Every year, between 5% and 9% of all pregnant women in the United States develop gestational diabetes. There are usually no symptoms, so these women are completely unaware they have this condition. Typically, your doctor orders a glucose screening test to rule out gestational diabetes around 24 weeks of pregnancy (since it’s usually found between 24 and 28 weeks).

This usually involves drinking a very sugary beverage within a set amount of time to see if your body can quickly process a large amount of sugar. Your doctor then determines if you need further testing for gestational diabetes.^1,2,3

Historically, the standard glucose screening test drink is glucola, which is designed with 50 grams of sugar dissolved in water.

Some pregnant women dislike the taste of the drink or have concerns about the ingredients and additives used. So, let’s explore some potential glucose test alternatives and whether they’re even suitable for reliably screening and diagnosing gestational diabetes during pregnancy.^2,3

What Is the Pregnancy Glucose Test?

Oral Glucose Tolerance Tests (OGTT) are designed to find gestational diabetes in pregnant women. Your doctor may order the glucose challenge test, the glucose tolerance test, or both. The glucose challenge test, also called the glucose screening test, is a simpler, shorter version of the glucose tolerance test.

First, you drink the glucose screening beverage containing 50 grams of sugar; typically, glucola is the drink of choice. You don’t have to fast for this test. Then, an hour later, your blood is drawn to examine your blood glucose level. If the level is above 130-140, or higher, depending on the institution’s threshold, your doctor will most likely order a glucose tolerance test.^5,24

The glucose tolerance test is a little more involved and lasts longer. For this test, you must be fasting (typically, you don’t eat or drink anything except water after midnight or for at least 8 hours before the test). It starts with having your blood drawn before you ingest “the drink.” Then, you wait and have your blood taken 1, 2, and 3 hours after drinking the glucose screening test drink. Your doctor reviews the blood results to determine if you have gestational diabetes.^2,5

Related: Glucose Test During Pregnancy: Everything You Need To Know

Common Concerns About the Glucola Beverage

Let’s explore the concerns some may have with the glucola beverage:

High Sugar Content

The glucola beverage is a non-carbonated drink that contains 50 grams of glucose and is used for gestational diabetes screening.⁵ To put this in perspective, a 7.5-ounce can of Mountain Dew contains 29 grams of sugar.¹⁵ Consuming glucola is equivalent to drinking about 1.3 cans of Coca-Cola.¹⁶

The high concentration of sugar can be challenging for some individuals due to the high sugar content.

Artificial Dyes and Food Additives

Glucola is available in various flavors, some of which contain artificial dyes, flavorings, and preservatives such as sodium benzoate. Concerns have arisen around the use of Brominated Vegetable Oil (BVO), though the U.S. Food and Drug Administration (FDA) considers it safe within the specified limits. However, due to growing consumer concerns, BVO is being phased out.^4,6,25

Additionally, the dextrose in glucola is often derived from corn, which may not always be GMO-free. If you prefer a version without artificial dyes, the lemon-lime flavor is a good option.²⁷

Related: How To Lower Your Risk of Gestational Diabetes With Diet

Side Effects

Some women report experiencing side effects after consuming glucola, including nausea, dizziness, and fatigue.³ These reactions may be more pronounced in those with preexisting conditions such as gastroparesis or a history of bariatric surgery, which can affect how the body processes glucose.

In such cases, you may discuss alternative testing methods, such as serial blood glucose monitoring, with your healthcare provider.^22,23

Can I Refuse the Glucose Test When Pregnant?

Any patient can refuse any test at any time; that’s your right.

But you should always make informed decisions before you refuse a test that your doctor has ordered, especially if the test is related to your unborn baby’s health. Even healthy, active individuals can still develop gestational diabetes during pregnancy. That’s why the glucose screening test is so important!

