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Gestational Diabetes

There are a number of issues for women with diagnosed, or suspected, gestational diabetes.
Below are links to information about the tests for diagnosis, ideas and support for controlling it through your diet, plus info on your birth options.  Yes, you still have options.

There are issues that can be raised about the tests, and the cut off points, or thresholds.  
For starters, Cochrane, the internationally respected research  database states: "There was insufficient evidence to determine if screening for gestational diabetes, or what types of screening, can improve maternal and infant health outcomes."
The test for GD most often used is the Glucose Tolerance Test, GTT, but some women don't think that staving themselves then drinking a highly sugary, and sometimes chemically based, drink is the best thing for them and their baby, and instead chose to self test with daily finger prick blood tests for a week, or not doing the test.  It is worth noting that the thresholds are higher in the guidelines for Scotland and Ireland than England and Wales, and that different hospitals may have different thresholds in their own policies.

Birth options
There are three main issues relating to GD and birth.
1. Your insulin levels may be affected by the exertion of labour.
2. The baby may be affected immediately after birth due to the change to the regulating system from yours to theirs.
3. The baby may be big, and some professionals are concerned about the baby having difficulty getting their shoulders through the pelvis, which is known as shoulder dystocia.  However the latest research has not shown any link between the two. From the UK Birth Place follow up study:
"However, although UK clinical guidelines state that women with obesity are at significantly increased risk of shoulder dystocia,[3] the evidence does not clearly show that obesity is an independent risk factor. A meta-analysis of studies identified by systematic searches did not show a significantly increased risk of shoulder dystocia in obese women."

In fact, while women with high BMI have slightly increased chance of emergency caesarean and having their labour speeded up (perhaps because they are more likely to be continually monitored which is associated increased cs, and therefore stuck to a bed, which is associated with a slow labour), they have a lower chance of needing forceps or ventose (called assisted birth), than women with 'normal' BMI. There were no differences between babies' wellbeing and high/normal bmi.

Place of birth
From the Birth Place Study report on high BMI: "However, the NICE criteria for recommending birth in an obstetric unit [for high BMI] were based on consensus rather than high quality evidence."
They found no difference in outcomes between those giving birth at home, or hospital.

Further research may be required to determine whether adverse perinatal outcomes associated with shoulder dystocia are also reduced in this ‘otherwise healthy’ group. If so, it may be reasonable to review the BMI criteria for planned birth in non-obstetric unit settings, particularly Alongside Midwifery Units where obstetric and neonatal care is available on site if needed. More generally, parity should be taken into account when assessing the potential risks associated with birth in non-obstetric unit settings.

More on this below, but half the babies that are big (4kg or over) are born to women who do not have GD.  And midwives say that shoulder dystocia is often caused by the woman lying on the bed which makes her pelvis smaller than if she was in upright position.

I have more to write here and will add to this section very soon.  Cathy x


Cochrane review:
There was insufficient evidence to determine if screening for gestational diabetes, or what types of screening, can improve maternal and infant health outcomes. 

The Birth Place Study report on outcomes for women with high BMI.  It is worth noting they excluded women with complicating factors.  About 50% of women with high BMI (>35) had complicating factors and this is much higher than other groups.  As they say in their conclusion, if other research does not make a difference between those who have complicating factors and otherwise healthy women then it is hard to know if the outcomes are a result of the complicating conditions or the high BMI.

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