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Do Women With Gestational Diabetes Give Birth Early?

Have Gestational Diabetes? Timing Of Delivery Matters

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 >>

Gestational Diabetes

Gestational Diabetes

Diabetes mellitus (also called diabetes) is a condition in which too much glucose (sugar) stays in the blood instead of being used for energy. Health problems can occur when blood sugar is too high. Some women develop diabetes for the first time during pregnancy. This condition is called gestational diabetes (GD). Women with GD need special care both during and after pregnancy. The body produces a hormone called insulin that keeps blood sugar levels in the normal range. During pregnancy, higher levels of pregnancy hormones can interfere with insulin. Usually the body can make more insulin during pregnancy to keep blood sugar normal. But in some women, the body cannot make enough insulin during pregnancy, and blood sugar levels go up. This leads to GD. If I develop GD, will I always have diabetes? GD goes away after childbirth, but women who have had GD are at higher risk of developing diabetes later in life. Some women who develop GD may have had mild diabetes before pregnancy and not known it. For these women, diabetes does not go away after pregnancy and may be a lifelong condition. Several risk factors are linked to GD. It also can occur in women who have no risk factors, but it is more likely in women who are of African American, Asian American, Hispanic, Native American, or Pacific Island background When a woman has GD, her body passes more sugar to her fetus than it needs. With too much sugar, her fetus can gain a lot of weight. A large fetus (weighing 9 pounds or more) can lead to complications for the woman, including severe tears in the vagina or the area between the vagina and the anus with a vaginal birth What other conditions can a woman with GD develop? When a woman has GD, she also may have other conditions that can cause problems during pregnancy. For ex Continue reading >>

How Gestational Diabetes Affects You & Your Baby

How Gestational Diabetes Affects You & Your Baby

When you're pregnant, hormone changes can make your blood sugar level rise. Gestational diabetes will raise the odds of pregnancy complications. After you're diagnosed, your doctor or midwife will want to watch your health and your baby's health closely for the rest of your pregnancy. Most women with gestational diabetes have healthy pregnancies and healthy babies. Getting good treatment makes all the difference. How Will It Affect My Baby? Your higher blood sugar affects your baby, too, since they gets nutrients from your blood. Your baby stores that extra sugar as fat, which can make them grow larger than normal. They're more likely to have certain complications: Injuries during delivery because of their size Low blood sugar and mineral levels when they're born Jaundice, a treatable condition that makes the skin yellowish Pre-term birth Later in life, your baby might have a greater chance of obesity and diabetes. So help your child live a healthy lifestyle -- it can lower their odds for these problems. How Will It Affect Me? You might have: A higher chance of needing a C-section Pre-term birth Your blood sugar will probably return to normal after you give birth. But you'll have a higher risk of developing type 2 diabetes later or gestational diabetes again with another pregnancy. A healthy lifestyle can lower the odds of that happening. Just as you can help your child, you can lower your own chances of obesity and diabetes. Although you may need a C-section, many women with gestational diabetes have regular vaginal births. Talk to your doctor or midwife about your delivery options: Does my baby need to be delivered by C-section? How accurate are birth-weight estimates? Could my baby be smaller than you think? What are the risks to my baby and I if I don’t have a C-s Continue reading >>

Gestational Diabetes And Giving Birth

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 >>

Pre-existing Diabetes And Pregnancy

Pre-existing Diabetes And Pregnancy

If you have type 1 or type 2 diabetes and are planning a family, you should plan your pregnancy as much as possible. Controlling your blood sugars before conception and throughout pregnancy gives you the best chance of having a trouble-free pregnancy and birth and a healthy baby. If you have diabetes and your pregnancy is unplanned, there’s still plenty you can do to give your baby the best start in life. The information on this page is for women who have diabetes before becoming pregnant. If you develop diabetes during pregnancy, it is called gestational diabetes. Planned pregnancy Visit your doctor or diabetes educator at least 6 months before you start trying to fall pregnant, if you can. You will be given advice and guidance on controlling your blood sugars as tightly as possible, and taking necessary supplements like folate. You may also be advised to change medications. If you are healthy and your diabetes is well controlled when you become pregnant, you have a good a chance of having a normal pregnancy and birth. Diabetes that is not well controlled during pregnancy can affect your health long-term and can also be risky for your baby. Unplanned pregnancy Not everybody can plan their pregnancy. If you have diabetes and think you might be pregnant, see your doctor as soon as you can. Your healthcare team You may be cared for by a team of health professionals including: an obstetrician who can handle high risk pregnancies a specialist experienced in diabetes care during pregnancy, who may be an endocrinologist or who may be a general physician a diabetes educator to help you manage your diabetes a dietician who can provide dietary advice at all the different stages - before conception, while pregnant and after the birth a midwife who is experienced in all aspects Continue reading >>

How Will Gestational Diabetes Affect My Birth Options?

