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Impaired glucose tolerance and timing of delivery
If this condition has not progressed into gestational diabetes, it should not influence the timing of delivery. This is because it cannot harm the mother or the baby.
If any intervention is recommended, this will be done on the basis of other complicating factors and not because of impaired glucose tolerance.
Gestational diabetes influence on the timing of delivery
Debate still rages about this. There is no doubt that for patients where the gestational diabetes was controlled by diet alone, there is little justification to intervene, unless there are other complicating factors.
For those who need insulin, debate is wheth
er they should be allowed to go beyond forty weeks of gestation. Historically, because
of increased unexplained stillbirth among diabetic expectant mothers after 38 weeks,
delivery used to be planned around this stage. The argument now is that the control
of diabetes in pregnancy and the ability to monitor the fetal well-
Not everybody agrees with the above contention. Certainly, some cases of unexplained stillbirth near term, in the presence of seemingly good diabetic control, still occur but these are few and far between.
The body of opinion seems to be moving towards managing these pregnancies like any
other, provided the blood-
Ultimately, the condition of the fetus, the obstetrician's opinion and, most importantly, the mother's own wishes will determine the timing of delivery. Care has got to be individualized.
Mode of delivery in gestational diabetes
Again, this depends on all the other factors in pregnancy. If there is no contraindication to vaginal delivery, this will be the natural choice. Gestational diabetes itself should not directly influence the mode of delivery.
However, if the fetus is estimated to weigh significantly above average (over 4.5 kg or 10 lb.), the mother may be advised to have a caesarean section unless, of course, she has had a vaginal birth of a baby of similar or higher weight in the past without problems.
Labor in gestational diabetes
In many ways, labor in the presence of gestational diabetes will not differ from any other. However the mother will have an intravenous infusion throughout. This is necessary to ensure that her blood sugar is well controlled throughout labor. Her blood sugar level will be checked at least every hour. She may have an insulin infusion as well, if this is found to be necessary.
This close monitoring in labor is crucial. If good control is not achieved in labor,
control of the baby's blood-