst, excessive urination, increased food intake,
and an elevated plasma glucose (blood sugar) level. Diagnosis of diabetes mellitus is generally made on the basis of test
results alone if the fasting plasma glucose levels are persistently elevated.
The symptoms of diabetes mellitus are associated with one of three major physiological conditions: a lack of insulin,
an elevated production of glucose, or an insulin resistance. These conditions have several root causes [see
chart]. A lack of insulin can be caused by viruses(5) or a diet high in unsaturated fatty acids, low in magnesium,
and low in vitamin B-6, which can damage the pancreas enough to reduce insulin secretions.(6)
Elevated plasma glucose levels, or hyperglycemia, can be produced by an infection or the presence of epinephrine
(adrenalin), estrogen, or steroids in the blood.(7) In response to the stress of infection, the body secretes
epinephrine and cortisol. Epinephrine increases blood sugar by causing the liver to break down glycogen (a stored carbohydrate).
Estrogen, progesterone, and lactogen may raise blood sugar by counteracting the action of insulin. Steroids stimulate the
liver to form more glucose from proteins and fats.
The third condition, insulin resistance, can be caused by obesity, physical inactivity, or food deficiency (especially
carbohydrate deficiency). Obesity reduces the relative number of insulin receptors, which are needed in the transport of
insulin across the cell wall.(8) Physical inactivity or insufficient food can cause a decreased carbohydrate tolerance, which
in turn leads to insulin resistance.(9) In extremely rare cases, insulin resistance is due to the secretion of unusual
types of insulin.(10)
In addition, genetic factors can predispose the body to react to any of the above influences with symptoms of diabetes.(11)
In such instances, as well as in some of the above situations, an individual with normal test results may be "considered
a potential diabetic because of lifestyle, physical history, or family history."(12)
In "gestational diabetes"--also known as Class A, latent, chemical, or preclinical diabetes--a pregnant woman having no symptoms
of diabetes has test results similar to those of nonpregnant diabetics. By definition, this "diabetes" ceases once the pregnancy
is over. Clinical diabetes that is diagnosed prenatally and persists beyond the pregnancy is not properly called "gestational
diabetes." [see sidebar]
Many birth practitioners question the existence of "gestational diabetes" because it is often diagnosed solely on the basis
of a response to a test. Why would a nonsymptomatic mother show elevated blood sugar levels? Perhaps her body is reflecting
the chemical gymnastics imposed by the test itself--which may involve fasting followed by the consumption of large doses of
concentrated glucose. Or perhaps her body is registering a healthy response to the inherent dynamics of pregnancy.
Blood sugar elevations during pregnancy can result from several factors. Any of the root causes of clinical diabetes mentioned
earlier may be operative. Another possibility is that the placenta secretes lactogen, estrogen, and progesterone--hormones
that counteract the function of insulin--as well as potent enzymes that destroy insulin.(13) Would the placenta, an organ
designed to sustain a pregnancy and nourish a baby for nine months, consistently make this "mistake"?
It is important to understand that the body handles glucose differently during pregnancy. In Birthrights, Sally Inch
explains one reason for the pregnant body's need for "hyperglycemia" (higher blood sugars): "Instead of being rapidly converted
to glycogen and stored in the liver for future use, the glucose remains for longer periods in the [woman's] bloodstream so
that her developing baby has an easily available source of energy that can be used for growth and storage as fat (+glycogen)."(14)
Tom Brewer, MD, has found that well-nourished pregnant women can maintain rather stable plasma glucose levels and adequate
glycogen stores in the liver, whereas poorly or marginally nourished women have minimal or nonexistent glycogen stores. In
such instances, the plasma glucose level "falls soon after eating and scrapes along until the next meal."(15) If today's
pregnancy standards have been set by research conducted on undernourished women--a likely assumption, based on several decades
of recommended weight restriction--then low blood sugar levels may appear to be the norm. However, it may be truly normal
to maintain higher levels than current standards allow for.(16)
Another normal occurrence in pregnancy is a lowered renal threshold for glucose and other sugars. On the average, the kidneys
filter 170 liters of filtrate out of the blood daily. Only 1 to 1 1/2 liters are eliminated as urine, whereas about 108
liters are absorbed into the bloodstream for bodily use. Some of the substances reabsorbed have a well-defined reabsorption
limit, or "renal threshold."(17) During pregnancy, the renal threshold for sugar changes, and glucose is excreted in the
urine at a lower blood plasma (liquid portion of the blood) levels.