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 >>

Risk Factors For Early Delivery

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 >>

Planned Birth At Or Near Term For Pregnant Women With Gestational Diabetes And Their Infants

Planned Birth At Or Near Term For Pregnant Women With Gestational Diabetes And Their Infants

Planned birth at or near term for pregnant women with gestational diabetes and their infants The aim of this Cochrane review was to find out if planning an elective birth at or near the term of pregnancy, compared to waiting for labour to start spontaneously, has an impact on the health of women with gestational diabetes and the health of their babies. Planned early birth means either induction of labour or caesarean birth, and 'at or near term' means 37 to 40 weeks' gestation. To answer this question, we collected and analysed all relevant studies conducted up to August 2017. Women with gestational diabetes (glucose intolerance arising during pregnancy) and their babies are at increased risk of health complications (e.g. high blood pressure, bigger babies). Because of the complications sometimes associated with birthing a big baby, many clinicians have recommended that women with gestational diabetes have an elective birth (generally an induction of labour) at or near term (37 to 40 weeks' gestation) rather than waiting for labour to start spontaneously, or until 41 weeks' gestation if all is well. Induction has disadvantages of increasing the incidence of forceps or ventouse births, and women often find it difficult to cope with an induced labour. Caesarean section is a major operation which can lead to blood loss, infections and increased chance of problems with subsequent births. Early birth can increase the chance of breathing problems for babies. It is important to know which approach to birth has a better impact on the health outcomes of women with gestational diabetes and their babies. Our search identified one trial involving 425 women and their babies. In this trial , 214 women had an induction of their labour at term, the other 211 women waited for a spontan Continue reading >>

Does Gestational Diabetes Always Mean A Big Baby And Induction?

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 >>

Gestational Diabetes

Gestational Diabetes

Overview Gestational diabetes develops during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby's health. Any pregnancy complication is concerning, but there's good news. Expectant women can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. Controlling blood sugar can prevent a difficult birth and keep you and your baby healthy. In gestational diabetes, blood sugar usually returns to normal soon after delivery. But if you've had gestational diabetes, you're at risk for type 2 diabetes. You'll continue working with your health care team to monitor and manage your blood sugar. Symptoms For most women, gestational diabetes doesn't cause noticeable signs or symptoms. When to see a doctor If possible, seek health care early — when you first think about trying to get pregnant — so your doctor can evaluate your risk of gestational diabetes as part of your overall childbearing wellness plan. Once you're pregnant, your doctor will check you for gestational diabetes as part of your prenatal care. If you develop gestational diabetes, you may need more-frequent checkups. These are most likely to occur during the last three months of pregnancy, when your doctor will monitor your blood sugar level and your baby's health. Your doctor may refer you to additional health professionals who specialize in diabetes, such as an endocrinologist, a registered dietitian or a diabetes educator. They can help you learn to manage your blood sugar level during your pregnancy. To make sure your blood sugar level has returned to normal after your baby is born, your health care team wil Continue reading >>

Induction | Gestational Diabetes Uk

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 >>

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

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 >>

Gestational Diabetes

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 >>

Gestational Diabetes Birth Stories

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 >>

Treatment

Treatment

If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels. You'll also need to be more closely monitored during pregnancy and labour to check if treatment is working and to check for any problems. Checking your blood sugar level You'll be given a testing kit that you can use to check your blood sugar level. This involves using a finger-pricking device and putting a drop of blood on a testing strip. You'll be advised: how to test your blood sugar level correctly when and how often to test your blood sugar – most women with gestational diabetes are advised to test before breakfast and one hour after each meal what level you should be aiming for – this will be a measurement given in millimoles of glucose per litre of blood (mmol/l) Diabetes UK has more information about monitoring your glucose levels. Diet Making changes to your diet can help control your blood sugar level. You should be offered a referral to a dietitian, who can give you advice about your diet, and you may be given a leaflet to help you plan your meals. You may be advised to: eat regularly – usually three meals a day – and avoid skipping meals eat starchy and low glycaemic index (GI) foods that release sugar slowly – such as wholewheat pasta, brown rice, granary bread, all-bran cereals, pulses, beans, lentils, muesli and porridge eat plenty of fruit and vegetables – aim for at least five portions a day avoid sugary foods – you don't need a completely sugar-free diet, but try to swap snacks such as cakes and biscuits for healthier alternatives such as fruit, nuts and seeds avoid sugary drinks – sugar-free or diet drinks are better than sugary versions; be aware that fruit juices and smoothies contain s Continue reading >>

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