It’s also important to consider the possible complications of gestational diabetes. These can include:^7,10,12

• Higher birth weight or larger baby size, which increases the risk of needing a C-section delivery
• Higher incidence of birth injury (such as shoulder dystocia) to the baby since they’re larger
• Increased blood pressure in the mother, causing a condition called preeclampsia
• A premature or early birth, which can involve breathing difficulties for the baby
• Seizures in the baby caused by low blood sugar (hypoglycemia)
• Increased risk of type 2 diabetes in the mother as she ages
• Increased chance of newborn jaundice and possible neonatal intensive care

If you have concerns about the glucose screening process, talking openly with your provider can help you make the most informed decision for your pregnancy.

Potential Glucose Test Alternatives

Glucose test “alternatives” should be used only for those who cannot tolerate the glucola beverage. It’s very important to recognize that the only validated way to screen and diagnose gestational diabetes mellitus (GDM) is the glucola beverage, which the American College of Obstetricians and Gynecologists (ACOG), the American Diabetes Association (ADA), and numerous other medical organizations endorse.¹³ ACOG and ADA haven’t endorsed any of the alternatives listed below, and research on these alternatives is still fairly limited.

The Fresh Test

Some providers will work with their pregnant patients to find alternatives to the standard glucose test. “The Fresh Test” is one alternative. It comes as a powder or a ready-made drink with only three ingredients: crystallized lemon, non-GMO dextrose (made from tapioca or corn), and mint.

The bottles have added water but are all gluten-free, non-GMO, and organic. This is an excellent substitute for glucola, and it tastes like lemonade with a hint of mint.¹¹ One study found that women preferred this drink over a traditional glucose beverage.¹⁸ Up to 30% percent of pregnant women don’t tolerate the glucose drinks very well.⁹ One downside to consider is that the insurance companies may not cover the cost.

Related: 5 Questions (And Answers) About Gestational Diabetes

Jellybeans and Twizzlers

Some studies conclude that jellybeans and Twizzler licorice ropes could replace the glucola drink.^8,9 Jellybeans are cost-effective, and women tolerate them much better than glucola since they don’t experience the unpleasant taste or nausea.

One study used 18 jellybeans, but the challenge with recreating this method would be finding 18 jellybeans of exactly the same size, each containing the same amount of sugar. This could lead to an unreliable total sugar amount being calculated.⁸ Similarly, the pros of using Twizzlers are their cost-effectiveness and better tolerance for women. According to another study, the only downside to eating 10 strawberry-flavored Twizzler licorice twists is the need to eat them within 5 minutes. Some pregnant women may still find this difficult to tolerate.⁹

At-Home Testing

Another alternative is to test blood sugar at home.¹⁴ This is already a common part of diabetes management for many people. It doesn’t catch 100% of all gestational diabetes cases, but it’s an excellent alternative for glucose testing for women with medical issues who can’t do the glucose screening test drink.¹⁷ At-home testing involves performing a finger prick to collect a drop of blood, then using a glucometer to measure the glucose level.^19,20

Usually, your provider will have you do this daily for one week, before and after each meal, around 24 to 28 weeks of pregnancy.^14,19,21

Some potential downsides include:^17,19

• You have to stick your fingers with tiny needles three times a day for a week.
• Some insurance plans may not cover all the costs of this testing (glucometer, test strips, lancets, alcohol pads, etc.).
• You must be dedicated and not miss any of the ordered times to measure your blood glucose. Otherwise, your provider might have you redo the test for another week.
• It doesn’t catch all cases of gestational diabetes.

The Bottom Line

Currently, laboratory-based glucose screening tests are the only way for medical providers to accurately diagnose gestational diabetes in pregnant women. It’s just one of the many routine tests that pregnancy requires to help keep both mother and baby healthy. The glucola beverage in the U.S. is the standard of care for glucose tolerance tests, and the best alternative to glucola is the Fresh Test, but your insurance company may not cover it.

Accurate screening for GDM can be life-saving. If you have any specific concerns about the test or testing process, please bring them up with your doctor. They can work with you to ensure you feel safe and comfortable and are comfortable with the testing process and understand your options.

Frequently Asked Questions (FAQ)