Do Women With Gestational Diabetes Give Birth Early?

Timing Of Delivery In Gestational Diabetes Mellitus: Need For Person-centered, Shared Decision-making

Go to: Abstract Gestational diabetes mellitus (GDM) is a medical as well as obstetric challenge, which needs person-centered management. The timing of delivery of women with GDM is discussed by various obstetric professional bodies. We highlight pertinent medical, obstetric, and psychosocial factors which may influence the timing of delivery in women with GDM. This commentary proposes a person-centered approach to decide the delivery timing in GDM and supports shared decision-making based upon the individual’s biopsychosocial characteristics and environmental factors. Keywords: Antenatal corticosteroid therapy, Cephalopelvic disproportion, Diabetes, Fetomaternal distress, Labor, Macrosomia Go to: Introduction The prevalence of gestational diabetes mellitus (GDM) is rapidly increasing across the world and it is a common endocrine complication in obstetric practice today [1–3]. GDM, as a syndrome, is marked by controversy related to virtually every facet, ranging from its nomenclature, screening tools, and diagnosis to management strategies [4, 5]. Most debate on GDM management centers on medical issues, such as appropriateness of oral hypoglycemic agents. In this communication, we discuss the timing of delivery in GDM and emphasize the need for person-centered, shared decision-making in this regard. Compliance with Ethics Guidelines This article does not contain any new studies with human or animal subjects performed by any of the authors. Go to: Current Recommendations Expert recommendations suggest that women with uncomplicated GDM take their pregnancies to term, and deliver at 38 weeks gestation [6]. Such a decision is not as simple as it seems. These recommendations differ from earlier findings, which suggested earlier induction of labor [7], but are consonant wi Continue reading >>

Have Gestational Diabetes? Timing Of Delivery Matters

Have gestational diabetes? Timing of delivery matters Have gestational diabetes? Timing of delivery matters Maternal-fetal specialists pinpoint which week is safest for baby Dr. Nir Melamed with his patient Cherrylou Bautista. Melamed is a clinician-scientist specializing in maternal-fetal medicine at Sunnybrook Research Institute. Gestational diabetes affects up to 15%20% of pregnant women. It is often clinical practice to induce labour in these cases at 38 or 39 weeks to decrease complications that include cesarean delivery, birth trauma and shoulder dystocia, a severe obstetrical emergency, whereby, after delivery of the head, the anterior shoulder of the infant gets stuck against the womans pubic bone. This condition can lead to nerve injury and paralysis of the arm, as well as fetal asphyxia and death. Doctors are not sure, however, whether inducing labour actually improves outcomes because only a few studies with small sample sizes have looked at the issue. This lack of clarity led Dr. Nir Melamed , a clinician-scientist in the Women & Babies Research Program at Sunnybrook Research Institute (SRI) to investigate. The purpose was to determine whether routine induction of labour at 38 or 39 weeks can decrease the risk of cesarean section and improve the babys outcomes, says Melamed. The rationale is that gestational diabetes can lead to accelerated growth of a baby who might be exposed to high levels of glucose and insulin. A large infant increases the risk of serious complications, he notes. Melamed led the study using data from the Better Outcomes Registry & Network Ontario, or BORN, a registry of all births in Ontario. He looked at 14,600 women with gestational diabetes who delivered babies between April 2012 and March 2014. He and his colleagues compared the ou Continue reading >>

Risk Factors For Early Delivery

Any pregnant woman can have preterm labor and premature birth, even if she’s done everything right during pregnancy. However, certain factors can make some women more likely than others to go into labor and give birth early. These risk factors include: multiple gestation (more than one baby in the womb) history of premature birth vaginal bleeding in the middle of pregnancy infection polyhydramnios (an excessive amount of amniotic fluid surrounding the baby) problems with the cervix problems with the uterus certain genetic conditions drug and alcohol use limited access to prenatal care It’s important to remember that most women with these risk factors will carry their pregnancy to full term. However, it’s helpful to be aware of your risk so you can be thoroughly evaluated and closely monitored by your doctor. Multiple gestation puts a pregnant woman at risk simply because the uterus must stretch more when it’s holding two or more babies. The uterus, just like any other muscle in the body, tends to contract when it’s stretched beyond a certain point. In a multiple gestation pregnancy, the uterus may be stretched to an extent where contractions begin before the babies are fully developed. The risk for preterm delivery increases with each additional baby in the womb: Number of babies in the womb Average gestational age at birth* One 40 weeks Two 35 weeks Three 32 weeks Four 30 weeks *Gestational age refers to the number of weeks a woman is pregnant. It is usually calculated from the first day of the last known menstrual period. Multiple gestation also places an expectant mother and her babies at an increased risk for other complications. The mother has a higher risk of developing preeclampsia and gestational diabetes, while the babies have a greater risk of gettin Continue reading >>

