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When should a diabetic mother expect to deliver?
In the absence of complications and with good blood sugar control, she is likely to be allowed to go into labour at term. If she does not go into labour by her due date (at forty weeks), whether she is allowed to go beyond this stage will ultimately depend on her wishes and her obstetrician's opinion. Because such pregnancies are intensively monitored, most mothers do not want to wait beyond their due date, and it is probably unfair and unwise for the obstetrician to try to persuade her otherwise.
As for how safe going post-date is, the honest answer is that nobody knows.
What if the blood-sugar control has not been optimal during the pregnancy?
If it appears that the mother's blood glucose control has been poor, an obstetrician is faced with a difficult decision. Leaving delivery too late clearly courts the risk of stillbirth. Early delivery could result in prematurity complications that could be difficult to manage. The compromise may be to admit the mother into hospital and try to bring the blood sugar under control.
If this is achieved, then she may remain in hospital and be delivered at or after thirty-eight weeks of gestation. If control is not secured even in hospital, then a close surveillance of the fetal condition is maintained (in hospital) and delivery may be at any time, if and when the fetal condition appears unsatisfactory.
If the baby is delivered at thirty-eight weeks, is he or she still prone to lung maturity problems?
Unfortunately, yes, especially if diabetic control has not been good. This is, however, uncommon at this gestation and, when present, can be controlled satisfactorily in most maternity units.
What is the likely method of delivery?
Diabetes in itself is not an indication for caesarean section. If this is recommended it will be for the usual obstetric reasons, such as fetal distress or abnormal lie of the fetus.
What about the size of the baby?
Diabetic mothers are prone to have big babies, which obviously increases the probability of a caesarean delivery. This problem is minimized by good diabetes control.
With diabetes, what happens during labour?
There are different regimes in different centres but all are based on the principle of continuous infusion of both dextrose (glucose) and insulin. The mother's blood-sugar is checked every hour and adjustments in the rate of the infusions made accordingly. This is aimed at maintaining her blood-sugar within a strict (normal) range, to minimise complications to the baby after delivery.
In diabetes, what are the possibe immediate complications, post-delivery?
If blood-sugar control has been poor during labour, the baby may soon develop severe hypoglycaemia (low blood-sugar) as well as an imbalance of some essential minerals such as calcium and magnesium.
This may be in addition to respiratory difficulties to which these babies are prone. The baby's condition may deteriorate quite rapidly, requiring intensive care.
Is it true that the baby will be prone to develop jaundice?
Yes, but this is hardly ever serious. This develops a few days after delivery and is usually quite mild. The level of the pigment (bilirubin) causing the jaundice will be checked in the baby's blood. If this is found to be significantly raised, treatment by being put under a special light (phototherapy) may be administered. This is rarely necessary.
What happens to the diabetic mother after delivery?
Her insulin requirement goes down and this is immediately after delivery. In some cases, it may be necessary to stop insulin temporarily (for 24 to 48 hours) before resuming at a dose used before conception.
In any case, her blood glucose will be monitored closely in the first twenty four hours to determine her individual requirements.
The final word?
Good blood sugar control is key to controlling the condition before conception, in pregnancy, and during labour and delivery. If this is achieved, the mother's expectations and outcome should be similar to anybody else's.
Last update: October 11, 2012