There is a good reason for a lowered renal threshold for glucose during pregnancy. If a woman is eating well, her blood volume
increases by 40 to 60 percent. (If a woman is not eating well, her blood volume may decrease.) As a result, the amount
of blood flowing through the kidneys and the rate at which fluid passes from the blood through capillary walls in the
kidneys increas by about 40-60 percent. At the same time, the reabsorption rate of the filtrate into the blood remains the
same or decreases.(18)
Since the reabsorption rate does not keep up with the filtration rate, some substances do not get reabsorbed as efficiently
as in nonpregnancy. For instance, in nonpregnancy, the kidney will continue to reabsorb glucose until blood sugar levels
reach about 170 mg/100 ml., when the kidney will begin excreting glucose with the urine; during pregnancy, however, the kidney
may stop reabsorbing glucose at a much lower blood sugar level (100 mg/100 ml), and sugar may show up in the urine even
though glucose levels in the blood are normal.
Finding sugar in the urine at a prenatal visit usually does not mean that plasma glucose levels are higher than is
healthy. According to William's Obstetrics, about one-sixth of all pregnant women spill glucose in the urine.(19)
Evelyn Burns, in "Diabetes Mellitus and Pregnancy," reports that glucose in the urine occurs in 50 percent of all normal
A birth practitioner who does not believe that some glycosuria (the presence of glucose in the urine) is normal in pregnancy
or who wishes to rule out other symptoms suggestive of clinical diabetes will recommend prenatal testing. Typical options
include a fasting blood sugar test, a one-hour glucose test, a two-hour postprandial blood sugar test, a random blood sugar
test, a hemoglobin A1C test, and a glucose tolerance test (GTT). Some practitioners consider the two-hour postprandial and
random blood sugar tests to be nonstandardized (not uniformly analyzed) and prefer not to use them.
The fasting blood sugar test requires an eight- to 12-hour fast, after which a sample of blood is drawn to determine
the fasting blood sugar level. Normal values range from <105 mg/100 ml to <150 mg/100 ml, depending on the philosophy
of the birth practitioner. (Note: "<" means "less than.")
The one-hour glucose test requires an eight- to 12-hour fast, after which a preliminary sample of blood is drawn.
The mother is then given 50 grams (the equivalent of 2 ounces) of glucose, in the form of a "glucola" drink; one hour later,
a second sample is drawn to determine the level of glucose present. "In general, the upper limit of normalcy increases with
age and during pregnancy."(21)
An interesting variation of this test appears in the winter 1987 issue of Midwifery Today. Here, the one-hour glucose
test is conducted at 24 to 28 weeks gestation, and the mother does not fast for the test. A value of 140 mg/100 ml
or higher suggests "gestational diabetes." Also included is a recipe for a homemade glucose concentrate to be given during
A major problem with both standardized tests is the long period of fasting that is required.(22) Even a well-nourished pregnant
woman depletes the glycogen supplies in her liver after 12 hours of fasting. (An under-nourished woman may deplete her glycogen
stores soon after each meal is digested.) This depletion causes the nausea that many women experience after eight to 12 hours
without food. Ideally, pregnant women should eat something every two to three hours around the clock.
Fasting during pregnancy creates problems on the metabolic level as well. When blood sugar levels are low, the body restores
them by breaking down reserves of fat. "The continued demand for glucose and amino acids for fetal anabolism [tissue building]
causes a state of 'accelerated starvation.' Lypolysis [fat breakdown] to mobilize fat as metabolic fuel occurs more rapidly
during pregnancy."(23) As a result, blood levels of ketones (by-products of fat breakdown) rise. After repeated episodes
of high ketone levels over a period of several days or weeks, especially in the first trimester, impaired intellectual performance,
developmental abnormalities, or fetal death can occur.(24) The postprandial, random blood sugar, or hemoglobin A1C tests
may be better alternatives than those with extensive fasting requirements.
