Tell midwife that you're doing a high carb breakfast and then just eat whatever you want for breakfast. I suspect if you're posting here, you're already eating properly. You're best off if the blood test does not give anyone an excuse to try to manage your diet with conventional wisdom or worse try to put you on insulin

Someone gave a downvote. Because I'm not answering the question? Or because I'm suggesting lying to midwife? I will say that my wife was diagnosed with gestational diabetes when she was pregnant with our second based on a fasting blood sugar of 94. This meant she had to attend nutrition counseling where they recommended she eat whole grain carbs 5 times daily to keep her blood sugar level. She also had to check her blood sugar 3 times a day for the rest of her pregnancy. Not a huge deal, but surely a hassle, especially considering the backwards advice they'd give if there was ever a problem.

Based on the midwife's recommended breakfast of pancakes and syrup, I can guess that she would not be able to give much help in terms of nutrition, especially given OP's seemingly good understanding of what it means to eat healthy, so I would definitely either refuse to do blood sugar test or at least not ingest a bunch of refined carbs in support of the test. Honestly, who cares how your body responds to a breakfast of pancakes and syrup or eating a bunch of jellybeans, if you don't plan to eat that way during your pregnancy anyway? I stand by that.

The glucose tolerance test isn't that useful when on a lower carb diet. But, gestational diabetes can be pretty bad.

Ask if you can do other things to show your blood sugar levels are fine. You can buy a glucose monitor for around $10 (and they usually have mail in rebates). I would offer to track your blood sugar over two days: morning fasting, 1 and 2 hours after you eat. Your midwife can see that with your normal eating, your blood sugar is fine (or, if it isn't, you can be more careful during the rest of your pregnancy.)

The fact that they are giving you those two options is really confusing. If they're basing your test results on a set range, it has to depend on a pre-set amount of sugar. Also, high protein breakfast can raise your blood sugar, especially if you're insulin resistant because protein causes an insulin and glucagon release. A proper OGTT should be done fasted.

When I was pregnant the first time, I did the nasty glucose drink thing and it made me feel awful all day (I wasn't doing paleo, but was really strict about sugar and refined starches). So this most recent time around, I told my OB I didn't want to do it. She instead had me come in three times before eating breakfast, did a quick glucose test with one of those monitors diabetics use, then had me eat whatever normal thing I ate for breakfast and then checked again one hour later. It was kind of a pain going into the office three times, but it seemed to work fine and I didn't have to eat anything nasty. Maybe you could propose something like that to your midwife?

My understanding is that you will get a FALSE positive on an oral GTT unless you "carb up" for at least 3 days before the test. There is a small degree of physiological insulin resistance that happens when you don't eat a lot of carbs, and it takes your body a few days to readjust.

I was reading someone's blog last night (sorry, I can't remember whose) about which tests she chose and which tests she refused during her pregnancies, and among them was the OGTT, because of the high number of false positives in people who don't eat a lot of carbs. She negotiated with her birth team to permit her to monitor her fasting and post prandial blood glucoses for a two week period around 26 to 28 weeks in lieu of the OGTT. And she was fine.

If you have gestational diabetes, it WILL show up with diligent blood glucose monitoring. But if you fail the 1 hour OGTT because of a false positive you won't be certain it's false, so then you'll have to submit to a 3 or 5 hour test and a lot more monitoring.

If it is the 50g post breakfast one, go for the big meaty breakfast, with vegetables, and beans if you eat them (per the recommendation of my midwife to stabilize blood sugar). That one isn't too rough, and I think the lower carb breakfast will keep you more stable feeling.

I did the 50g one last pregnancy and had a huge salad with a can of tuna and a half can of beans for breakfast with loads of olive oil and vinegar dressing, and did just fine.

This pregnancy they changed protocols using only the fasted test, and I bombed the 75g fasting one. I'm now wondering how I would have done either repeating the 50g non-fasted test, or if I would have also failed the 75g fasted one last pregnancy. Or if maybe I didn't eat enough in the way of carbs in the week leading up to the test this time.

I wish you luck.