Gestational diabetes and VBAC?

[chisub]

I just got diagnosed with GD last week.  I've gone up and down mentally, but mainly b/c I can't find enough info on GD and VBAC.  My next midwife appt is at the end of the month where I'll discuss it further.  Right now I'm just watching what I eat and keeping my numbers within the range they want them to be. 

My biggest concern is how long they'll let me go and what kind of risks there are.  I had DS at 40w6d and as of now I have the green light to go to 42w. 

Any info or success stories of GD and VBAC past 40w (I'm just assuming I'll go after my EDD again)?  Any kind of extra hurdles you had to go over to get that VBAC? 

[mncowmom]

I currently have GD, so I'm seen by both a midwife and a family doctor.  Both say that if I keep my numbers in the normal range then I am just like any other pregnant woman and there is no reason that I can't go past 40 weeks.

There really is very little good scientific information on GD in pregnancy and there is no universal guidelines for diet or recommended blood glucose levels.

[chisub]

Originally Posted by mncowmom 

There really is very little good scientific information on GD in pregnancy and there is no universal guidelines for diet or recommended blood glucose levels.

Ugh, this is the part that is driving me bonkers!  I feel like I have educated myself so well on the VBAC front, but this GD is throwing me for a loop since I can't seem to find as much info as I'd like. 

[JAHerr]

Below is some research out there on Gestational diabetes and VBAC. 

Check out pubmed or the Cochrane Database.

You can find an excerpt online.  According to this analysis women with diet controlled Gestational Diabetes have rates of VBAC success of 68%.  This is pretty similar to rates I have seen quoted for nondiabetic women.

Obstetrics & Gynecology:
January 2010 - Volume 115 - Issue 1 - pp 60-64
doi: 10.1097/AOG.0b013e3181c534ca
Original Research
White's Classification of Maternal Diabetes and Vaginal Birth After Cesarean Delivery Success in Women Undergoing a Trial of Labor
 

I good source of information on gestational diabetes is the plus_size_pregnancy website.  Henci Goer has a great article on Gestational Diabetes.  Check out pubmed for some research.  The risks of GD is greater if it has to be insulin controlled.  The risks are less if it is diet controlled. 

For general support check out ICAN of Chicago yahoo group or one of the other ICAN groups.  I know there are some moms who had successful VBACs with GD on there.  There was one mom on the Chicago gorup who seemed fairly knowledgeable.     

Good luck

Julie

[JAHerr]

Here is a 2009 article about Gestational Diabetes - active (induction or planned c/s) vs. expectant (waiting) management

http://journals.lww.com/greenjournal/Abstract/2009/01000/Active_Compared_With_Expectant_Delivery_Management.28.aspx

For me the take away message is that there is no difference in neonatal risks.  A few observational studies showed this some differences but it wasn't enough to make it statistically significant.  The baby may be bigger.  I would have to see why this is a concern.   Generally, I think immediately of shoulder dystocia.  In this study there was  no significant difference in shoulder dystocia, cesarean delivery, neonatal hypoglycemia, or perinatal deaths.  That doesn't mean it will never happen just that in the how ever many studies that were reviewed it did not.

 

[chisub]

Thanks!  I've been meaning to post on the Chicago ICAN board too b/c I remember somebody recently dealing with GD and issues with Swedish Covenant.  I'm at West Sub, so I'm hoping that is a plus for me, but my next appt isn't until the end of the month.

[TiffanyToo]

KMOM has a ton of awesome information on GD in her website here is the link. Hope it helps. http://www.plus-size-pregnancy.org/gd/gd_index.html