Gestational Diabetes Birth Stories

After experiences of your labour and birth for those who had gestational diabetes Gestational diabetes occurs when your body can not cope with the extra demand for insulin during pregnancy and results in high blood sugar. When gestational diabetes is well managed you can reduce the risk of complications to mum and baby. Read our expert advice on what gestational diabetes is and how to manage it. Get educated I had gestational diabetes and had the best pregnancy and birth. I managed my sugar levels through diet and exercise – it was easy to do and I felt great. By the end of pregnancy I gained only 8 kilos, which is now all gone since I continued my diet after I had my boy. I have always been on the smaller side so we little people can get diabetes too (it runs in my family). The birth was as easy as a birth can get – my waters broke and 3 hours later my little man arrived naturally. He was 10 days early and he weighed a tiny 6lb 4oz., which was fantastic. Actually a lot of my friends have had gestational diabetes and said it was the best thing for them because it forced them to eat properly and exercise. If you get the right education and manage your diabetes properly then you will be fine. Good luck Mai Footless baby jumpsuits for regular sugar testing Bring in jumpsuits with no feet, and buy baby socks, that way you don’t have to undress them every time they need to test babies blood sugars. It will make it so much easier on both of you – Sarah Regular growth scans I was on metformin and had regular scans tracking bubs growth. A week before due 1 had a one off high bp reading but that meant I spent the next week have daily appointments with gp or midwife or bloods or scans. I got a call 2 days before due date to go to hospital to be induced as blood flow to bu Continue reading >>

Gestational Diabetes

Gestational diabetes is high blood sugar that develops during pregnancy and usually disappears after giving birth. It can occur at any stage of pregnancy, but is more common in the second half. It occurs if your body cannot produce enough insulin – a hormone that helps control blood sugar levels – to meet the extra needs in pregnancy. Gestational diabetes can cause problems for you and your baby during and after birth. But the risk of these problems happening can be reduced if it's detected and well managed. Who's at risk of gestational diabetes Any woman can develop gestational diabetes during pregnancy, but you're at an increased risk if: your body mass index (BMI) is above 30 – use the healthy weight calculator to work out your BMI you previously had a baby who weighed 4.5kg (10lbs) or more at birth you had gestational diabetes in a previous pregnancy one of your parents or siblings has diabetes your family origins are south Asian, Chinese, African-Caribbean or Middle Eastern If any of these apply to you, you should be offered screening for gestational diabetes during your pregnancy. Symptoms of gestational diabetes Gestational diabetes doesn't usually cause any symptoms. Most cases are only picked up when your blood sugar level is tested during screening for gestational diabetes. Some women may develop symptoms if their blood sugar level gets too high (hyperglycaemia), such as: But some of these symptoms are common during pregnancy anyway and aren't necessarily a sign of a problem. Speak to your midwife or doctor if you're worried about any symptoms you're experiencing. How gestational diabetes can affect your pregnancy Most women with gestational diabetes have otherwise normal pregnancies with healthy babies. However, gestational diabetes can cause problems s Continue reading >>

Do You Deliver Early If You Have Gestational Diabetes??

All Communities > Expecting > Do you deliver early if you have gestational diabetes?? Do you deliver early if you have gestational diabetes?? Samii - posted on 12/11/2009 ( 6 moms have responded ) I'm 19 and I'm about 31 weeks right now. I was tested for gestational diabetes and just my luck they told me that I have it. I was wondering if you deliver early due to the diabetes?? I've heard that with your first baby you usually deliver late but having diabetes I'm not sure now...? I recently had a doctors appointment and the doctor asked about my sugar levels and said that everything looks really good with them. She also told me that all I have to do is test 2 times a day twice a week. I was so happy to hear that everything is going well with my baby! I only have about 7 weeks to go until I can finally meet him! It seems like forever tho! lol I had gestational diabetes with my first and I delivered my first at 40 weeks 6 days. My doctors tried to pressure me into being induced, but there was no reason for it, the baby was fine, I was keeping my sugars easily in control and the due date is an ESTIMATION! There is no reason why you would have to deliver early just because of the gestational diabetes. Just keep your sugars in control, especially in your last 6 weeks of pregnancy because that is when your baby can gain the most weight. Good luck! Continue reading >>

