Should I Drink the Sugar Water?
No, I do not want to drink the “lime-flavor” syrup containing 50 grams of pure glucose in 5 minutes or less. Starting my day off guzzling sugar and then taking the G downtown for a blood test is not the ideal Monday to me. I’m sick of it, the urine cultures and hepatitis and rubella and hemoglobin tests, the nuchal translucency test and AFP screening and thyroid function and Vitamin D test that have all shown that I’m not sick. The glucose tolerance test that requires drinking this syrup is the most uniquely unpleasant one so far and a part of me just wants to skip it.
For someone who’s been lucky enough to enjoy physical health for most of her life, the transition that comes with pregnancy from person to patient can be abrupt and disorienting. The standard ob/gyn practice slots you in to a rigid schedule of tests and checkups whose authoritativeness can make you feel comforted by their vast professional knowledge and helpless due to your lack of it. They reassure you that they know what they’re doing, but always edged with the threat of danger if you step outside their prescription. My insurance thinks I’ve had too many ultrasounds, but once when I went for a checkup that didn’t have one scheduled, my doctor helpfully reminded me that “miscarriages can happen after 10 weeks, you know,” which guaranteed that I would wait for the next slot even though it made me late for work.
Our entrepreneurial health system in America creates a circle jerk of industry partners in managing pregnancy that benefits everyone except the pregnant person. Many more tests are routine here than in, say, the U.K. It’s easy and profitable, and safer from a liability perspective, for an American clinic to run a test and overcharge a patient’s insurance. Over-screening and over-treatment are at least part of the reason that the U.S. spends more on healthcare than anywhere else in the world. The appointments can be taxing for patients, as well as contribute to the sense that your pregnancy is not a natural process, but a delicate medical condition whose prognosis can only be observed by experts.
The case of the glucose tolerance test that I have on Monday is one that’s drawn particular controversy. One issue is that while the test can detect gestational diabetes, it’s unclear if anything can be done at that point to change how it affects the pregnancy. As I read about gestational diabetes, I also began to wonder about its predictive power. Some of the main risk factors for gestational diabetes are obesity before pregnancy and weight gain during pregnancy. The negative outcomes associated with it mainly have to do with having a baby that’s too big, which can make birth more dangerous. But, unsurprisingly, the correlation between higher weight of pregnant person and higher weight of baby is pretty strong. Indeed, a 2018 study found that weight gain during pregnancy was a better predictor of negative pregnancy outcomes than was gestational diabetes. So what exactly does this test do for us? In my case, I started out with an average weight and have had below-average weight gain, so the negative outcomes are unlikely for me independent of what this test shows.
After a number of frustrating interactions with my ob/gyn, I switched my care to a group of midwives who are allowed to practice in NY hospitals (a deplorably rare situation, but that’s a topic for an upcoming newsletter). The midwife organization is a VC-backed startup with buggy software that still feels impersonal but at least I have time to ask questions during my appointments. When I brought up my reservations about the glucose test, the midwife didn’t treat me like an idiot and didn’t say I had to take it. She strongly encouraged it and urged me to bring home the bottle of glucose anyway.
So do I drink the sugar water? It won’t be so awful, really. And I would endure so much more if I thought it was important for my baby. I don’t like what the test represents, but my hesitation probably comes from the urge to assert my agency in my own pregnancy. I try to focus on the ways I’m already doing that. I stretch and breathe, and normally I eat breakfasts that aren’t all sugar.
What I’m cooking
Smoky black lentil soup with kale and butternut squash (v)
I wish this soup were prettier, but I promise it’s delicious and very filling. We had some yesterday after a nighttime snow romp, and just felt hugged. Subscribe to get the recipe on Friday!