My wife has gestational diabetes, and she tried diet and exercise, but it was determined that she needs two shots of insulin per day, and her readings are now pretty much under control. However, I have a few questions:

I’ve heard that women with gestational diabetes who need insulin have higher rates of stillbirth or other problems. Does the insulin cause these problems, or does the need for insulin identify other problems that probably cause these higher rates of incidence?
My wife’s fasting and two hour after meal blood sugars were pretty high. Is there any way to know if she had undiagnosed pre-existing diabetes?

A woman with type�1 diabetes (who essentially makes no insulin) has a high risk of fetal death if her blood sugar is not controlled. This is probably due to hyperglycemia throughout the entire pregnancy and its effects on the vascular system of the placenta. Insulin does not cause fetal demise. With proper control and close fetal monitoring, the risk of fetal demise is reduced to almost that of a woman without diabetes.

A woman with gestational diabetes who can be managed on diet only has a risk similar to that of a woman without diabetes. A woman with gestational diabetes requiring insulin may be at slightly increased risk but not the same as someone with type 1 diabetes.

There are some tests that can be done to determine if your wife has preexisting diabetes. If her hemoglobin A1c is elevated early in the pregnancy, that would suggest long standing hyperglycemia. After she delivers, if her glucose test is still abnormal, then she may have persisting diabetes.

OWJ