Risks Of Going Overdue With Gestational Diabetes

Timing Of Delivery In Women With Diabetes In Pregnancy

Timing of delivery in women with diabetes in pregnancy 1Maternal Fetal Medicine St Michaels Hospital, Toronto, Ontario, Canada 2University of Toronto, Toronto, Ontario, Canada 1Maternal Fetal Medicine St Michaels Hospital, Toronto, Ontario, Canada 2University of Toronto, Toronto, Ontario, Canada 1Maternal Fetal Medicine St Michaels Hospital, Toronto, Ontario, Canada 2University of Toronto, Toronto, Ontario, Canada Copyright The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav The incidence of both gestational and pre-gestational diabetes is increasing worldwide. The main cause of this increase is likely the concomitant increase in the incidence of global obesity, but in the case of gestational diabetes, changes in the diagnostic criteria are also a contributing factor. The adverse outcomes associated with pre-gestational diabetes are well known and have led clinicians to implement various strategies that include increased fetal surveillance and induction of labour at various gestational ages. In many cases these same strategies have been applied in clinical practice also to women with gestational diabetes despite there being differences in the type and magnitude of perinatal complications associated with this diagnosis. Despite the widespread application of these clinical practices, there is a paucity of quality data in the medical literature to guide the clinician in choosing a strategy for fetal surveillance and timing of delivery in both gestational diabetes and pre-gestational diabetes pregnancies. In the following review, we will discuss the rationale and consequences of planned delivery in gestational diabetes and pre-gestational diabetes, the evidence supporting different strategies for delivery and finally highlight future targets Continue reading >>

Gestational Diabetes Versus Unwanted Interventions

Deborah is 36 weeks pregnant and has gestational diabetes. She’s been careful about diet and exercise and has maintained very stable blood sugar levels. Her doctor, however, is warning her she’ll probably need to be induced at 39 weeks and may need a c-section. He wants her to get an early epidural so she’ll be ready for surgery, “just in case.” Deborah’s warning bells are going off because that’s not the labor she had in mind. She’s hoping for a spontaneous and un-medicated labor and worries her doctor is setting her up for interventions she doesn’t want. Gestational diabetes (GD) can have a big impact on mothers’ and babies’ health, but it doesn’t always have to be a big deal that requires all the tools in the medical toolbox. Often times, complications like GD can be managed carefully without making major diversions from the patient’s hoped-for birth plan. Deborah’s doctor told her that GD babies have to be induced at 39 weeks because sometimes they “just don’t come” until they’re two or three weeks past their due date. Deborah, that doesn’t sound quite right to me. GD babies are at somewhat higher risk to come earlier than their due date, not later. If mom’s blood sugars aren’t well controlled, babies can get too much glucose through the placenta and grow too big. That can trigger premature labor, damage the placenta and bump up risks for delivering a baby whose lungs aren’t fully developed. Premature and super-sized babies tend to have more respiratory problems and a tough time stabilizing their own blood sugars too. That doesn’t mean these problems are guaranteed to happen to you and your baby, Deborah. It means there’s a greater risk. Many GD babies are born healthy with normal weights and perfect birthdays and neve Continue reading >>

Going Over 40weeks - Babycenter

Can any of you ladies who have already had GD in previous pregnancies tell me, do they allow you to go over 40weeks?? x My hospital don't allow you to go over 40wks. I'm diet controlled (this time and last) induced at 39wks. I was allowed to go to 40 weeks because I was diet controlled and they induced me on my due date. I never had any extra scans ( consultant said he was happy with me apparently) my baby was born at 9lb15oz!!! I asked the midwife after if I should have been induced and she said its a hard call to make because some times it causes more harm then good. Some hospitals have a policy to induce early. All I will say is when I was induced to say it was a hospital and they knew I had GD they didn't really cater good wise for me as I couldn't eat cereals and they only had normal bread unless I ordered it! I was allowed to 41 weeks I was diet controlled my baby came naturally. I've been told age is a factor too. My friend was 41 she was told if she was 31 they would let her go over a week. She was induced on her due date. I'm allowed to go overdue, but she has said she still aims to deliver around due date. I'm going to push to go as far as possible till i go into labour naturally as i reaaally want to avoid another induction. I was 40+10 and on metformin. My baby was 8,9oz blood sugars fine. Easy induction. My birth story on here a way back. My baby was born 4th August of u want to look back and have a read x I was 40+4 in the end. I was diet controlled and all growth scans ok. My obstetric consultant didn't want to induce me at all (previous section he couldn't understand why I wanted a vbac). I refused a section at 39+6 as I'd been having lots of contractions and my cervix was getting favourable so they could try and break my waters. I spoke to a different Continue reading >>

