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    Jul 01
    2006

    gd increases risk of stillbirth?

    Archived User
    I recieved this email from a student today. Any advice?
    Amie

    I had a checkup today that went well until the last 2 minutes. The ultrasound was good- my fluids were normal, baby weighs about 6 lbs 5 oz. and I haven't begun to dilate. The doctor I saw, not my usual, was completing a form for my leave of absence from work when she realized I'd be 38 weeks next week and told me I'd need to be induced by then because of the GD. She asked if my regular doctor had mentioned this and then explained that insulin dependent diabetics are usually induced then. My regular doctor has never mentioned this to me. I guess she sensed my skepticism and then said that there was an increased chance of a still birth. I told her I'd see my regular doctor next week and she said she'd make a note of inducing me next Thursday. I plan to call my doctor on Monday, I have an appointment on Wednesday, and see what he says. I find it odd that everything was fine and then stillbirth was mentioned, so I don't put much stock in what she says. Got any advice?
    By: akrake
    Archived User
    Obstetricians are not diabetic specialists. I strongly recommend this woman consult with an endocrinologist before agreeing to an induction. There are potential harms with induction, especially induction at 38 wks. If this woman is expecting her 1st baby, she doubles her chance of having cesarean surgery with an induction. Even if she has prior births, some studies have found that inducing with an unripe cervix, regardless of whether cervical ripening agents are used, may increase her likelihood of having a cesarean. Moreover, babies induced at 38 weeks have increased likelihood of having respiratory problems serious enough to land them in neonatal intensive care.

    Before agreeing to an induction, she will want to weigh the benefits against these risks. For example, the main question is whether she is, in fact, at excess risk for stillbirth. From what I have read on this issue, well-controlled pre-pregnant diabetics are not at excess risk unless they have developed complications of diabetes--and it isn't clear from her e-mail that she was a prepregnant diabetic. And if you think about it, logic and common sense say that if her blood sugar is under control, and she has no medical problems that could compromise the baby, why would she be any different from any pregnant woman who isn't carbohydrate intolerant?

    -- Henci By: Henci Goer

    All Times America/New_York

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