Stillbirth is relatively uncommon, but uncontrolled gestational diabetes is one of many possible risk factors. Timely diagnosis and effective management of gestational diabetes can dramatically reduce risks to you and your baby.

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Stillbirth occurs when a baby dies in the womb at or after 20 weeks of pregnancy. Stillbirth occurs in about 1 in every 160 deliveries in the United States. There are many varied risk factors for stillbirth.

Gestational diabetes (GDM) is diabetes arising during pregnancy and often resolves with delivery. It’s increasingly common, affecting about 2–10% of U.S. pregnancies. If you have GDM, your pregnancy causes the production of hormones that increase your resistance to insulin. When you’re resistant to insulin, you’ll have higher circulating blood sugar.

Uncontrolled GDM poses some risks to pregnant people and their babies, including a possible increased risk of stillbirth. But timely diagnosis and management of GDM can greatly reduce those risks.

If you’re pregnant, a doctor will likely recommend screening for GDM at 24–28 weeks’ gestation. If you receive a diagnosis of GDM, a doctor can help you bring your blood sugar down to a healthy level with recommended dietary changes, exercise, and, if needed, medications.

Learn more about GDM.

It’s long been known that pregnancy in people with pre-existing diabetes carries a higher risk of stillbirth.

Studies on stillbirth in those with GDM have produced conflicting results. This may be due to the rarity of stillbirth, changes in the diagnosis and management of GDM over time, and overlap between the risk factors for GDM and the risk factors for stillbirth.

GDM has previously been associated with an increased risk of stillbirth in U.S.-based research.

But a 2021 analysis of the scientific literature found that elevated risk of stillbirth in people with GDM tended to appear in older studies and in those defining stillbirth as occurring after 28 weeks’ gestation. The analysis found no significant increase in the overall incidence of stillbirth in people with GDM.

Regardless, it’s clear that unmanaged high blood sugar poses risks to the pregnant person and their baby. Effectively managing your blood sugar levels if you have GDM has been shown to reduce your risk of complications, including the risk of stillbirth, to near-normal levels.

Having continually high blood sugar if you have GDM can cause abnormalities in your placenta, which is responsible for delivering nutrition and oxygen to your growing baby. Low oxygenation and placental anomalies are significant risk factors for fetal distress and stillbirth.

Unmanaged GDM also increases your risk of conditions like pre-eclampsia (a type of high blood pressure in pregnancy), excessive amniotic fluid, and abnormal fetal growth patterns. These complications can further increase your risk of stillbirth.

Stillbirth is more likely when GDM goes undiagnosed, remains untreated, or is unmanaged. Unmanaged GDM means having continually high blood sugar in pregnancy.

Having GDM, along with one or more additional risk factors for stillbirth, particularly hypertension, can also increase the odds of stillbirth.

If you’ve received a diagnosis of GDM, you have already completed the important first step of timely screening! A doctor will work with you to manage your blood sugar and will help monitor your baby’s growth and health throughout your pregnancy.

Research has shown that managing your GDM can reduce your risk of stillbirth to normal or near-normal levels.

About 70% of GDM in people can be managed with diet and exercise. When this isn’t enough, a doctor will discuss oral medication or insulin to help manage your blood sugar.

Depending on your individual circumstances, extra ultrasounds or fetal monitoring may be recommended during your pregnancy.

For those with well-managed GDM, a doctor will likely plan for a term delivery at or after 39 weeks of pregnancy. When GDM can’t be managed despite medication, earlier induction of labor may be recommended.

GDM resolves with delivery in the majority of people who have it. But having GDM increases your risk of developing type 2 diabetes over time. If you have received a diagnosis of GDM, a doctor will likely recommend rescreening for type 2 diabetes 4–12 weeks after delivery and every 1–3 years thereafter.

How likely is it to have a stillbirth from gestational diabetes?

The U.S. Centers for Disease Control and Prevention (CDC) reports that in 2020, stillbirth occurred in 5.7 per 1,000 pregnancies overall.

A 2012 U.S. study estimated a stillbirth risk of approximately 17 per 10,000 in people with GDM, compared with 12.7 per 10,000 in pregnancies uncomplicated by GDM. But other research hasn’t associated GDM with an increase in overall stillbirth risk.

The risk of complications associated with GDM, including the risk of stillbirth, can be reduced to typical levels when blood sugar is well managed.

Can gestational diabetes harm the unborn baby?

GDM can cause complications for babies, including:

  • excessive growth (increasing risk of birth injuries)
  • preterm birth
  • newborn breathing difficulties
  • newborn hypoglycemia
  • newborn jaundice
  • increased risk of diabetes and cardiovascular disease later in life

These risks can be reduced by taking steps to manage your GDM.

At what week do most stillbirths occur?

Although the actual number of stillbirths is very low, the risk appears highest in people with GDM when their baby is at around 28–36 weeks’ gestation. Compared with pregnancies without GDM, relative risk peaks around 37 weeks before declining. Risk begins to rise again after your due date.

Can gestational diabetes cause fetal distress?

Signs of fetal distress are decreases in fetal heart rate, movement, and amniotic fluid level.

A 2020 study found that babies affected by GDM were more likely to experience fetal distress.

GDM is an increasingly common pregnancy-related form of glucose intolerance. Particularly when not successfully managed, GDM can increase the risk of stillbirth and other health complications for you and your baby.

If you’re pregnant, talk with a doctor about universal diabetes screening, which ensures GDM will be found quickly.

If you have received a diagnosis of GDM, you can significantly reduce the risk of complications for you and your baby by taking steps to manage your diabetes together with a healthcare team.