GD/Insulin and Going Past Due Date?

[mb122]

I posted this in the "I'm Pregnant" forum, but haven't received any responses yet. But I thought it would be very helpful to also receive some advice/guidance from any of the birth professionals here. What do you usually do when your client with GD approaches/passes their due date? I have an appt. with my OB tomorrow and I'd like to be as informed as possible and not be scared into doing one thing or the other/be objectively informed of the risks, etc. Here is my situation below (what I posted in the other forum).

Can anyone who has had gestational diabetes and been on insulin during previous pregnancies share with me their experience going past their due dates? What was your midwife/OBs opinion on this? What was your care like during this time (frequency NSTs, etc.)? Did anyone get to 42+ weeks?

I'm 39 weeks today and I'm trying to inform myself as best I can about what to expect for the coming week/s. I've been on insulin to help control my morning fasting blood sugar (a small dose). My post-meals numbers have been fine all along (with diet). I actually just stopped with insulin because my numbers came down dramatically when I hit 37 weeks (is this really a sign of the placenta aging?), but I was on insulin for about 5 weeks there.

Anyways, I feel pretty sure my HCP won't hassle me about getting to my due date (induction hasn't even been mentioned yet), but I know that things can be different with re: to GD w/insulin pregnancies and I was looking to hear others' experience (BTDT moms). I have an appt. later this week when I'll be 39.5 weeks.

For the record, my first DC was over 10 pounds at 39 weeks (I wasn't diagnosed with GD during that pgncy, but very well may have developed it later on). During my 2nd pregnancy, I passed the 1 hour just fine and had an 8 pound baby at 38.5 weeks. And actually, I passed the 3-hour this time, but asked to see a nutritionist (b/c of family history w/diabetes) and sought help monitoring my BS. Turns out, my fasting sugars started to climb there after 30+ weeks. Regardless, I'm not particularly concerned about my ability to birth a large baby (nor is my HCP). I'm just concerned in general and would like to make the best decision for my health and the health of my baby.

Are there any other reasons why the topic of *inducing* comes up with regard to GD besides the concern for a large baby? I've seen a few places mention that insulin may actually age the placenta...Has anyone heard this before? Right now, I'm going in for weekly NSTs. Should that be enough to give me peace of mind that all is well if I go past my due date?

[maxmama]

I was to be repeat sectioned at 42 weeks. I had NSTs weekly from 34 weeks for another complication, so no change in monitoring.

The issues with postdates and diabetes come from studies done in women with preexisting diabetes, and likely some subclinical vascular damage from that. GD, whether diet-controlled or insulin-controlled, isn't associated with the same risks.

[7kiddosmom]

I am very interested in the responses here. I am expecting my 9th baby, 4th that I have had GD with. I have controlled it in the past w/ diet alone, but this time at 18 weeks my fasting levels are way too high. I am worried about having to change from my mw to an OB if I must take insulin. I too have had big babies, 13 lbs, 10-2, 9-7.

My mw mentioned that sometimes the blood glucose levels will be off because the baby's pancreas is producing the insulin that you are not especially in the last trimester. So even though your levels seem to be going down, it might be the baby working for you.

Anyway, I hope that you get some good responses.

[maxmama]

Originally Posted by 7kiddosmom

I am very interested in the responses here. I am expecting my 9th baby, 4th that I have had GD with. I have controlled it in the past w/ diet alone, but this time at 18 weeks my fasting levels are way too high. I am worried about having to change from my mw to an OB if I must take insulin. I too have had big babies, 13 lbs, 10-2, 9-7.

My mw mentioned that sometimes the blood glucose levels will be off because the baby's pancreas is producing the insulin that you are not especially in the last trimester. So even though your levels seem to be going down, it might be the baby working for you.

Anyway, I hope that you get some good responses.

Insulin cannot cross the placenta, so this is not possible. What may happen is as the placenta ages, it produces less of the hyperglycemic hormones that are causing the trouble.