Induction | Gestational Diabetes Uk

In order for a baby to be born the cervix (neck of the uterus) has to shorten, soften and open and there needs to be contractions. In most pregnancies this process happens naturally between 38 - 42 weeks and is known as 'spontaneous labour'. Induction of labour is the process of starting labour artificially. Prolonged pregnancy - where pregnancy continues after 41 weeks Pre labour rupture of membranes - where the waters surrounding the baby break and labour does not start within 24 hours and there is a risk of infection Medical reasons - where it is felt there is increased risk to the health of your baby or you should the pregnancy continue Does a diagnosis of gestational diabetes mean induction? For many ladies with gestational diabetes, we may fall into the 3rd reason stated above (Medical reasons). According to the current NICE guidelines induction (or elective caesarean section) should only be consideredbefore 40+6weeks for women with gestational diabetes if there are maternal or fetal complications. 1.4.1Discuss the timing and mode of birth with pregnant women with diabetes during antenatal appointments, especially during the third trimester.[new 2015] 1.4.2 Advise pregnant women with type1 or type2 diabetes and no other complications to have an elective birth by induction of labour, or by elective caesarean section if indicated, between 37+0weeksand 38+6weeksof pregnancy.[new 2015] N/A for gestational diabetes 1.4.3 Consider elective birth before 37+0weeksfor women with type1 or type2 diabetes if there are metabolic or any other maternal or fetal complications.[new 2015] N/A for gestational diabetes 1.4.4 Advise women with gestational diabetes to give birth no later than 40+6weeks, and offer elective birth (by induction of labour, or by caesarean section if indic Continue reading >>

How Will Gestational Diabetes Affect My Birth Options?

How will gestational diabetes affect my birth options? Approved by the Society for Maternal-Fetal Medicine I have gestational diabetes. Can I still have a vaginal birth? Probably, especially if your gestational diabetes is under control. Having gestational diabetes does increase your risk of needing a c-section , but most women with the condition are able to have an uncomplicated vaginal birth. The size of your baby is the main factor your healthcare provider uses to determine whether you can have a vaginal delivery. Gestational diabetes can make your baby grow larger than normal, or be large for gestational age (LGA). A newborn is considered LGA if the baby's birth weight is greater than 90 percent of other babies born at the same gestational age. ( Macrosomia is another labor complication related to a large baby.) If you have gestational diabetes, your baby may also have large shoulders and extra upper body fat. This increases the risk of the baby's shoulders getting stuck behind the pubic bone during birth (shoulder dystocia). This condition is uncommon but can lead to injuries, such as a broken collarbone or damage to the nerves in a baby's neck and shoulders (brachial plexus injury). These injuries almost always heal well. Occasionally, very large babies and babies with shoulder dystocia don't get enough oxygen during birth, which can have serious consequences. Giving birth to a big baby can also cause problems for you during delivery: You may have a greater risk of perineal tears and blood loss. Having a c-section is the alternative, but this also has risks. Talk to your provider about the potential risks and benefits of a vaginal birth as opposed to having a c-section. Is it likely that my baby will be born early? Gestational diabetes raises the risk of high blo Continue reading >>

I Have Pregnancy Induced Gestational Diabetes, Is There Possibility That I Will Deliver My Baby Late

Because I had my first child born at 37 weeks will i give birth early again even if I have gestational diabetes? To my knowledge, most OB's will induce or take a baby early if the mother has GD. Most of those babies gain weight faster and the doctors might not want to chance you have a 10 pound baby. I had GD w/ our first child, and I monitored it very closely by diet. Our baby was born on her due date, perfectly healthy and a mere 7 pounds. Watch the sugars and carbs you eat, and GD is nothing more then a few stretch marks! I think it really depends on your doctor, so my best advice would be to talk to them. I was being checked twice a week with stress tests and once a week with ultrasounds, and my gestational diabetes was controlled with low doses of insulin daily. My OB would not induce me early because everything with my baby and I were fine, but he did say he wouldn't let me go past 41 weeks. I went into labor on my own on my due date and had my baby the next day. He was born weighing 7lbs 14oz and was completely healthy! Each pregnancy is different, so ask your OB. :) I hear most women with gestational diabetes are delivered early because of risk to the baby. I have GD that is controlled by diet alone and I at my 36 weeks appt, the ultrasound showed my baby to already be 7 lbs 7 oz and my dr. thinks if I go to term she will be over 9 lbs and needless to say he plans to induce me 2 weeks early...ad I have to say that I am kind of relieved so she will be safe and I not have to have a c-section and have to deal with a long recovery....your dr. will do what is best for you and your baby....there are too many risks to having a large baby...good luck to you... This is my 2nd pregnancy with GD. For the first one, I delivered 4 days late and baby was 8lbs even. Typically Continue reading >>

