October 15, 2000
Gestational Diabetes
Question from Seattle, Washington, USA:
I’m 38 weeks pregnant and have borderline gestational diabetes During an ultrasound, I was told that the baby weighs 9 pounds, 5 ounces, give or take 27 ounces. An obstetrician has told me that, because of the gestational diabetes, I should seriously consider a voluntary C-section if the baby is estimated to weigh over 8 pounds 13 ounces. This seems extremely conservative to me, as my blood sugars have been extremely well under control (only two two-hour post-prandial readings over 120 mg/dl [6.7 mmol/L], and one fasting level over 95 mg/dl [5.3 mmol/L] in 10 weeks of testing four times per day), and I’m a large person (5 feet 8 inches). Are there any statistics available on this issue? Do you have any advice?
Answer:
Your obstetrician is most worried about a problem called shoulder dystocia. This is situation where the head of the baby delivers through the birth canal, but the shoulder gets stuck behind the pubic bone of the mother. The can be remedied through various maneuvers, but carries a high of injury to the baby or even death. Excessive weight (macrosomia) for a baby of a mother with diabetes is set at more than 4000 grams (8 pounds, 13 ounces). Unfortunately, estimating the fetal weight is difficult even with ultrasound. However, that is the only information available and this needs to be taken into consideration. Even with good blood glucose control you can still have a big baby.
OWJ