The two-hour postprandial test requires blood sampling two hours after a meal has been eaten. The mother should be
encouraged to eat a "generous breakfast in which carbohydrates are well supplied, such as pancakes, with syrup, sausages,
and a large glass of orange juice."(25) Normal test values range from <120 mg/100 ml to <140 mg/100 ml.(26) (One obstetrician
in the Chicago area accepts an upper limit of 170 mg/100 ml.) Postprandial guidelines often suggest glucola in lieu of a
generous breakfast; however, eating a meal is a healthier option.
The random blood sugar test evaluates blood that is drawn at a random time of day. Fasting is not necessary, and only
one blood sample is needed. The upper range of normal varies from about 100 mg/100 ml to 110 mg/100 ml. Test results for
women on the high-protein Brewer diet [see For More Information] and women who eat several snacks between meals tend to be
slightly higher than those for mothers who eat only three meals a day.
The hemoglobin A1C test also does not require fasting. It analyzes glucose levels over the previous 120 days (the
life span of a red blood cell), and results are not influenced by food eaten in the hours before the blood is drawn. A1C
is a type of hemoglobin that absorbs glucose; a large percentage of saturated hemoglobin may indicate high blood sugar levels.
Only one blood sample is drawn, and the normal values range from 4 to 7 percent of total hemoglobin.
The glucose tolerance test (GTT) is often considered the most definitive procedure for determining whether or not glucose
is being properly managed. The GTT requires an eight- to 12-hour fast, after which the first blood sample is taken to determine
a fasting glucose level. Then the woman drinks 50 to 100 grams (2 to 4 ounces) of concentrated glucose (glucola), and blood
and urine samples are taken at half-hour (sometimes omitted), one-hour, two-hour, and three-hour intervals. Infrequently,
a five-hour sample is taken. The normal blood plasma values for the three-hour GTT are as follows: fasting-- <105 mg/100
ml; half-hour-- <200 mg/100 ml; one hour-- <190 mg/100 ml; two hours-- <165 mg/100 ml; and three hours-- <145 mg/100 ml.
Normal values are lower when whole blood is tested.(27)
Because of the widespread use of the GTT, it is important to be aware its drawbacks. First, the mother is required to fast
for eight to 12 hours before being tested. Secondly, several factors can lead to false-positive results: "It is mandatory
that the patient be on a preparatory diet containing 250 to 300 g carbohydrate for three days before testing; otherwise a
decreased carbohydrate tolerance may be observed, known as starvation diabetes. Physical inactivity also decreases
carbohydrate tolerance, and therefore prolonged bedrest may give false-positive results."(28) Women taking the GTT or the
one-hour glucose test are advised to take a long walk--from 1 to 3 miles--between ingesting the glucose and having each blood
sample drawn, as this will tend to lower the blood sugar levels. And thirdly, the GTT floods the mother and baby with high
levels of concertrated glucose. The effects of glucose flooding, particularly after several hours of fasting, are unknown.
Finally, one of the greatest problems with the GTT is its inaccuracy. Influences such as diet, age, stress, fever, infection,
overwork, lack of exercise, illness, and worry can easily cause unreliable results. Even anxiety about the needles or about
the the consequences of test results can provoke a flood of epinephrine, which in turn releases glucose and blocks insulin
release, resulting in unusually high recordings of glucose levels.(29)
How accurate can the GTT be, and how accurate is it? Dr. Edward Pinckney writes in Dissent in Medicine that an excellent
test is right at least 97 percent of the time, and any test that is less than 80 percent accurate should not be undertaken
until its potential benefits are shown to outweigh its known risks.(30) According to Foster in Harrison's Principles of
Internal Medicine, 75 percent of clients shown by the GTT to have "impaired glucose tolerance" (a possible tendency for
diabetes) never actually develop diabetes.(31) The implication is that positive GTT results are accurate only 25
percent of the time.