Overdue Induction With Gd

Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. I was diagnosed with GD in week 31 and it's been well controlled with diet and a steadily increasing does of Glyburide. My due date is Aug. 28, three days away, and my doctor was really accomodating about letting me get to my due date because I was hoping for a natural childbirth. But now that the day is here, I'm getting a lot of pressure to begin cervix ripening and induction. Anyone know how common it is to be allowed to go past your due date with GD -- or is that just unheard of? And do cervix ripening and induction go hand in hand, or could I do the ripening without the pitocin and buy some more time to try to go into labor spontaneously. I'm pretty adamant about natural birth, but I don't want to be dangerous or unsafe. Everything about what you just posted screams "NO, don't do it!!" to me... it doesn't sound like you're a good candidate for induction at all if they're wanting to do ripening first. Have you had a lot of monitoring already? NST's and BPP's? If those are all looking great, I'd probably opt to wait it out a little bit longer, as long as the monitoring continues to look good.. especially since you're not on insulin. You could potentially do the ripening without the AROM or pitocin... however, depending on what methods they use, that can still put you into labor, which still technically makes it an induction, and would carry similar risks of complication and ending in C/S. That said, I walked into both of my inductions at 3cm and 80% effaced.. I was ready to go, I just needed a bit of a kick start. I had my water broken and got low doses of pitocin (so low in fact that it w Continue reading >>

Does Gestational Diabetes always mean a Big Baby and Induction?

Complications Of Gestational Diabetes

Is my baby at risk of complications now I have gestational diabetes? Gestational diabetes is a serious condition which can cause many complications. The advice given by your diabetes health care professionals should be taken seriously as uncontrolled or poorly controlled gestational diabetes can lead to severe complications. Having gestational diabetes itself automatically causes higher risk of certain complications during pregnancy, although the risk of complications is greatly reduced if gestational diabetes is diagnosed and managed properly throughout your pregnancy. Gestational diabetes only causes bigger babies - expelling the myth! The most well known complication and general cause of concern of gestational diabetes is 'large babies' - the excessive growth caused by excess sugars in the mother's bloodstream. HOWEVER, if gestational diabetes is controlled and managed well, babies are rarely born 'big', but they may suffer other complications which are related to the condition. We often hear new members of our support group say that they are not worried as baby isn't measuring big, but monitoring for other complications which gestational diabetes can cause or be related to is extremely important. Unfortunately there are many more complications which can be related to gestational diabetes and poor glucose control than 'just a big baby'. If you have family and friends that are struggling to understand gestational diabetes, then you may want to refer them to this page and our page on gestational diabetes and the family to have a look. Possible complications if blood glucose levels are not controlled or poorly controlled If gestational diabetes is not managed properly, or goes undetected/undiagnosed, it could cause a range of serious complications for both you and your Continue reading >>

Asking For A Friend. Gd Diet Controlled Past Due Date

Asking for a Friend. GD diet controlled past due date Is it the norm for doctors to let GD mommies go past due date? She's diet controlled but has had severe Siatica problems for a month. She's on crutches and can barely walk. Not had an ultrasound since week 20. Due date was yesterday. Dr today said come back next week. I guess not all GD mommies get ultrasounds in third trimester but I thought they needed to monitor baby fsize esp going past due date. & what about the placenta? How do they know if it's not detiriating without an ultrasound. My doctor wouldn't be comfortable with me going over my due date, especially without scans. However they'd be plenty of mums that wouldn't even know they have GD. I think bring on insulin is much more of a factor when considering placental deterioration. But I personally would be asking my doctor more questions about this (before my next appointment). She was due yesterday. She's been very miserable for 2-3 weeks. She was hoping something would happen last week. He said no progress sent home. She went today at 40+1 and said same thing. I would be worried without scans. And past due date. My midwives will let me go to 41 weeks but no later. I'm diet controlled with really good (like normal, non GD pregnancy) numbers 99% of the time. I have had a few ultrasounds because my fundal height has been measuring behind but if it wasn't I wouldn't have had those either. Starting last week (at 36 weeks) I have a NST once a week at my appointments. Does she not even have NSTs? Because the rest of it seems okay to me but not even having those seems really strange. Especially being overdue now. From what my midwife has told me, if GD is diet controlled, the pregnancy can be considered normal. If I go that long, I'll be in the same boat (minus t Continue reading >>

