Glucose tests, placental abruption, and the WELLS Act

Welcome to the weekly ZIP - your Zenith Informed Pregnancy!

Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research. 

This week's top pregnancy questions:

1️⃣ Are there alternatives to the glucose test?

2️⃣ Choosing between an OB or Midwife supported pregnancy?

3️⃣ What is a placental abruption?

Are there alternatives to the glucose test?

If you’ve heard mixed reviews about the glucose test, you’re not alone – it’s one of the most talked about (and dreaded) parts of prenatal testing, whether due to anxieties about the taste, feeling sick afterward, or fear of “failing” the test and getting a gestational diabetes diagnosis. Lots of moms ask whether the standard glucola drink is the only option for gestational diabetes screening, or if there are any alternatives available. Here’s what the data says about what’s available and what’s effective. 

📚The tl;dr from the evidence:  The glucose test is used to screen for gestational diabetes with a drink called glucola, which has a specific glucose load (50g or 100g, depending on the test) and comes in different flavors. This drink is the gold standard clinically, as the 2-step process of the 1 hour/3 hour tests using glucola is well studied and highly reliable in identifying gestational diabetes. While the drink may not be the most pleasant (although some women actually report enjoying the tase!), it’s very important to accurately diagnose/rule out gestational diabetes - as it’s not always apparent by symptoms, and if left unmanaged can lead to serious (but preventable!) complications for mom and baby. 

There are a handful of alternatives emerging, although none have evidence as strong as the glucola drink. For example, some candies (like ~28 jelly beans or ~10 Twizzlers) have been shown to be effective, although are more likely to lead to a false negative result (missing a GD diagnosis) as getting the correct glucose load and absorption can be more difficult/variable with candy, vs a standardized drink designed for an exact glucose load. There are also newer commercial alternatives like The Fresh Test, which is a glucose beverage, but meant to be a more natural alternative to glucola.

Newer research is even exploring approaches that don’t involve consuming glucose in a testing setting - like continuous glucose monitoring (CGM) devices, or blood-based biomarkers – but so far, none of these options have robust evidence demonstrating that they’re as effective and reliable as the glucola drink. So for now, the glucola drink remains the option that is strongly recommended by clinical organizations like ACOG for its accuracy. If you have concerns about glucola, due to allergies, intolerances, or other concerns, you can work with your provider to identify the safest and most effective alternative for your situation. 

👀 Read Penny’s full summary of the evidence for more on the glucola drink and alternatives

Choosing between an OB or Midwife supported pregnancy?

The midwifery model of care is becoming more popular across the US (in comparison to other nations, where midwives are standard practice for most low-risk/healthy pregnancies), and many moms are wondering if working with a midwife would be beneficial. Whether for your first pregnancy, or exploring midwifery as a different option after prior OB-supported pregnancies, here’s what the evidence shows on weighing which approach is right for you. 

📚The tl;dr from the evidence: Obstetricians are medical doctors who are trained and equipped to support all types of pregnancies, including pregnancy complications and surgical intervention (like C-Sections). Certified nurse midwives (CNMs), on the other hand, are registered nurses with specific, advanced training in midwifery, and can provide a broad range of general prenatal, L&D, and postpartum care.

OBs are recommended for higher-risk pregnancies (with known complications, chronic health conditions, or other risk factors) as they are better equipped to manage complex medical situations. For low-risk pregnancies, evidence has shown that both OBs and midwives can be safe and effective care models, each with unique benefits depending on your personal values and preferences.

For example, midwives can often provide more personalized, flexible and holistic care - supporting natural birth preferences or pain management options (like epidurals), home or hospital births, etc. They also often have more time for emotional support, education, and hands-on labor support. Some studies have shown that in low-risk pregnancies, midwifery can lead to higher rates of maternal satisfaction and fewer interventions (like C-section), without increases in adverse outcomes for mom or baby. 

