Late GD diagnosis

Sometimes we see ladies come to our group for support where they have had late GD diagnosis. Some have passed multiple tests for gestational diabetes, only to be diagnosed a couple of weeks before baby is due.

Raeesa who is a admin and member of our support group found us in her second pregnancy and has kindly shared her birth stories of her two children to compare. Her first story is about her son Zane. During this pregnancy she passed 3 glucose tolerance tests for gestational diabetes and had very late GD diagnosis at 39+5 where she was booked in for a c-section a few days later at 40+1. Raeesa was diagnosed much earlier in pregnancy with her daughter Astrid and found our support group for help.

Here's Raeesa's stories...

Zane...

In 2011, I passed 3 GTTs [glucose tolerance tests] – 12 weeks, 28 weeks and 32 weeks. At every midwife appointment I complained there was something wrong and I just knew it. I measured big throughout my pregnancy, but as my husband is 6ft 4, the answer was "well of course you are going to have a big baby!" (I’m 5ft by the way and pre-pregnancy was a size 6 and weighed 50kgs! So, it was assumed that I had none of the “risk factors” for GD)

I had 2 massive bleeds in my second and third trimester and after 2-week long stays in hospital, I was told it’s just an anomaly! At 39 weeks, I was struggling to breathe. I felt like baby had gotten so big he was crushing my lungs. The midwife measured me and said maybe I should have another GTT.

It was just before Christmas and everywhere was short staffed. They managed to fit me in for a GTT at 39+5. My fasting was super high as were my 1 hour and 2 hour tests. Scans showed my baby was measuring very large and already looked swollen.

I was booked in for the next C-Section available which was at 40+1. I was given no advice about my diet or about treating my baby and the GD. I was in pain and uncomfortable, a first time mum and completely lost.

I don’t actually remember much about the day my son was born. I rely on my husband and my mum to remind me of what happened. I was put on a sliding scale as soon as I got to the hospital as my sugars were out of control.

The consultant told my husband afterwards that she had fully prepared herself to lose one of us on the operating table that day as we were both very unwell at the time of my section.

Zane was born 9lb 11oz and extremely swollen. I was very swollen too. I couldn’t even eat after my section. We were in hospital for 5 days and even those 5 days seem a distant blur in my mind. He wasn’t well at all. Sleepy, wouldn’t feed, wouldn’t latch, I had no milk. It was the lowest point of my life.

Eventually hubby bought formula and fed him and my mum spoon fed me soup as I hadn’t eaten in 3 days! My consultant said she’d couldn’t understand how my GD had gone undetected when it was so bad! I swore after that I’d never have another child.

Astrid...

Fast forward to 2015 when I found out I was pregnant just before 12 weeks. I called the hospital immediately and because of what had happened, they booked me in for a GTT immediately.

This time it registered I had GD, but barely!! I had a fasting reading of .1 over the limit! My 1 hour and 2 hour post readings were perfect. They were not going to take any chances though and neither was I.

With the help of Jo’s diet and the advice here I was going to conquer GD! I started testing immediately and in 26 weeks with GD my 1 hour post meal levels were rarely over 6. (My target was under 7 at 1 hour).

Within 3 weeks of testing I was put on Metformin, for 3 fasting readings of 5.1. My target was to be under 5 for fasting. I honestly never questioned their judgement and happily took the medication, knowing it would be helping my baby. Never again did I want a poorly baby. The guilt from Zane’s birth had never left me.

At 32 weeks I developed Obstetric Cholestasis [OC, also known as intrahepatic cholestasis of pregnancy (ICP)] and this meant weekly monitoring, more pills, more blood tests and more scans! It also meant that the risk of a still birth was increased tenfold. I was now regarded as very high risk. I was in great spirits though as the knowledge and constant checks (even though it meant a whole day each week sat in hospital) meant that everyone was keeping a close eye on my baby!

At 35 weeks scans showed that her tummy had become very large. I was so confused?! My diet was so strict. No sugar or treats at all and my carb portions were very controlled. In fact, my diet was mostly eggs, cheese, meat and veg. (Not that I was complaining, it suited me fine!) Something was wrong though.

