Pregnancy Glucose Test Alternatives To Test for Gestational Diabetes

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 normally involves drinking a very sugary drink within a specific time frame 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 patients don’t like the way it tastes or have concerns regarding the 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 an easier and shorter version of the glucose tolerance test. First, you drink the glucose screening test drink 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 greater than 130-140 or higher based on different institutional thresholds, most likely, your doctor will order the 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 have anything to eat or drink except water after midnight or within eight hours of the test). It starts with having your blood drawn before you ingest “the drink.” Then, you wait and have your blood taken one hour, two hours, and three hours after drinking the glucose screening test drink. Your doctor reviews the blood results to determine if you have gestational diabetes.^2,5

Concerns With the Glucola Beverage Explained

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 concentrated sugar load 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, flavoring, and preservatives like 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

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 may interfere with glucose absorption. 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. You can be an athlete, a nutritionist, or someone who follows a strict diet, but no one is 100% immune from gestational diabetes. 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 for 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

Glucose Test “Alternatives”

Glucose test “alternatives” should only be 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 their study designs have several limitations:

The Fresh Test

Some providers will work with their pregnant patients to find alternatives to the standard glucose test during pregnancy. “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 The only con is that the insurance companies may not cover the cost.

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 nasty taste or nausea. One study used 18 jellybeans, but the con of replicating this method would be having to find the exact same size of 18 different jelly beans containing the same amount of sugar. This could lead to an unreliable amount of total sugar calculated.⁸ Similarly, the pros of using Twizzlers are their cost-effectiveness and better tolerance for women. Based on another study, the only con to using 10 strawberry-flavored Twizzler licorice twists is the necessity to eat them within a five-minute period. I’m sure some women couldn’t or wouldn’t want to do that!⁹

At-Home Testing

Another alternative is doing blood sugar testing at home.¹⁴ This is a common practice for many diabetic individuals. 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 produce a drop of blood and then using a glucometer to measure the amount of glucose in the blood.^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

The cons related to this testing are the following:^17,19

• You have to stick your fingers with tiny needles three times a day for a week.
• Some insurances 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.

Frequently Asked Questions (FAQ)

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 protect the health of the mom-to-be and baby. The glucola beverage in the U.S. is the standard of care for glucose tolerance tests, and the best alternative available for glucola is the Fresh Test, but your insurance company may not pay for it.

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