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Does the diagnosis of impaired glucose tolerance influence the timing of delivery?
No. If this condition has not progressed into gestational diabetes, it should not influence the timing of delivery, because it cannot harm the mother or the baby. If any intervention is recommended, this will be done on the basis of other complicating factors and not because of impaired glucose tolerance.
Does gestational diabetes influence the timing of delivery?
Debate still rages about this. There is no doubt that for patients where the gestational diabetes was controlled by diet alone, there is little justification to intervene, unless there are other complicating factors.
For those who need insulin, debate is whether they should be allowed to go beyond forty weeks of gestation. Historically, because of increased unexplained stillbirth among diabetic expectant mothers after thirty-eight weeks, delivery used to be planned around this stage. The argument now is that the control of diabetes in pregnancy and the ability to monitor the fetal well-being has advanced so much that this is no longer necessary.
Not everybody agrees with this contention. Certainly, some cases of unexplained stillbirth near term, in the presence of seemingly good diabetic control, still occur but these are very few and far between. The body of opinion seems to be moving towards managing these pregnancies like any other, provided the blood-sugar control is impeccable. Most obstetricians will hesitate at the idea of allowing the pregnancy to go beyond 41 weeks.
Ultimately, the condition of the fetus, the obstetrician's opinion and, most importantly, the mother's own wishes will determine the timing of delivery. Care has got to be individualised.
What is likely to be the method of delivery in gestational diabetes?
Again, this depends on all the other factors in pregnancy. If there is no contraindication to vaginal delivery, this will be the natural choice. Gestational diabetes itself should not directly influence the mode of delivery. However, if the fetus is estimated to weigh significantly above average (over 4.5 kg or 10 lb.), the mother may be advised to have a caesarean section unless, of course, she has had a baby of similar or higher weight in the past vaginally, and without problems.
Should labour be expected to be different?
In many ways, no. However she will have a drip (intravenous infusion)) throughout. This is necessary to ensure that her blood sugar is well controlled throughout labour.
Her blood sugar level will be checked at least every hour. She may have an insulin infusion as well, if this is found to be necessary.
Why is this very close blood-sugar control suddenly necessary in labour?
If good control is not achieved in labour, control of the baby's blood-sugar could be difficult. In fact, the baby's blood-sugar may drop quite steeply shortly after he or she is born, putting the baby at risk of brain damage.
What happens to the gestational diabetes mother after delivery?
Her insulin requirements drop sharply immediately after delivery and therefore she will still have her blood-sugar monitored closely, especially in the first 24 hours, to determine how much (if any) insulin she requires.
In the medium term (i.e. one day after delivery), virtually all gestational diabetics have their insulin stopped.
In the long term, a small group may continue to have diabetes, which will need some form of management. This group consists of those who had latent diabetes and pregnancy simply helped to unmask it.