I am a 33 years old, have type 1 diabetes and am in week 33 of my pregnancy. My husband is also diabetic. My 1Ac throughout my pregnancy has been below 7.0 and my gynecologist is satisfied with my ultrasound reports, so far. She does not see any cause for concern. I want to know:

What are the chances that our baby will be diabetic?

Is there any test to confirm whether the baby is diabetic before he/she is born?

Should we wait for normal delivery or have a Caesarian between 37 and 39 weeks? The baby is not macrosomic.

What are the chances that I might go into pre-term labour?

What are the complications of premature birth for the mother and the baby?

What tests the new born should be subjected to immediately after birth to ensure his/her safety?

Let me answer your questions in order:

There are many causes of diabetes and it is not possible to predict if your child will ever develop diabetes.

There is not a prenatal test for diabetes in a fetus.

If the baby is normally grown and all the prenatal testing is reassuring, then I would encourage you to try for a vaginal delivery. Timing may be the issue. Traditionally, many doctors will induce women with diabetes around 37 to 38 weeks, if the baby’s lungs are mature. My personal preference is to try and get the pregnancy as close to term as possible (assuming the mother and baby are doing well) hoping for spontaneous labor. This reduces your chances of ending up with a cesarean section due to a failed induction.

Pre-term labor cannot be easily predicted. Risk factors would be a history of pre-term delivery, a cervix that is becoming short (less than 2.5 cm in length), and any prior operations on your cervix (such as a cone biopsy) that may weaken the cervix. Although at 33 weeks, you should not worry about this too much.

The complications of pre-term birth to you are the same as any delivery. Complications to the baby depend on how far along you are. I am not a pediatrician, so my answer is generic. At 33 weeks there is some risk for lung immaturity which may require a brief period on a ventilator. Following that, the main issues will be feeding, maintaining temperature and growth. There is very little risk for major complications such as chronic lung disease, eye problems or bleeding in the brain.

The pediatricians should check a blood glucose along with all the other testing that is done after delivery. Frequently babies of mothers with diabetes become hypoglycemic. This is temporary and in a few days, if not sooner, the baby will adjust its insulin production to match its glucose intake.

OWJ