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November 6, 2007

Gestational Diabetes

Question from London, United Kingdom:

I am pregnant with my first child. I was diagnosed with diabetes during the first trimester, but the doctors don't know if it was pre-existing or not. It appears to be very mild. I am diet controlled. I'm now at 30 weeks and my obstetrician tells me that they normally induce their diabetic patients at 38 weeks, even if they are well-controlled because of the risk of unexplained intrauterine fetal death. However, I have read that if the diabetes is diet controlled, then there is no greater risk of stillbirth. Could you please give me your opinion?

Answer:

You are correct that gestational diabetes does not carry the same risk of unexplained fetal death as in a woman with preexisting diabetes. However, you were diagnosed in the first trimester which raises the suspicion that you had diabetes before you conceived. Therefore, your doctors are managing you conservatively as if you have preexisting diabetes. Having said that, it is not always necessary to induce labor early as long as you are doing well (no preeclampsia, etc) and the baby is doing well as determined by ultrasound and fetal heart rate testing (the nonstress test). In addition, if your doctor insists on delivering earlier than 39 weeks, it will be important that you have an amniocentesis for fetal lung testing unless there is an additional compelling reason for early delivery.

OWJ