Gestational Diabetes

Gestational diabetes (pronounced jess-TAY-shun-ul die-uh-BEET-eez) is one of the most common health problems for pregnant women. It affects about 5 percent of all pregnancies, which means there are about 200,000 cases each year. If not treated, gestational diabetes can cause health problems for mother and fetus. The good news is that gestational diabetes can be treated, especially if it is found early in the pregnancy. There are some things that women with gestational diabetes can do to keep themselves well and their pregnancies healthy. Controlling gestational diabetes is the key to a healthy pregnancy. and can be achieved by following the Gestational Diabetes Treatment Plan. Gestational Diabetes is a kind of diabetes that only pregnant women get. In fact, the word gestational means “during pregnancy.” If a woman gets diabetes or high blood sugar when she is pregnant, it is gestational diabetes. Diabetes Diabetes means your blood sugar is too high. Diabetes is a disease of metabolism, which is the way your body uses food for energy and growth. Your stomach and intestines break down (or digest) much of the food you eat into a simple sugar called glucose (pronounced GLOO-kos). Glucose is your body’s main source of energy. After digestion, the glucose passes into your bloodstream, which is why glucose is also called blood sugar. Once in the blood, the glucose is ready for your body cells to use. However, your cells need insulin (pronounced IN-suh-lin), a hormone made by your body, to get the glucose. Insulin “opens” your cells so that glucose can get in. When your metabolism is normal, your body makes enough insulin to move all the glucose smoothly from your bloodstream into your cells. If you have diabetes, your body does not make enough insulin and your cells Continue reading >>

Do You Want To Deliver Your Baby Early?

The last few weeks of pregnancy are very important for your babys development. For years, we thought babies born at 37 or 38 weeks were fine, says Scott Berns, MD, deputy medical director of the March of Dimes. But over the last 10 years, experts have learned thats not true. Babies born even a couple of weeks early have a higher chance of medical problems, he says. Sometimes moms or doctors try to plan childbirth around their busy schedules, trying to fit the delivery more easily into their own work or vacation schedule. Or a doctor may be trying to make sure he or she handles the delivery instead of another doctor at his or her practice. Its become more popular to try to schedule delivery rather than wait for labor to start on its own. The number of babies delivered through early, induced labor almost doubled between 1992 and 2004, and rates of early induction remained high. This means the number of babies born between 36 and 38 weeks has been rising, while the number of babies delivered at 39 weeks has been going down. That's not good for babies or their families. To help reverse the trend, the March of Dimes has launched a campaign, Healthy Babies Are Worth the Wait. And the U.S. Department of Health and Human Services (HHS) has launched the Strong Start Program. When parents find out how much the last weeks count, Berns says, they almost always decide to wait and let nature take its full course. It's best for you, and it's best for your baby. A babys important organs, like the brain and lungs , are still developing in weeks 37 and 38. Babies born earlier than 39 weeks are more likely to have medical conditions that require time in the intensive care unit. A baby delivered early may have: Breathing problems because his lungs are not fully developed Feeding problems Continue reading >>

Gestational Diabetes And Giving Birth

The latest guidance from NICE, published in 2015, has extended the time by which women with gestational diabetes should give birth to 40 weeks, 6 days – not much less than the general guidance for all pregnant women, which is 42 weeks. If you have not gone to birth at this point, induction of labour will be recommended. "When I was in the hospital, I felt I didn’t know what was going on. I would have liked more information about that part so I could have been better prepared." Gemma, mum of one The main reason for induction is to prevent stillbirth. For all women, the risk increases when their pregnancy goes past 42 weeks. However, one study has shown that women with gestational diabetes may be at risk earlier. So for this reason, the guidance in England and Wales states that if you have gestational diabetes, you should not go beyond 40 weeks, 6 days. An induction or caesarean may also be advised if your baby is very large (macrosomia) – as this may cause difficulties during the birth. On the other hand induction may also be recommended if the team detects poor growth in your baby. In Scotland, most women with diabetes in pregnancy are induced within 40 weeks. The guidance says that this decision should be determined on an individual basis. If you are taking diabetes medication or insulin, it recommends that you should be assessed at 38 weeks and delivered by 40 weeks. Choices you might need to make for labour and birth Most women with gestational diabetes have a healthy birth. But before you make your birth plan, you may need to take some things into account to make sure you and your baby are safe during and after the birth. If you have gestational diabetes, you will have less choice about where to deliver your baby. This is because you will need to deliver your Continue reading >>

