I was diagnosed with gestational diabetes 24 weeks into my pregnancy. I was put on a special diet and exercised daily, but this was not enough to control it so I was then put on insulin. My blood sugar levels were within normal range, and everything appeared to be just fine, but my son was stillborn at 28 weeks gestation due to placental abruption.

The pathologist suggests that due to findings he believes that the diabetes had more to do with it than previously thought. Can being insulin dependent for gestational diabetes put you at an increased risk for stillbirth? Could I have had diabetes the whole time and not known it so it went untreated until 24 weeks gestation? My doctor here is not helping much, and I am searching for answers as to what happened to my son.

Determining the cause of a fetal death can be difficult. In the past, type 1 diabetes was associated with a very high fetal loss rate, particularly in the latter third of gestation. However, with close fetal surveillance and good glucose control, this rate has come down to almost equal to that in women without diabetes. Although the exact cause of fetal death in association with diabetes is not known, one theory suggests it may be due to lactic acidosis in the fetus.

Gestational diabetes in general does not have the same increased risk of fetal death probably because there is not secondary vascular disease and the same metabolic problems seen in type 1 diabetes. However, fetal death can occur. In your case, I would be hard pressed to attribute the death of your baby to just the diabetes. There are other disorders (in particular a predisposition to forming blood clots) that can lead to placental abruption that should be investigated because there may a recurrence rate that can be diminished with proper treatment.

OWJ