Burton Rochelson MD Chief of Maternal Fetal Medicine and Obstectrics ai NS LIJ Healthcare System DrMDK
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Dr. Rochelson: Gestational Diabetes is a condition where the mom just gets diabetes during the pregnancy and this is because their placenta works against the action of the body’s own insulin. If diabetes is uncontrolled during the pregnancy, the baby can be extremely large and it can be a difficult delivery and the shoulder could get trapped. That is called a shoulder dystocia or the mom can have a Caesarian delivery. And I am going to get back, I guess I am singing the same song over and over but it is very important. If the mother for example is in her first pregnancy and she has gestational diabetes and the baby gets too big and she has a caesarian delivery. In many, many practices, she would be destined to have a caesarian delivery for all of the subsequent pregnancies and to put this in perspective, there is something called placenta accreta. Placenta accreta is where the placenta gets stuck in the uterus and does not come out and it is really an obstetrical emergency. If you have had two previous caesarian deliveries and the placenta is low. Your risk of having placenta accreta of the placenta being stuck is about two thirds of the time. So it is critically important to avoid that first caesarian delivery. If you avoid that first caesarian delivery, the likelihood of having another one is extremely small. It is about 4% as supposed to 40%. So the way this ties into diabetes is that it is really important to be under good control so that is not a 10 pound and 11 pound baby that would mandate a caesarian delivery. We see more and more older mothers, I have had women in my practice now that are 54 and 55, so what we define as advanced maternal ages, changed a lot but certainly we see a lot of women that are over 35 or 40 and there is definitely an increased risk of diabetes and hypertension, caesarians and preterm birth.
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