Gestational Diabetes and risks to baby

[MommyD]

Hi - I had my 34 week growth scan yesterday, due to borderline gestational diabetes. The baby's abdomen measurement was out of the normal range by quite a bit and the estimated size was just short of 7lbs already!! Assuming this is all correct, what are the risks to the baby? At 20 weeks the abdomen measurement was well within the normal limits.

Isn't there a higher risk of still birth if you go past 40 weeks? And risk of difficult delivery if baby is too big, which is another reason they like to induce if they think baby is a whopper?

Really, i don't know, but am bumping up so others will see.

hi fellow july-mum . first of all, don't panic. scans are notoriously unreliable (my consultant scanned me the day before i was induced with ds, swore he wouldn't be bigger than 6lbs & he was 7lbs10.....).

the risks to the baby of uncontrolled gestational diabetes are that he/she gets too big, & after birth, may suffer from low blood sugar. they should be giving you serial growth scans (i have existing diabetes & have them every 4 weeks) to see how things are going. have you been monitoring your blood sugars? if so, have you been given any guidelines?

you will probably be induced early (38-39 weeks), & the baby's blood sugar will be monitored. if it's low, you will probably have to give the baby formula for 24 hours, even if you intend to breastfeed. when ds was born his blood sugar was actually ok (it depends on what your blood sugar has been during labour), but they insisted on top ups. i was very stroppy about breastfeeding, he was cup fed, & we had no problems establishing bf.

umm, this is all a bit disorganised, hope it makes sense. just ask if you have any questions.

I have to have a C-section at 38 weeks so, I suppose the risks you mention do not really apply to me.... ?

Hi HC - I have been monitoring sugar (sometimes) and each time the levels were fine. I was lulled into a false sense of security and stopped doing it for a while. Monday my sugar level was 11.6 2 hours after breakfast, which I think is far too high.

it's such a pain isn't it. 11.6 is high. are you taking insulin? what kind of things are you eating? i've been told to aim for between 7 & 8 after meals. mostly i manage this.....

do you have to have a section because of the diabetes?

No- I have taken no insulin and that is the only high reading I have had. Normally around 8 afterr food. I also keep getting dreadful sugar lows. I felt giddy and clammy the other day and took my blood sugar. It was 2.8!! Surely this is the opposite of diabetes? What's the link to this low result and diabetes. I also felt dreadful when sugar was 11.6! What is going on!!?

I have to have a section because I have had 2 emergency ones already and the Royal Free will not let me try VBAC after 2 previous sections

With regard to giving the baby formula for 24 hours, be aware that you can refuse this. The paediatrician insisted that my dd was force-fed formula at two hourly intervals because I had gd and dd was borderline with her blood sugar; I was really unhappy about it, and the midwives eventually told the paed that if a problem developed they would review the situation, but I would breastfeed.

They will take blood from a heel prick every two hours too, which upset me, and eventually I asked them to stop. Again, I was told that if she developed other problems she would have to have the tests re-started, which I agreed to, but she was fine.

If you're getting problems with your blood sugar, give your midwives a ring and ask if the diabetes nurse can give you a check over soon.

Don't take too much notice of the scans either. At 36 weeks I was told my baby was going to be enormous; she was 8lb 8oz which is hardly the 11lb they told me she was likely to be.

Hello MommyD. I have insulin dependant diabetes and I was always told that they would induce me at 38 weeks with DD. I ended up with pre eclampsia so had to be induced at 36 weeks and we had some problems with blood sugars after birth. DD's sugar was taken every 3 hours with the heel prick test and hovered around 2 for hours. We managed to keep them up with regular feeding. You certianly shouldn't need to give formula automatically. If you are producing any colustrum at the moment then you could always try and freeze some to help out.

During my pregnancy I was very well controlled and they monitored my control by the HbA1C blood test (taken approx every 6 weeks to show how good control has been- taken intravenously) the result should be below 7. That figure doesn't realte to your actual blood sugar. The genaral advice is no higher than 8 after meals (taken on a finger prick test) Even on insulin that is hard to maintain and you have a lot less control if you are on tablets. I wouldn't worry about the odd 11. I am 8 weeks pregnant now and do struggle with indiviual blood sugars especially after breakfast and I try to look at teh bigger picture rather than worrying about the odd high one.

Your 2.8 was probably a hypo caused by too much medication or not enough carbohydrate- I would speak to your health team about this. A hypo is generally any result below 3.5 and you will need to take some fast acting sugar - I find orange juice good. I carry cartons with me wherever I go as I probably have at least one hypo a day at moment - probably because am in early stages of pregnancy.

Have you had an HbA1C test that you know of?

Hope the above helps in some way.

Ta Bojangles - No idea about the HbA1C test - what is it? I am only borderline GD - with a 2 hr fasting result of 7.9.

I think my 11.6 result could have been attributble to a large glass of orange juice (that I don't normally drink) - - perhaps?

I get lots of hypos - are hypos something that most people get, or is it linked to diabetes in some ways? Seems to me to be the opposite of diabetes!

Never taken insulin or any medication for GD

Does baby's sugar level rise after a while and stay up or does the high level in-utero affect him/her for quite a while?

Thanks!

My take on your questions are:

• The HbA1c is just a blood test taken from you arm at same time as routine blood tests. It shows how your actual control has been over the last 6 weeks or so. It means that you cannot cheat by pretending that your sugars are ok. They generally look for a reult below 7%. Mine is currently 6.5% which is fine but during pregnancy with DD it was 5.8%. Maybe they don't use it at your hospital. Are you being monitored by the hospital?

• A glass or orange juice is very likely to cause a sharp rise in your blood sugar - perhaps try drinking it dilluted to counteract this.

• hypos in diabetics taking insulin are generally caused by too much insluin, not enough carbohydrate or too much exercise. I undertand that the same can happen on some types of tablets.

People without diabetes can be hypoglycaemic but my understanding was that this wasn't as severe as a diabetic hypo - I would check with your Dr about your low blood sugar as it does sound odd - perhaps you hadn't eaten for a while.

• with my DD her blood sugar was quite low for a few days but that could also be because she was 4 weeks early, jaundice and I was struggling to feed her. Once they went up to normal range they stayed up. Before having her I was led to belive that it might have an effect for around 24hours before she started to regulate her own blood sugar and insulin supply. I was told that the baby gets used to having slightly higher blood sugars whilst in the womb and this makes them produce more insulin making them hypo when they are born beacuse the higher blood sugar supply has been taken away.

Hope that helps and I would definately talk to your health team.

Hi- I'm 34 weeks and have just been told I have gestational diabetes. I had a fasting test 3i/2 weeks ago but was told results were normal; only to later be told this was wrong - totally panicked and although have calmed down now feel angry to have health of my baby played fast and loose with. I'm booked for a c section at 39 weeks but am now going to ask it's brought forward by at least 1 week.
It's very hard to have an additional worry loaded on at this point as have already been unhappy with amount of foetal movement and have had quite a bit of monitoring. This is my 4th pregnancy so you'd think it would be a breze!
Would love some reassurance as have been told horror stories of newborns being carted off to special care, and have specialist muttering about emergency hysterectomy during delivery.