Problems afflicting premature babies

The biggest problem is usually lung function.

Babies of diabetic mothers are particularly prone to poor lung function. Normally, when a premature delivery is anticipated, a short course of steroid injections over 24 to 48 hours is administered. The steroids stimulate the fetal lungs to produce a chemical (surfactant) which helps to facilitate good lung function.

For diabetic patients, however, this is not a straightforward affair. Firstly, steroids disrupt diabetic control as they increase insulin resistance, which will make the mother prone to high blood sugar.

Secondly, the fetus of a diabetic mother does not respond quite as well to steroids. Most obstetricians agree, however, that if prematurity is a distinct possibility, steroids should be given and close and intensive blood sugar surveillance maintained.

Timing of delivery in insulin-dependent diabetes

In the absence of complications and with good blood sugar control, a diabetic mother is likely to be allowed to go into labor at term. If she does not go into labor by her due date (at 40 weeks), whether she is allowed to go beyond this stage will ultimately depend on her wishes and her obstetrician's opinion.

Because such pregnancies are intensively monitored, most mothers do not want to wait beyond their due date, and it is probably unfair and unwise for the obstetrician to try to persuade her otherwise.

As for how safe going post-date is, the honest answer is that nobody knows.

Sub-optimal blood sugar control during the pregnancy and timing of delivery

If it appears that the mother's blood glucose control has been poor, an obstetrician is faced with a difficult decision. Leaving delivery too late clearly courts the risk of stillbirth. Early delivery could result in prematurity complications that could be difficult to manage. The compromise may be to admit the mother into hospital and try to bring the blood sugar under control.

If this is achieved, then she may remain in hospital and be delivered at or after 38 weeks of gestation. If control is not secured even in hospital, then a close surveillance of the fetal condition is maintained (in hospital) and delivery may be at any time, if and when the fetal condition appears unsatisfactory.

Unfortunately, the baby might still have complications even if delivered at 38 weeks, especially if diabetic control has not been good. This is, however, uncommon at this gestation and, when present, can be controlled satisfactorily in most maternity units.

Method of delivery for a diabetic mother

Diabetes in itself is not an indication for caesarean section. If a caesarean delivery is recommended, that will be for the usual obstetric reasons, such as fetal distress or abnormal lie of the fetus.

Size of the baby and mode of delivery

Diabetic mothers are prone to have big babies, which obviously increases the probability of a caesarean delivery. This problem is minimized by good diabetes control.

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