Gestational Diabetes + Induction + Help Please

Gestational Diabetes + Induction + help please Sorry about another GD thread but I have some other questions I didn't see answered on others. I just found out earlier today that my GTT came back abnormal and that I have gestational diabetes, so far nobody has told me anything about it and obviously I can't help but worry. I've read that this can increase the risk of stillbirth and newborn death and now I'm really scared I was wondering, do they always induce you early if you have Gestational Diabetes? how many of you were induced at 38 weeks? I'm so scared after reading the risk of stillbirth that I really don't want to go over due with this baby i want her out ASAP and I'm going to ask about being induced. Another thing that's annoying me is that I was supposed to sit this GTT FOUR weeks ago but they refused to see me because I was 5 minutes late, and I was only literally 5 mins late!!! so I've had GD for four weeks longer than needed without actually knowing about it im so scared about what harm this might have done to her. Will they still give me growth scans to make sure she's not too big now and how many of them should I expect to have? now I just pray nothing bad happens to my baby I don't know about induction because I had a planned c section, but towards the end of my pregnancy I was scanned every fortnight. I was told that if you needed insulin because diet/exercise didn't improve your bs levels, then my hospital would consider induction at 38/39 weeks. I am also having growth scans every 2-3 weeks, but nearer the end of the pregnancy, they may scan me every week and I will need to be monitored a couple of times a week too! I doubt you have "done anything" to your baby, as all of her organs etc are already developed, and your 20weeks scan would've picked up an Continue reading >>

Going Over 40 Weeks With Gd

Would anybody with experience of going over 40 weeks with GD be free (and willing) to have a chat? We've had a horrible experience at my appointment today. After being told all pregnancy that my GD is extremely well controlled and poses virtually no risk to myself or baby as a result, that scans and CTGs have showed baby is very happy and healthy and that my placenta is functioning well, we went to my appointment today at 39+6 and they were originally talking about induction at 41 weeks. Then suddenly they said "oh wait, GD, we need to induce at 40 weeks". We were suddenly told that all of these risks apply to me purely because I "have the label of GD" and that I should be induced ASAP. I asked if we could have extra scans or monitoring from now on and was told that they would essentially be worthless. We were made to feel like absolute crap for not wanting to accept an induction date straight away. We asked questions that were fobbed off and when I asked what risks were involved with continuing the pregnancy past 40 weeks, the midwife said "well you tell me!" To which I responded with "I don't know - you're the midwife!" We are feeling completely misinformed and essentially bullied. They dismissed any research/information I had read or been told by other doctors and basically just stated hospital policy. We have now ended up with an induction booked in at 40+3 that we feel incredibly uncomfortable about because we don't feel like we understand the risks either way (eg. continuing past 40 weeks vs induction etc). I'd just really love to talk to somebody else who has gone over 40 weeks about how we're feeling. Xx Continue reading >>