On the flip side, OBs typically provide a more standard, medicalized approach, with quicker access to interventions if needed. Some women may prefer this model for convenience or peace of mind, particularly those worried about complications or emergencies. 

And lastly, don’t count out a collaborative care model - where midwives and OBs work together to support a pregnancy. There are lots of exciting groups emerging in this space - like Oula for moms in the NY/CT areas! 

👀 Read Penny’s full summary of the evidence for more on midwifery vs obstetric care

What is a placental abruption?

Over the past week, we’ve seen a big jump in questions about a rare pregnancy complication - placental abruption - following the tragic news about TikTok creator Tini Younger, who shared that a placental abruption late in her pregnancy led to the loss of one of her twin girls. Our hearts go out to Tini and her family, and all of the other moms who have experienced loss. Placental abruption is uncommon, but serious - it’s completely understandable to feel anxious after hearing stories like this with so many unknowns and such severe potential outcomes. Quick diagnosis and intervention can make a big difference in helping you and your baby stay safe - so here’s what to know about the signs, risks, and what you can do if you’re worried. 

📚The tl;dr from the evidence:  Placental abruption is uncommon - happening in less than ~1% of pregnancies. It’s a complication that occurs when the placenta detaches (either partially or entirely) from the wall of the uterus. Because the placenta is what supplies the baby with oxygen and nutrients, abruption can result in reduced oxygen and nutrients for the baby, bleeding, and other complications. The placenta cannot reattach to the uterus or resolve on its own, so immediate assessment and care is very important to improving outcomes. 

Abruption can occur suddenly, or develop over time, and when it does happen, it’s typically in the third trimester, during the last few weeks before birth. The symptoms can involve bleeding (ranging from light to heavy), abdominal cramping, pain, or tenderness, uterine contractions or firmness, and/or signs of fetal distress. The best treatment path varies depending on a number of things - how far along you are, how much of the placenta has separated, and other health considerations - with milder cases often manageable through close monitoring, and other cases requiring immediate delivery (typically via C-Section) for the safety of you and your baby. 

While there are some risk factors associated, such as acute trauma to the abdomen (e.g. a hard fall, a car accident), high blood pressure, smoking/drug use, or other pregnancy complications, the exact cause is often unknown - and it’s important to remember most people, even with risk factors, will never develop an abruption. 

👀 Read Penny’s full summary of the evidence for more on placental abruption

🤓 Zenith's top read of the week

Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!

Rep. Kelly announces WELLS Act (Press Release - Office of U.S. Rep. Robin Kelly) - Over the past few weeks, a series of heartbreaking videos have been making waves on social media, showing the dismissal of several Black women by the very healthcare providers/hospital staff who are meant to support them through a safe labor and delivery. One of these women, Mercedes Wells, ended up giving birth in her car on the side of the road, assisted only by her husband, after being discharged from an Indiana hospital despite repeatedly advocating for herself (knowing she was in active labor) with the hospital staff. 

For every video like this that we see covered on social media or in the news, there are thousands more that we don’t see on our feeds, but happen every day – and so we are very glad to read the news that Congresswoman Robin Kelly (IL-02) is introducing the WELLS Act, or the Women Expansion for Learning and Labor Safety Act, in Mercedes’ honor. This legislation will aim for hospitals (anywhere with an obstetrics, L&D, or emergency department) to create and implement safe discharge labor plans, as well as racial bias training for health workers. Maternal health is a result of systems consistently working well for all moms, and it’s great to see policywork aiming to improve these systems.

Key excerpt:

“Mercedes’s courage to speak out about her experience and advocate for change propelled me to introduce the WELLS Act to ensure no other mother goes through the same pain,” said Rep. Kelly, Chair of the Congressional Black Caucus Health Braintrust. “Mercedes has given birth three times before and was telling the nurse she was in active labor, but far too often, Black women’s pain is ignored, dismissed, and discharged. This cannot continue to happen.”