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November 2, 2001

Gestational Diabetes

Question from Hellertown, Pennsylvania, USA:

I am 34 years old, 36 1/2 weeks pregnant, was diagnosed with gestational diabetes four and a half weeks ago (treated with insulin and diet), and my sugars have been controlled well. I'm now faced with a dilemma and not sure which way to go because of conflicting medical advice. One very firm suggestion is that I have an amniocentesis at 37 weeks to check lung maturity and be induced at 37 1/2 weeks. I was told this would reduce the very scary risk of stillbirth as well as other not so serious complications. The other suggestion is to wait it out. Do not get an unnecessary amniocentesis because of the risks of that, and get induced around 39 weeks (if I have not given birth yet). I have had four normal non-stress tests and two normal amniotic fluid checks. The baby is right on dates with weight and measurements. How necessary are the amniocentesis and the early induction? The threat of fetal demise is scaring me, so I'm wondering which risks are higher.

Answer:

Both options are reasonable. In my practice, as long as the fetal testing is reassuring, I try and get mothers as close to term as possible. If the situation changes, then delivery is indicated. The risk of a stillbirth is very low with normal fetal testing. Discuss this further with your obstetrician.

OWJ