QuestionI am in my third pregnancy with GD. I have been induced twice. Both at about 30 weeks. The other babies have been 6lbs and 7 oz. I have two questions does a diagnosis of Gestational Diabetes automatically result in labor being induced? My Dr has already said I would deliver a week early and I am only 14 weeks along. I hated being induced and would like to have a spontaneous labor and delivery. I have had not other complications during pregnancy except my 2nd was breech but was turned with a version at 38 weeks. So does protocol say that GD equals labor induction? My other question is about macrasomia. What weight is considered a baby with macrasomia? Obviously 6 lbs 7 oz is not very big. I wanted a natural delivery and ended up with an epidural because of the more intense labor. I am afraid of even talking to my Dr about not wanting to be induced because I am afraid he will treat me poorly. Thank you for your answer.
AnswerIn order to fully answer your questions, I first want to give you an overview of gestational diabetes.
With gestational diabetes, placental hormones interfere with the action of mother's insulin (which is produced in the pancreas to control blood sugar). As a result of this, glucose builds in the blood, hence the term, "elevated blood sugar".
Left untreated or uncontrolled, this condition can seriously affect baby, so your OB healthcare provider has a pretty strict plan of care for you based on what he/she knows can happen with the dangerous effects of gestational diabetes.
With gestational diabetes, mom's pancreas is working overtime - although ineffectively - to produce insulin in an attempt to lower blood sugar. This additional maternal insulin doesn't cross the placenta, but the increased amount of glucose does! This in turn makes baby's pancreas produce additional insulin, which can decrease baby's blood sugar after devliery.
But, the bottom line is that baby is getting more energy than it needs in the form of glucose, and that extra energy is stored as fat, making for a baby that has macrosomia - or a baby weighing over 4000 grams, or around 9 pounds.
Babies with macrosomia face health problems of their own, including shoulder dystocia during birth. This means baby is so big, birth of it's shoulders is very difficult. Because of the extra insulin made by the baby's pancreas, baby may have very low blood glucose levels at birth. These babies are also at risk for respiratory problems.
Your doctor wants to induce you a little early to try and lessen the potential for these problems. It's all in your and your baby's best interest, and most importantly, the standard of care for mothers with your same condition. It's the medically responsible thing to do.
Hope this helps. Don't be afraid to talk to your doctor. He's your best resource, and it's his job to explain your plan of care to your satisfaction.