How reliable is prenatal diabetic evaluation? In 1979, the National Diabetes Data Group lowered the commonly accepted standards
for normal glucose levels in pregnancy. The upper limit for the fasting glucose test dropped to 105 mg/100 ml from the previously
accepted level of 140 mg/100 ml. The upper limit for the two-hour postprandial test dropped to 120 mg/100 ml from 150 mg/100
ml.(32) Consequently, many well-nourished women with normal plasma glucose levels before 1979 would now be considered to
have abnormal glucose levels and would be diagnosed as having "gestational diabetes."
Diagnostic Objections and Complications
The diagnosis and treatment of "gestational diabetes" elicits four major objections for birthing reform advocates.
The pregnant woman is diagnosed purely on the basis of a test and is not perceived in the context of her multifaceted life.
Laboratory results that are used as more than ancillary guides to diagnosis lead to false conclusions. The many factors
that can influence a woman's blood sugar level must be investigated. Is her insulin production being affected by a virus
(mumps, hepatitis, infectious mononucleosis, congenital rubella, or Coxsackie) that she may have been exposed to shortly before
or after conception? Is her insulin production being inhibited by diuretics, adrenalin (due to anxiety or stress), or a diet
high in unsaturated fats and low in magnesium and vitamin B-6? Is she afraid of needles, hospitals, or medical settings in
general? Could she be experiencing starvation diabetes from morning sickness, the flu, or the belief that she should restrict
her weight gain? Has her insulin been tested to see if it is an unusual type? Is she on bedrest or living a sedentary lifestyle?
Is she overworked or worried? Does she have an infection? Is she having conflicts in her personal relationships?
The laboratory tests are often misunderstood and misused. Standards vary from lab to lab, and different labs evaluate
different parts of the blood and use different techniques for measuring blood glucose. Some tests--the fasting glucose, the
one-hour glucose, and the GTT--measure an artificial response to the test and do not account for the mother's particular metabolism
The baby is affected by the mother's diagnosis. Prenatally, the baby is influenced by the testing, dietary restrictions,
and medication; postnatally, the baby is often subjected to hourly heel pricks for the first 12 hours of life. Blood sugar
checks such as these may be justified for babies born to mothers with poorly controlled clinical diabetes--since these
infants may be hypo glycemic after birth, which could lead to tremors, respiratory distress, listlessness, feeding difficulties,
Do babies born to mothers diagnosed as "gestationally diabetic" require continuous monitoring? Some pediatricians say no.
They feel that if the mother's blood sugar levels are not abnormally high, her baby will not have problems with hypoglycemia.
Dr. Robert Mendelsohn, author of How to Raise a Healthy Child...In Spite of Your Doctor, took this one step further.
He claimed that "gestational diabetes" does not exist and that the baby born to a mother diagnosed as such does not need
to be tested.
Is "gestational diabetes" a defect in metabolism or a myth borne out of a misunderstanding of normal pregnancy? The definitive
answer is not in yet. Unfortunately, as Elizabeth Noble says, "a great many people share the medical establishment's mechanistic
view that control of nature is good and that progress is only a matter of more--more pills, more techniques, more information."(34)
It is unrealistic and unreasonable to routinely screen the entire pregnant population for diabetic tendencies. According
to Tom Brewer, no study in any of the medical literature indicates adverse effects from "gestational diabetes." The effects
that are usually referred to, he says, are found in poorly nourished women with poorly controlled "real" (clinical) diabetes.
It is quite possible that "gestational diabetes" in the well-nourished woman is simply evidence of her body trying to do
its job of growing and birthing a healthy baby.*
This article will be re-written and updated soon.
See the bottom of this page for the notes for this article
See this article for more information on gestational diabetes: "The Emperor Has No Clothes", by Henci Goer
See here for another very good article on this issue, by Henci Goer: "Gestational Diabetes"
See here for another very good article on this issue, by Henci Goer: "Gestational Diabetes: A Practical Approach"
See here for a very good article by Dr. Michel Odent, "Gestational Diabetes: A Diagnosis Still Looking For a Disease?"