Gestational Diabetes And Induction Of Labour – What You Should Know

Gestational Diabetes and Induction Gestational diabetes (GD) was once a relatively rare condition, occurring in about 4% of pregnancies. In recent years, the rate of women developing GD has doubled, and experts believe the incidence of the disease will keep increasing. Most women with GD are told by their care providers they will need to be induced before their due date, destroying their hopes for a natural and intervention free birth. Having GD can have a big impact on mothers’ and babies’ health during pregnancy, but does it really need to change how we give birth? What Is Gestational Diabetes? Gestational diabetes is a condition that only occurs during pregnancy. Certain pregnancy hormones interfere with your body’s ability to use insulin. Insulin converts blood sugar into usable energy, and if this doesn’t happen, blood sugar levels rise. Insulin resistance can cause high blood glucose levels and can eventually lead to gestational diabetes. Some women will have symptoms of GD, while others will have none. Many women can manage the condition without treatment other than dietary and exercise changes. Around 20% of women will need insulin injections. So for many women, well managed diabetes means they can still have healthy babies and normal births. Induction Of Labour Many care providers routinely recommend that women with gestational diabetes be induced around 38-39 weeks. The most common reasons given for induction at this gestation are to prevent stillbirth, and to prevent babies growing too large for vaginal birth. However, the evidence related to induction for women with GD comes from the review of one trial, which looked at 200 women who had either GD, Type 1 or Type 2 diabetes. The World Health Organization states this evidence for induction before 41 w Continue reading >>

Fearing The Worst: The Real Risks Of Stillbirth

Fearing the Worst: The Real Risks of Stillbirth Stillbirth.Just saying the word makes me cringe and take a deep breath to avoid feeling nauseated. Loss after 20 weeks in pregnancy is medically referred to as stillbirth. Luckily, the risk of this type of loss is rare. The current rate in the US at 6/1000. Still, its a common fear among pregnant women. Here are the most common conditions associated with stillbirth, and what you and your doctor can do to help lower your risk of a bad out come. When I was pregnant, my husband came to only a couple of my prenantal visits. Afterward, he remarked, that they seemed pretty pointless. All they did was weigh you, check your blood pressure, make you pee and listen to the heart beat. He said. It only took 5 minutes. I explained to him how much valuable information these routine checks actually gives the doctor. The earliest signs of preeclampsia can show up in these numbers. By intervening early in preeclampsia, we can help improve the safety of delivery and prevent bad outcomes. Hypertension effects all the blood vessels in the body, including the placenta. Over time it can reduce nutrient flow to the baby. Preeclampsia is a specific type of hypertension that you get only during pregnancy. It is more common in the final weeks of pregnancy which is one of the main reasons we make you come to the doctor more frequently during the last month. Attending your regular prenatal visits is the best screening for preeclampsia. If you do have hypertension, then your doctor will often do ultrasounds and nonstress tests to make sure that your baby is doing well. Much as high blood pressure effects the entire body, so does diabetes. If you have diabetes, it is best to meet with your doctor before conception to optimize your health and review yo 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: Q And A

Q. What is gestational diabetes? A. Gestational diabetes is a form of diabetes that develops during pregnancy. It is different from having known diabetes before pregnancy and then getting pregnant. Gestational diabetes is generally diagnosed in the second and third trimesters of pregnancy, and usually goes away after the baby is born. Gestational diabetes can cause problems for the mother and baby, but treatment and regular check-ups mean most women have healthy pregnancies and healthy babies. Q. Am I at risk of gestational diabetes? A. Gestational diabetes affects between 10 and 15 per cent of pregnancies in Australia. Women of certain ethnic backgrounds — Australian Aboriginal or Torres Strait Islander, Indian, Asian, Middle Eastern, African, Maori and Pacific Islander — are more at risk of developing gestational diabetes than women of Anglo-Celtic backgrounds. Other factors can also increase your risk, including: being overweight; having a family history of diabetes; having had gestational diabetes in a previous pregnancy; being 40 years or older; having polycystic ovary syndrome (PCOS); taking medicines that can affect blood sugar levels (such as corticosteroids and antipsychotic medicines); and previously having a very large baby (more than 4.5 kg). Q. How would I know if I had gestational diabetes? A. Gestational diabetes does not usually give rise to symptoms. For this reason it is important to be tested during pregnancy, usually between 24 and 28 weeks. Women with risk factors for diabetes may be offered testing earlier than this – sometimes at the first antenatal visit, which is often at around 10 weeks. Women who do develop symptoms may experience: extreme tiredness; being thirsty all the time; symptoms of recurrent infections (such as thrush); and needi Continue reading >>

What Are The Risks Of Gestational Diabetes?

