GD and Impact on Baby

Dear Dr,

I am 38 yo and 30 wks pregnant.  I was diagnosed with diabetes immediately after getting pregnant (I have hypothyroid and my endo tested as soon as I was pregnant), and started on insulin at about 14 weeks (I guess this means it was preexisting but ok with my diet and exercise prepregnancy).  My blood sugars have always been within target < 95 fasting and < 120 2 hrs after eating, except recently when they are only slightly above range (ie. < 100, <130) and I expect we'll increase insulin when I see my endo next.   However, I have gained a lot of weight (30 lbs so far - all in the past 3 months - had appendicitis at 3 mos and lost weight leading up to and immediately after laparotomy surgery), and have a lot of swelling (Grade 4).  BP normal. Last HA1c 2 months ago was mid normal range.

My Ob did u/s today and said baby having growth spurt and is too large.  33 weeks size (4.4lbs), vs expected 30 wk size (3lb) (previous measurements baby was on target).  She says maybe the GD kicking in. Has asked me to be even more careful with the BS control and to stop gaining weight.  Although I have D, my BS is not out of control.  

At what levels of BS would GD cause baby to be too big?  I do have D, but BS are pretty much on target.  Should I be targeting lower levels than the 95/120?  Any idea how many calories should I be targeting (am 5'5" and currently weigh 194 lbs)?

I really don't want CS, am terrified of additional surgery.  Also very worried about what I am doing to my baby with all these complications.

Thanks so much for any advice.

[Anita Ramsetty, MD]

Hello,

I am afraid I cannot give you an absolute number above which your baby is likely to be be "too big." In your current case it may not be so much the absolute glucose numbers but more the weight that you have gained--the amount of weight gain does also have an impact on the size of your infant. Continue keeping a close eye on your glucose levels and try to keep them within target. At your next visit, be sure to discuss your weight gain and what can be done to bring it under control for the rest of your pregnancy. You are doing a good job, hang in there and best of luck,
Take care

[katie_ghosh]

A related discussion, COMPLICATIONS was started.