Ask An Expert: Gestational Diabetes and Delivery

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Ask An Expert: Gestational Diabetes and Delivery

Question:

I was recently diagnosed with gestational diabetes. My doctor is recommending induction at 37 weeks. Would we need to worry about lung maturity in the baby for a delivery at 37 weeks?

Answer:

Gestational diabetes is defined by high blood sugars during pregnancy. These result from changes in the balance of the body's hormones. Pregnant women in general are resistant to the effects of insulin, the hormone that regulates blood sugar. The pancreas of a pregnant woman needs to produce more insulin to keep sugar values at their usual level. In some women, the body can't keep up, not enough insulin is produced (or, their body is too resistant) and blood sugar levels rise.

Most women are tested for gestational diabetes between 24 and 28 weeks of pregnancy. Women who have diabetes at the start of pregnancy do not need testing, and testing may be skipped in some women at low risk (very young, thin, no family history of diabetes). On the other hand, some women may be tested earlier in pregnancy because they are felt to be at high risk based on family history, past pregnancy history or other health measures (such as body weight).

The diagnosis of gestational diabetes clearly identifies a group of women at risk for diabetes later in life. The degree to which gestational diabetes is associated with risks to the pregnancy itself, particularly if blood sugars are followed and regulated with medication, is a matter of much debate.

Because some evidence suggests that there may be complications if pregnancies of women with gestational diabetes are allowed to continue too long, many doctors prefer to have such patients deliver by 39 to 40 weeks of gestation (your due date marks 40 weeks). How much sooner than the due date to deliver is a matter that needs to be considered individually, based on how well or poorly blood sugars are controlled, other information about the baby (such as size, amount of amniotic fluid and other measures of fetal well-being, or concern for other problems) and information about maternal health and medical conditions.

Balanced against these concerns are risks associated with an early delivery including, as you suggest, a risk that the fetal lungs will not be prepared for breathing. Sometimes an amniocentesis (removal of a small amount of amniotic fluid with a fine needle) is performed to measure the activity of a certain lung chemical that helps determine if the baby's lungs are ready to function.

Timing of induction is individualized based on the factors that I have mentioned, as well as any special less common concerns.

Jeffrey Ecker, M.D. is an Associate Professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics and Gynecology at Massachusetts General Hospital, where he practices maternal-fetal medicine.

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Last updated:	January 24, 2007