A risk means there is a chance that something might happen. With every pregnancy there are some risks, but if you have gestational diabetes your risks of some things will be increased. Managing your blood sugar level brings these risks right down again though and most women with gestational diabetes have healthy pregnancies and healthy babies. These things are very unlikely to happen to you, but understanding the risks may help you see why it is important that you follow your healthcare team’s advice. The risks linked to gestational diabetes are caused by blood glucose levels being too high. If you can keep your blood glucose as close as possible to the ideal level, your risks will be reduced. Risk of having a large baby (macrosomia) If your blood glucose level is high, it can cause high blood glucose levels in your baby. Your baby will produce more insulin in response, just like you do. This can make your baby grow larger than normal. This is called macrosomia. Babies weighing more than 4kg (8lb 8oz) at birth are called macrosomic. Macrosomia increases the risk of: Birth trauma - either the mother or baby can be affected when it is difficult for the baby to be born. Trauma may include physical symptoms, such as bone fractures or nerve damage for the baby, or tearing and severe bleeding for the mother as well as psychological distress. Shoulder dystocia - where the baby’s shoulder is stuck in your pelvis once the head has been born. This can squash the umbilical cord, so the team need to use additional interventions to deliver the baby quickly and safely. It means you may have labour induced early or to have a caesarean section so that your baby is born safely. Your baby's weight will be monitored carefully in pregnancy to see whether these interventions are needed. Continue reading >>

For Anyone Who Has/had Gestational Diabetes Did Your Dr Let You Go Over Your Due Date?

For anyone who has/had Gestational diabetes did your Dr let you go over your due date? I saw my OB yesterday thinking it would be my last appointment (I'm due on the 4th) and that he would book in my induction before the 4th but he said that the private hospital that I'm going to is fully booked until the 11th and that is when he will induce me.....a week past my due date!!!! Now having gestational diabetes I would have thought that would be a no no. This is my third time around with GD and have never gone over my due date (last time was I was induced 4 days before my due date). I was just totally gobsmacked that he even suggested that and felt like getting up and giving him 2 black eyes, I'm just over it all. Now I know that it is more than likely that I will go into labour before then but I just thought that they would have reserved beds for special care cases. Private hospitals are not at all what they are cracked up to be and I'm p*ssed at my OB for not booking the induction about a month ago. Has anyone elses doctor let them go over with their diabetes and was your baby a whopper? I had gd with dd2 and she was delivered by cs 2weeks before my due date. She went into distress from the diabetes too and wasnt growing but i think most gd babies are born around 1-2 weeks earlier arent they? I would think that its a bit strange for him to let you go over your date due to the risk of bub being too big for a vaginal birth??? When you had gd with your other pregnancies were they big babies??? If you do go over then i would be insisting constant monitoring every day over your due date to make sure bub isnt in distress or anything Both of my kids were under 8 pounds and not considered big at all. I have kept my diabetes under control with insulin and he doesn't think this on Continue reading >>

What My Overdue Baby Taught Me About My Induction

Everett was born at home at 41 weeks and 3 days . My labor was 4 hours and 45 minutes including 20 minutes of pushing. Friend A was 41 weeks and 3 days with her third baby (her second HBAC), and her labor was 6 hours. Jill from Baby Rabies recently gave birth to her second baby at 41 weeks. She walked into the hospital at a 7 and delivered 2 hours after checking in after an intense and fast labor. Her birth story. We were all overdue, very large, uncomfortable, and ready to have a baby. We waited a long time One of my theories is that my babies need to bake longer than the 40 week mark. Every woman is different, every pregnancy is different. Why is there so much importance placed on this magic 40 week mark? The reason I say this is because of the differences I saw in my first son after birth compared to my second. My first son was induced when I was 39 weeks 3 days. To most pregnant people they would assume this is plenty of time to bake a baby. My OB decided to induce me because I had Gestational Diabetes and was told going 1 day over 40 wasnt an option (pshaw wish I had known) and because at my growth scans they noticed my babys abdomen was measuring small (but consistently small, why worry?). The day we went in for a follow up scan they told me to pack my bags and come in the next day because, and I quote, the baby has baked long enough. I had a pitocin induced labor which took over 20 hours from start to finish. I couldnt take the humpback contractions and opted for the epidural. To this day I am amazed I ended up with a vaginal birth now that I know the statistics for inductions and long labors. Fletcher was 7 lbs 2 0z and 19.5 inches long. He was coated with thick vernix. Why do I mention this? Typically, full term babies have already sloughed off most or all of Continue reading >>