Blood sugars can rise as pregnancy progresses, so you will
probably want to continue eating a diet that puts less stress on
your pancreas and monitoring blood sugar as well as getting regular
exercise. (Speaking of which, I hope that your OB has referred you
to someone trained in advising pregnant women with a tendancy to
high blood sugar on diet.) The bigger problem as I see it is that I
have skimmed the evidence report underpinning the March 2013 U.S.
National Institutes of Health conference on gestational diabetes.
Nowhere is there support for frequent ultrasounds or for inducing
labor as a means of improving outcomes. In fact, increased
induction of labor is listed as one of the harms of being
identified as a gestational diabetic. Here are the relevant
passages from the
report that came out of this conference:
4. Does treatment modify the health outcomes
of mothers who meet various criteria for gestational diabetes
mellitus and their offspring?
We also have very solid data that inducing for suspected big
baby in general increases likelihood of cesarean without
improving outcomes and that when the OB suspects the baby is large
(estimated birth weight > 4 kg), the woman is much more likely
to have a cesarean then when the baby actually is that big, but the
OB didn't suspect it. Here are the studies establishing that
induction for suspected big baby is not helpful:
O, Boulvain M. Induction of labour for suspected fetal macrosomia.
Cochrane Database Syst Rev 1998(2):CD000938.
L, Bernstein S, Kaunitz AM. Expectant management versus labor
induction for suspected fetal macrosomia: a systematic review.
Obstet Gynecol 2002;100(5 Pt 1):997-1002.
Here are studies showing that what your OB thinks he knows about
your baby's size can hurt you:
AB, Lockwood CJ, Brown B, et al. Sonographic diagnosis of the large
for gestational age fetus at term: does it make a difference?
Obstet Gynecol 1992;79(1):55-8.
N, Yogev Y, Meizner I, et al. Sonographic prediction of fetal
macrosomia: the consequences of false diagnosis. J Ultrasound Med
S, Severs CP, Sehdev HM, et al. Ultrasonographic prediction of
fetal macrosomia. Association with cesarean delivery. J Reprod Med
D, Walfisch A, Shachar R, et al. Suspected macrosomia? Better not
tell. Arch Gynecol Obstet 2008;278(3):225-30.
JW, Pitman T, Spinnato JA, 2nd. Fetal macrosomia: does antenatal
prediction affect delivery route and birth outcome? Am J Obstet
Z, Ben-Shlomo I, Beck-Fruchter R, et al. Clinical and
ultrasonographic weight estimation in large for gestational age
fetus. Eur J Obstet Gynecol Reprod Biol 2002;105(1):20-4.
If you continue to have a healthy pregnancy and blood sugar
remains under control, you may wish to refuse monitoring and
induction--or any other tests or procedures for that matter--unless
your care provider can demonstrate to your satisfaction that the
benefits of undergoing them outweigh the potential harms.
. . . One randomized controlled
trial has shown higher induction of labor rates in women with GDM
compared to normal controls. Women with GDM are more likely to
undergo increased maternal and fetal monitoring. Subjective
interpretation of ultrasound findings and fetal non-stress tests
produces a high rate of false positives and is a factor in
unnecessary induction of labor leading to failed inductions and
cesarean delivery. Data regarding the effect of changing the
diagnostic criteria for GDM on inductions are uncertain.
Cesarean rates may be higher in
women given the diagnosis of GDM, and it is uncertain whether
treatment can mitigate this increase. Cesarean delivery is
associated with a higher rate of short- and long-term
6. Given all of the above, what diagnostic
approach(es) for gestational diabetes mellitus should be
recommended, if any?
. There also is evidence that treatment of women with
GDM—diagnosed either by the one-step or two-step
approach—may improve some outcomes. Outcomes that have been
improved with treatment include the frequencies of macrosomia,
large-for-gestational-age birth weight, shoulder dystocia, and
hypertensive disease of pregnancy. Despite improvements in these
intermediate outcomes, the frequencies of composite neonatal
morbidity and cesarean delivery have not been consistently improved
with treatment. Long-term outcomes for mothers and their offspring
have not been improved in the few studies that have been