For more questions you can contact the following midwife:
Anne Frye, CPM
(Pacific time--three hours earlier than EST)
Anne provided full maternity care for women seeking homebirths for 14 years. When she studied to be a midwife, she was trained
to use the Brewer diet as a primary means of optimizing each woman's chance of achieving a healthy pregnancy. In working
with a poor immigrant population on the Texas/Mexican border she saw first-hand what a powerful tool diet can be to make this
possible. Since that time she stopped actively practicing and focused on teaching as well as authoring professional-level
textbooks with an emphasis on preventive care, including the nutritional management of pregnancy. Her textbooks include Understanding
Diagnostic Tests in the Childbearing Year, Holistic Midwifery, A Comprehensive Textbook for Midwives in Homebirth Practice,
Vol I Care during Pregnancy and Vol II Care of the Mother and Baby during Labor and Birth and Healing Passge: A Midwife's
Guide to the Care and Repair of the Tissues Involved in Birth. These texts are available through her website. She also regularly
offers consultations to care providers of all kinds as well as mothers who have questions about diet in pregnancy, troubleshooting
preeclampsia, nutritional support for multiple gestation, interpretation of laboratory results, as well as other issues. Feel
free to call her if you would like to talk to someone who has first-hand experience regarding the value of nutrition in ensuring
a healthy pregnancy.
In "Gestational Diabetes: Myth or Metabolism?" (seen above) you can read an explanation of how the results of the GTT (glucose
tolerance test) are often an indication of a faulty test, rather than an indication of a faulty pregnant body. The problem
with the GTT test has two sources.
1) The "normal" test results which have been accepted as the "standard of care" have been set too low for well-nourished
pregnant women. As with many other aspects of mainstream medical obstetrics, the "standard of care" is not always the best
2) The GTT test is very prone to false-positive results, and therefore it cannot be trusted, in my opinion. The reasons
that it is prone to false-positive results are also twofold......
a) It is not natural or healthy for a pregnant body to go 12 hours or more without food. It is not good for the mother,
and it is not good for the baby. In addition to that, it is not natural or healthy for a pregnant mother to add a carb-loading
glucose concentrate on top of that long period of fasting. Putting the pregnant body through this kind of metabolic gymnastics
is an unnatural activity. So the body cannot be expected to act normally under these abnormal circumstances.
b) Any time that the body experiences the "fight or flight" mechanism, that process triggers the body to release adrenaline.
This adrenaline surge causes the liver to release extra glycogen (sugar) that is stored there, and it triggers the pancreas
to block release of insulin. The result of this process is high blood sugar. The purpose of this elevated blood sugar is to
provide extra sugar to the muscles, so that the person can fight off a perceived threat or run from a perceived threat.
Many situations can trigger this "fight or flight" mechanism. When I worked for a practice of 3-4 midwives, I would routinely
sit with the women who "failed" their 1-hour GTT and ask them what they had been doing immediately before they took the test.
Here is a list of the kinds of situations which can trigger the "fight or flight" mechanism and give you a false-positive
result of the test....Having a fight with your spouse or children in the car or parking lot just before the test, fighting
traffic on the way to the test and/or fearing that you will be late for the appointment, stress at work, stress at home, a
fear of needles, a fear of hospitals or labs, a fear of what a "failed" test might mean for you, and conflicts with your care-giver
or others in your life.
So the problem is usually a faulty test, and not a pregnant body that is handling sugar poorly.
My first suggestion is to ask for an alternative screening test, instead of the GTT. The test that I would suggest is the
Hemoglobin A1C. That test is one that measures the level of blood sugar that the red blood cells have been exposed to for
the past 3 months. Since it is a test that shows what has been happening for 3 months, and not just in the past 12-15 hours,
no fasting or carb-loading is required, and it shows what the mother's body usually does, with the food and lifestyle that
is normal for her, AND it is not vulnerable to the "fight or flight" mechanism or any adrenaline surges.
If your midwife or doctor is not open to using the Hemoglobin A1C, then you can do several things to try to avoid triggering
the "fight or flight mechanism" and getting an adrenalin surge immediately before, or during, your GTT.
1) Check the "GD: Myth or Metabolism?" article mentioned above for info on what kind of diet to eat for the 3 days
before the test.
2) Schedule your appointment so that you are fasting the bare minimum of time necessary and not one minute more.
