Pregnant Women Should Avoid Toxic Glucose Testing Drinks

Is Glucola Necessary?

A foundational concept at the Midwives of New Jersey is choice. We do believe pregnant women should be screened for gestational diabetes mellitus (GDM) because, left untreated, it can have significant negative effects, both in the short and long term. But there is more than one way to skin a cat!

The majority of pregnant people in the United States are given only one way to screen for gestational diabetes – drinking sugary drink with artificial orange flavoring called Glucola. The clients at Midwives of New Jersey have 3 choices:

1. Glucola
2. An organic drink called The Fresh Test. The Fresh Test is an FDA Registered product used throughout the United States. We carry The Fresh Test at The Essential Market, on our online store
3. A 50g carbohydrate breakfast Lisa Lederer has used for over 30 years: 2 pieces of bread, 2 eggs, ½ c orange or apple juice, 1 c cow’s milk

There are some Midwifery and OB/GYN practices that have other alternatives. It is worth asking your provider what you could use as a substitution for Glucola.

Over the years, the ingredients in Glucola have become less toxic. This is in response to consumer demands. There are no more artificial colors (it used to be orange) and very few preservatives but preservatives are present . Glucola continues to have “natural” flavoring ingredient which can actually be a combination of up to 100 additives. There is no actual orange fruit juice in the Glucola.

The typical scenario for the glucose challenge test is to go to the laboratory, and be handed the Glucola to drink within 5 minutes. Then the person waits an hour to have their blood drawn.

We give the Glucola, Fresh Test or diet instructions to our clients so they can have their blood drawn within minutes of arrival at the lab or our office. We know that you are as busy as we are and prefer to not wait around for an hour.

The initial Glucose/carbohydrate challenge test (GCT) is a screening test. The American Diabetes Association guidelines state a blood sugar level of 140 mg/dL (7.8 mmol/L ) to less than 190 mg/dL (10.6 mmol/L ) signals the need for a follow-up diagnostic test.

This test is called the Glucose Tolerance Test (GTT) or the Oral Glucose Tolerance Test (OGTT). This test requires the pregnant person to arrive at the lab or the office fasting. An initial fasting blood draw is done and then the woman drinks a 100-gram Glucola or Fresh test and her blood is drawn every hour for 3 hours. A level of 70 to 99 mg/dL (3.9 and 5.5 mmol/L) is considered normal in the fasting blood glucose test.

What Causes Gestational Diabetes?

Gestational diabetes mellitus (GDM) is caused by an inability of the pancreas to compensate for increased insulin needs of pregnancy. This type of diabetes does not exist prior to pregnancy but women sometimes have factors that increase their risk of developing it:

• BMI >30
• Family history of diabetes/gestational diabetes
• Polycystic Ovarian Syndrome
• Excessive weight gain in pregnancy
• Sedentary lifestyle
• Having GDM in a previous pregnancy
• Certain race/ethnicities-Asian Americans, African Americans, Hispanics and Native Americans
• History of birthing a >9 pound baby
• Those with Polycystic Ovarian Syndrome
• Advanced maternal age
• Hemoglobin A1C >5.8 in first trimester of pregnancy

The Midwives of New Jersey Protocol for Gestational Diabetes

If a client has an increased risk of gestational diabetes, we advise her to see our wellness advisor to evaluate her diet, lifestyle and supplements and offer suggestions for change. If we can avoid the diagnosis, great. If she still ends up with Gestational diabetes, we have gotten a head start on modifications to keep it controlled by diet and not medications. Overall, a well-controlled case of Gestational Diabetes leads to very good outcomes and little need for intervention in a patient’s birth process.

We recommend several supplements which are safe in pregnancy and are known to improve sugar metabolism.

Myo-Inositol

The Midwives of New Jersey recommend Inositol supplementation for clients who are at risk for Gestational Diabetes and for those who have already been diagnosed with it. Myo-inositol at 2 g, two times per day reduces the incidence of gestational diabetes by 65.0%–87.3%. Studies showed reduced requirements for insulin, delivery at a later gestational age and fewer episodes of neonatal hypoglycemia (Source). There is an increased incidence of pre-eclampsia in people with Gestational Diabetes. Inositol reduces the likelihood of this poor outcome in diabetic pregnant women. No negative effects of Inositol taken in pregnancy have been found.

Recommended Dose:

Myo-inositol 2 gram of powder twice a day

Red Raspberry Leaf

In one case study, researchers examined the consumption of red raspberry leaf tea in pregnancy and found it to have properties of glycemic control. After patients’ consumption of two servings of raspberry leaf tea for 3 days, they saw in a reduction in insulin requirements. The causal relationship was further supported when the patients stopped drinking the tea and saw the same effect again when patients restarted the herb. Metabolic studies and fetal surveillance revealed no abnormalities.

Recommended Dose:

Red Raspberry Leaf Tea -1-2 cups/day in 2^nd trimester and 2-3 cups/day in 3^rd trimester

Vitamin C

People with ABOVE adequate dietary vitamin C intake were less likely to develop gestational diabetes when compared with others with adequate intake, and those with inadequate intake.

Vitamin C is important for reasons beyond reducing Gestational diabetes as it is necessary for the production of collagen. Collagen is needed to make the bag of water and the baby’s tissues. So, taking a higher dose of Vitamin C will have multiple beneficial effects.

Recommended Dose:

Liposomal Vitamin C 1000 – 2000 mg/day

Psyllium Husks

The Midwives recommend Psyllium husks for the regulation of fasting blood sugars to our clients with gestational diabetes. This water-soluble fiber has been shown in studies to also reduce Body Mass Index (BMI) and Insulin levels.

Recommended Dose:

Phyllium Husk Powder: One scoop in 8 ounces of water when you go to sleep.

Vitamin D

The Midwives of New Jersey monitor their clients’ Vitamin D levels for several reasons. Preventing gestational diabetes is one of them. After 15 years of monitoring, we have found that people are vitamin D deficient almost universally.

A 2016 study showed that Vitamin D deficiency (<50 nmol/L) at 10 to 14 gestational weeks was associated with a 2.82‐fold increased risk for GDM. Women with persistent Vitamin D deficiency at 15 to 26 weeks of gestation had a 4.46‐fold elevated risk for GDM compared with women persistently non‐deficient (Source).

Recommended Dose:

Vitamin D 4000 – 5000 IU/day

Calcium + Vitamin D

The Midwives encourage our clients to take Calcium with their Vitamin D supplement because of its positive effects on their pregnancy outcomes.

A 2021 study showed that when pregnant people with Gestational Diabetes supplemented with Calcium and Vitamin D, they had a lower rate of Cesarean birth, fewer hospital days and big babies, and their babies had a lower incidence of jaundice (Source).

Recommended Dose:

Mag Cal Formula: 2 tablets/day

Exercise

Exercise is an important part of managing blood sugar metabolism. We hope that our clients will prioritize exercise at least 3 days a week.

• Walking
• Weight-lifting
• Prenatal yoga
• Calisthenics

Conclusion

The cornerstone of our care at MNJ is choice and as such we have always offered alternatives to the Glucola drink.  Fewer people drink cow’s milk these days, so it is helpful to have organic The Fresh Test as an additional alternative to Glucola. We would be pleased to see other ACOG and FDA accepted alternatives developed since we want to offer vetted alternatives, not just something we or our clients determined independently. We continue to challenge the norm and listen to our clients’ feedback regarding prenatal care in the hope of improving birth outcomes in New Jersey and beyond.