January 8, 2003
Family Planning
Question from St. Paul, Minnesota, USA:
I am 34 years old, I’ve had type 1 diabetes for 25+ years, and my hemoglobin A1c have been mostly under 6.5% ( most recent: 5.8%). I just found out I am pregnant, and I met with a perinatologist recently who raised some diabetes-related pregnancy concerns which are new to me. She said that a woman with diabetes must deliver between 38-1/2 and 39-1/2 weeks and must certainly not be allowed to go to full term. I asked the doctor’s reasoning and was told that the placenta of a woman with diabetes ages prematurely, necessitating early delivery for the safety of the baby. I have not read or heard it anywhere in my research.
Is this accurate information? Is the placenta’s premature aging (if that actually does happen) moderated by tight glucose control? I have not discussed these questions yet with my endocrinologist because of the holidays, and I will certainly do that, but I would also be interested in your opinion and experience.
Answer:
How far to let a pregnancy go in a woman with type 1 diabetes is open to debate. Traditionally, babies were delivered early due to the reasons explained by your doctor. The most recent recommendation is that with good glucose control and reassuring fetal testing the pregnancy can go to full term (38-39 weeks is close enough). However, many doctors still elect to induce labor early with documentation of fetal lung maturity. Either course of management is acceptable.
OWJ