3) Schedule your appointment during a time when there is likely to be less traffic on the roads.
4) Leave any children that you have with a baby-sitter or relative at home.
5) Take a friend with you who can drive you there and sit with you during the test (choosing a friend who usually has
a calming effect on you).
6) During the time before and between blood draws, do something very relaxing--listening to relaxing music, reading
something relaxing, drawing, sewing, cross-word puzzles, meditation, yoga, or whatever relaxes you.
7) In the 5 minutes before each blood draw, have your friend help you with a guided relaxation--visualizing your favorite
safe place, or your favorite vacation place, such as lying on the beach, or in a hammock in the woods, etc. Take deep abdominal
breaths, and focus on helping all of the muscles in your body go completely limp. Ask your friend to name all the muscle areas
of your body, head to toe, as you visualize making them release and go limp: "All the muscles on the top of your head, all
the muscles at the back of your head, all the muscles in your forehead, all the muscles around your eyes, all the muscles
in your cheeks, etc, etc..."
When I have done this with clients of midwives that I worked for, as I recall they "passed" the test every time.
*Notes for "Gestational Diabetes: Myth or Metabolism?"
1. American Diabetes Association, "Gestational Diabetes Mellitus," in Diabetes Care, vol. 9, no. 4 (July-Aug. 1986):
2. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Prevention Services,
Division of Diabetes Control, Public Health Guidelines for Enhancing Diabetes Control through Maternal & Child Health Programs
(Atlanta, GA: CDC, 1986), p.3.
3. American College of Obstetricians and Gynecologists, Standards for Obstetrical and Gynecological Services (Washington,
DC; ACOG, 1985), p.18
4. Daniel W. Foster, "Diabetes Mellitus," in Harrison's Principles of Internal Medicine, 10th ed. (New York: McGraw-Hill,
1983), pp. 661, 664.
5. Ibid., p. 664.
6. Adelle Davis, Let's Have Healthy Children (New York: New American Library, 1981), p. 300.
7. "Diabetes Mellitus," in Harrison's Principles of Internal Medicine, 8th ed. (New York: McGraw-Hill, 1977), p. 569.
8. See Note 4, p. 664.
9. See Note 7.
10. See Note 4, p. 664.
12. Ibid., p. 661.
13. Evelyn Burns, "Diabetes Mellitus and Pregnancy," in Nursing Clinics of North America, vol. 18, no. 4 (Dec. 1983):
14. Sally Inch, Birthrights (New York: Pantheon Books, 1985), p. 33.
15. Gail Brewer, The Brewer Medical Diet for Normal and High-Risk Pregnancy (New York: Simon & Schuster, 1983), p.
16. Anne Frye, Understanding Lab Work in the Childbearing Year (New Haven, CT: Informed Homebirth, Inc., 1985), p.
17. E. Chaffee and E. Greisheimer, Basic Physiology and Anatomy (Philadelphia: J. B. Lippincott Company, 1969), pp.
18. R. Casey and R. Resnick, Maternal Fetal Medicine Principles and Practice (Philadelphia: W. B. Saunders, 1984),
19. J. Pritchard and P. MacDonald, William's Obstetrics, 15th ed. (New York: Appleton-Century-Crofts, 1976), p. 190.
20. See Note 13, p. 677.
21. See Note 7.
22. See Note 16, p. 57.
23. See Note 13, p. 675.
25. See Note 15, p. 164.
26. See Note 16, p. 58.
27. Ibid., p. 61.
28. See Note 7.
29. See Note 4, p. 661.
30. Edward Pinckney, "The Accuracy of Medical Testing," in New Medical Foundation, ed., Dissent in Medicine: Nine Doctors
Speak Out (Chicago: Contemporary Books, Inc., 1984), p. 87.
31. See Note 4, p. 662.
32. Diabetes, vol. 28 (1979): 1039.
33. Barbara Katz Rothman, In Labor: Women and Power in the Birthplace (New York: W. W. Norton & Company, 1982), pp.
34. Elizabeth Noble, Childbirth with Insight (Boston: Houghton Mifflin Company, 1983),p.4.