Gestational Diabetes and Swelling

[soontobedad]

Hi,

To start my wife is 26+ weeks pregnant, and is due in the beginning of May. Two weeks ago she tested positive for Gestational Diabetes both after a standard one hour test and later a three hour test. Her numbers were not high, but just high enough to consider it a positive result.

Also, about three to four weeks ago, she had swelling on her left foot. The swelling got very bad one night and turned hot and pink, and since I have had experience like this before with my parents, and she is a nurse, we noticed the cellulitis right away and went to an ER. the took x-rays of her foot and diagnosed an avulsion fracture and cellulitis and put her on Cefalex and rest for one week.

She went to her Orthopedist and he said he saw no fracture in the x-ray and the infection was going away and he suggested more rest with her foot up to relieve the swelling.

It is now almost three weeks later and the swelling is only getting worse. She had an MRI yesterday, and last night noticed that a similar bump had started on her right foot. The spot where the swelling began is about three inches from her toes above her pinky toe.

I am very worried about this. Both in the short and long term. I guess my questions are not clear.
1- I want to know if this can be related to the development of the diabetes.
2- What else could this be? Initially her Dr. said it was a sprain, but how could that still be going on with infections?
3- Her Dr. also thinks that now the bottom of her foot is infected and suspects the infection never left. He put her on another week of the same anti-biotic. Can this affect our baby, and also what can the infection cause for the baby?

Thank you.

[Keith Downing, MD]

Hello,

It sounds like your wife has been receiving good care.  What has her ob/gyn had to say about these developments?  I'd make sure they are closely involved in this management if they haven't been up to this point.  I have little to add about a possible diagnosis as I don't have the benefit of examining your wife or seeing her imaging.  However, with the mention of asymmetric lower extremity swelling it would be prudent she is ruled out for a blood clot.

If her blood sugars are well controlled, I'd suspect the infection is not related to her gestational diabetes as diabetic infections are usually the result of chronic poorly controlled blood sugars.  

Cephalosporins are safe in pregnancy and should not have a notable impact on the baby.

Best regards,

Dr. Downing

[soontobedad]

Thank you very much. We went for her anatomy sonogram this morning, (they tried at 21 and 24 weeks, but could only see the babys spine) and they said everything was normal. We also made an appointment with a vascular doctor and are going tonight.

Her OB is part of a Midwife practice and seems to be very casual about this whole development. They continue to say that we should see/speak to the orthopedist, who himself has not much to say.

This is so far very frustrating. Today the OB told us that she may not be able to return to work until after the birth in May.

[soontobedad]

Hi Dr. Downing,

I have a question, not related to the above.

My wife went in to see her OB today, and he told her she has to be put on insulin and then he sent her for a sonogram at a perinatal center. She went, and they are sending her to another center to get an electrocardiogram for the baby. She is now 28+ weeks pregnant.

We are both scared and very nervous. Do they think there is something wrong with the baby? The Dr. at the center said that they couldn't see all of the things they needed to check in the baby's heart, but that it was because the baby is breach right now and because my wife is overweight. Is that just something they say to calm us down. The EKG is not Wednesday.

Please help, I am sort of "freaking out".