Gestational Diabetes And Pregnancy

Gestational diabetes is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant. Some women have more than one pregnancy affected by gestational diabetes. Gestational diabetes usually shows up in the middle of pregnancy. Doctors most often test for it between 24 and 28 weeks of pregnancy. Often gestational diabetes can be controlled through eating healthy foods and regular exercise. Sometimes a woman with gestational diabetes must also take insulin. Problems of Gestational Diabetes in Pregnancy Blood sugar that is not well controlled in a woman with gestational diabetes can lead to problems for the pregnant woman and the baby: An Extra Large Baby Diabetes that is not well controlled causes the baby’s blood sugar to be high. The baby is “overfed” and grows extra large. Besides causing discomfort to the woman during the last few months of pregnancy, an extra large baby can lead to problems during delivery for both the mother and the baby. The mother might need a C-Section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery. C-Section (Cesarean Section) A C-section is an operation to deliver the baby through the mother’s belly. A woman who has diabetes that is not well controlled has a higher chance of needing a C-section to deliver the baby. When the baby is delivered by a C-section, it takes longer for the woman to recover from childbirth. High Blood Pressure (Preeclampsia) When a pregnant woman has high blood pressure, protein in her urine, and often swelling in fingers and toes that doesn’t go away, she might have preeclampsia. It is a serious problem that needs to be watched closely and managed by her doctor. High blood pressure can cause harm to both Continue reading >>

Does Gestational Diabetes Always Mean A Big Baby And Induction?

July 3, 2012 by Rebecca Dekker, PhD, RN, APRN © Copyright Evidence Based Birth®. Please see disclaimer and terms of use. This question was submitted to me by one of my readers, Sarah. “I have a question about gestational diabetes. It seems like everyone I know who has had it has ended up being induced. Does gestational diabetes automatically mean induction? Does it automatically mean big babies? It seems like people get diagnosed and then give up on a natural childbirth and are treated as a sick person.” I talked to Dr. Shannon (a family medicine physician), and she echoed Sarah’s perceptions about gestational diabetes: “I would say that ‘routine care’ in the U.S. is to induce at 38 to 39 weeks for gestational diabetes (leaning towards 39 weeks nowadays) if the mom’s glucose is uncontrolled or if she is controlled on medication. However, women can technically be treated as ‘normal’ if their gestational diabetes is well controlled and baby’s growth looks normal on a 32 week scan. So people just might want to know they will get major push back from their provider if they refuse induction. It’s tough. Many OB’s cite the risk of stillbirth as a reason for induction, because the risk of stillbirth in women with regular diabetes is higher. However, there is no evidence that the risk of stillbirth goes up in gestational diabetes.” Evidence Based Birth® offers an online course on Big Babies and Gestational Diabetes (3 contact hours)! To learn more, click here! Dr. Shannon brings up several good points. First, she is talking about “routine care,” which is very different from “evidence-based care.” Routine care means that this is what everyone is doing—it’s routine, it’s standard. Evidence-based maternity care means offering care that is Continue reading >>

Early Detection: Gestational Diabetes & Preeclampsia

Diabetes and preeclampsia are among two of the reasons why regular prenatal visits are so important. Gestational Diabetes: The Basics Chances are you'll sail through pregnancy without trouble. But even if you're feeling great, you should still seek regular prenatal care because some health problems that could hurt your baby are symptomless. These include gestational diabetes, which raises blood sugar levels during pregnancy, and preeclampsia, a form of high blood pressure. But with early detection and treatment, you can manage these problems and still have a healthy baby. What Is It? Gestational diabetes occurs when pregnancy hormones interfere with the body's ability to use insulin, the hormone that turns blood sugar into energy, resulting in high blood sugar levels. Each year, up to 4 percent of women develop this serious illness in pregnancy. While most women with gestational diabetes have no symptoms, a small number may experience extreme hunger, thirst, or fatigue. How Do I Know If I Have It? Your doctor will probably screen you for gestational diabetes between your 24th and 28th weeks of pregnancy. If you have certain risk factors (see "Who's at Risk?" below), your doctor may opt to screen you sooner. During your screening, you'll drink a sugary liquid, then take a blood test. If your blood sugar levels appear high, you'll need to take a longer test, during which you'll drink more liquid and your blood sugar will be tested several times to determine whether you have gestational diabetes. What Are the Risks Associated with It? Women who fail to seek treatment for gestational diabetes run the risk of giving birth to big babies (9 pounds or more), since much of the extra sugar in the mother's blood ends up going to the fetus. Larger babies are more likely to suffer b Continue reading >>