My consultant explained that sometimes, no matter how hard we try, sugars will still get through to baby and that this was probably happening to me. He upped my Metformin to the max dose and said that if her tummy growth did not slow down, it would be insulin.

Luckily, the extra metformin helped control her tummy growth, and although her tummy was still round at birth, it was more in line with her size than it had been.

Astrid was born via c-section at 38 weeks exactly. She was 7lb 9oz and felt dinky in my arms compared to Zane.

I remembered every single moment of the day she was born and I smiled from the minute I got to the hospital till the minute we left 24 hours after I had her.

The pictures of my babies on this page were taken roughly the same time after birth.

Borderline or not, GD is serious stuff and can completely turn on its head in the matter of days! Medication is not cheating or failing, medication is there to help our babies have the best possible chance of coming into this world safe and healthy!

All the info you will ever need is so amazingly compiled on this website! Astrid and I will always be thankful for Jo and the advice that led me to having a very different pregnancy and a very different birth.

What to do if you have late GD diagnosis

With late GD diagnosis (36 weeks +) some may think there is little they can do to help the situation as baby will already be affected by the high blood sugar levels.

Whilst you can do little regarding the growth of baby at this point, you can try to lower and stabilise your blood sugar levels as much as possible before the birth of baby through following a strict GD diet.

In some Trusts you may be offered medication or insulin to help gain control of your levels, but in some areas they may feel it is too late for this to make a significant impact.

By at least following a good GD diet up until the birth, you will give your baby a better chance to regulate their own insulin production which could help them lots after they have been born.

Babies born to diabetic mothers often struggle with low blood sugar levels following birth. This is because they are used to producing high amounts of insulin whilst growing in the mother and then once born although they are no longer being fed high sugars through the mother's blood, they continue to over-produce their insulin resulting in low blood sugar levels, which in turn can cause the baby to be very poorly.

If you're planning on breastfeeding, then you may want to try expressing colostrum (colostrum harvesting) before the birth of your baby. This means that once baby is born, despite any problems being able to feed, they can be given your colostrum tops to help raise their blood sugar levels. Check out our colostrum harvesting page for more details.

Birth choices with late GD diagnosis

Yes you have a choice! Medical professionals will assess your case and advise what they feel is going to be the best course of action for both you and your baby. But they can only advise and the choice as to what to do is ultimately yours.

With late GD diagnosis we often see ladies being offered early inductions of labour or elective caesarean sections as there are concerns over the baby being macrosomic at birth (large for gestational age) caused by the high blood sugar levels.

Macrosomia is associated with an increased risk of shoulder dystocia and birth trauma which can have adverse outcomes for both baby and the mother. These include maternal post-partum haemorrhage, 3rd and 4th degree tears and fractures, Erb’s palsy (damage to the brachial plexus during delivery of the baby) and hypoxic injury (severe head injury) to the baby.

Many ladies feel that it is best to have their baby delivered early, but are torn between a decision of having an induction of labour versus an elective caesarean section, especially first time mothers. Many find it helpful to talk through birth choices with other mothers who have been in a similar situation and so this is where our support group can help you find others who are willing to share their experiences and may help you work through any fears or concerns you may have that you feel your medical professionals cannot offer opinion on or help you with.

Research

How does induction of labor at or near term affect outcomes in pregnant women with suspected fetal macrosomia?

Induction of labor in pregnant women with suspected fetal macrosomia may not improve maternal outcomes and may in fact cause more perineal tearing than expectant management, but it reduces rates of infant injury during birth.

When assessing maternal outcomes, induction of labor in pregnant women with suspected fetal macrosomia didn't show any impact in cesarean section rates or rates of instrumental delivery compared with expectant management, but third- and fourth-degree perineal tears could be increased.

When assessing infant outcomes, low-quality evidence suggested that the procedure didn't have any impact on rates of brachial plexus injury. However, there is moderate-quality evidence showing that infant shoulder dystocia was decreased with induction of labor and high-quality evidence shows that it decreases the rate of any fracture in the newborn. No clinically relevant differences were found in birthweight. Underpowered analyses mean that no conclusions can be drawn regarding effects on Apgar score or arterial cord blood pH.

Cochrane Clinical Answers

Induction of labour at or near term for suspected fetal macrosomia

Timing and route of delivery in pregnancies at risk of shoulder dystocia