waiting it out vs. inducing with diabetes

blessedhope · December 2012

sorry for being a board hog this morning!

My OB said that diabetic babies lungs mature slower than babies born to mom without diabeties so she wants to keep my baby in until week 39. Because of my previous late loss and type 1 diabetes I would really like to deliver at 37 weeks. I certainly wouldn't want to deliver too soon if her lungs aren't matured but it seemed to me that diabetics and those with a history of late loss deliver at 37 weeks pretty often. Any thoughts or experience? Thanks!

kmc84 · December 2012

First, I am so sorry for your loss. I have never heard that the babies lungs develope slower. What they might be saying is that lung maturity compared to the size of the baby is going to be unproportioned, but this is with the assumption that the baby will be large due to poorly controlled diabetes. With your A1C, I really don't think that will be a problem.

What is true is that placentas of diabetic mom's age faster at the end of pregnancy, even with good control. The plan for me is to deliver at 38 weeks. If everything looks perfect, my doctors will consider waiting until 39 weeks, but not a day later.

With your history, I would feel safer at 37-38 weeks. Is your doc willing to dicuss this with you? If they are worried about lung maturity, would they consider steroids before delivery?

janabananac · December 2012

I don't have much in the way of medical advice but my friend had GD with her first baby and they also told her they were concerned about lung size. Between 36 and 37 weeks she had an ultrasound which showed that she had incredibly low amniotic fluid. They put her on bed rest for a few days but when nothing changed, they induced her due to low amniotic fluid. Her daughter was born perfectly healthy - no issue with her lungs at all. She was almost 7lbs at 36ish weeks so definitely a healthy weight. She is now 2 years old and a very happy and healthy little girl. (The mom just had another baby, born at almost 39 weeks who was 9lbs).

Good luck to you!

blessedhope · December 2012

kmc84:
First, I am so sorry for your loss. I have never heard that the babies lungs develope slower. What they might be saying is that lung maturity compared to the size of the baby is going to be unproportioned, but this is with the assumption that the baby will be large due to poorly controlled diabetes. With your A1C, I really don't think that will be a problem.
What is true is that placentas of diabetic mom's age faster at the end of pregnancy, even with good control. The plan for me is to deliver at 38 weeks. If everything looks perfect, my doctors will consider waiting until 39 weeks, but not a day later.
With your history, I would feel safer at 37-38 weeks. Is your doc willing to dicuss this with you? If they are worried about lung maturity, would they consider steroids before delivery?

Thanks for the info. When I have this discussion again with my OB I will ask about both the placenta health and the steroids.

blessedhope · December 2012

janabananac:
I don't have much in the way of medical advice but my friend had GD with her first baby and they also told her they were concerned about lung size. Between 36 and 37 weeks she had an ultrasound which showed that she had incredibly low amniotic fluid. They put her on bed rest for a few days but when nothing changed, they induced her due to low amniotic fluid. Her daughter was born perfectly healthy - no issue with her lungs at all. She was almost 7lbs at 36ish weeks so definitely a healthy weight. She is now 2 years old and a very happy and healthy little girl. (The mom just had another baby, born at almost 39 weeks who was 9lbs).
Good luck to you!

Thanks for sharing her story.

jbranden12 · December 2012

I talked to my ob about this Wednesday. Although I actually passed my 1 hour this time, I had GD with my first and have been following a modified diet ever since so I'm telling myself that's why I passed so I have to keep it up! But due to my history, I think I will also get antsy around 37 weeks. My ob said that around 36 weeks, it is possible to do an amniocentesis to test lung maturity.

We didn't make any decisions yet but will continue to talk about it and research it. Starting at 28 weeks we will also be doing weekly BPPs and NSTs so hopefully we will have a pretty good idea of where she's at.

emriley84 · December 2012

My best friend is a type 1 diabetic. She just had a baby in September. The plan for her was to do an amnio at 37 weeks to check for lung maturity, and if the baby's lungs were developed, they were going to induce. However, at 34.5 weeks she developed really bad pre-e and ended up having her then. The baby was perfectly fine. No respiratory issues, her sugars were low after birth, but that is common with late-preterm babies, and diabetic babies, so she needed supplementing for a few days.

kerbear135 · December 2012

OP, My OB mentioned the same thing about lungs possibly developing slower in babies who are born to GD moms..that said, he was willing to deliver between 38 and 39 weeks, but we waited until 39 weeks b/c I wasn't favorable for induction at 38 weeks. My advice would be sit down and have another discussion with your dr..maybe you can come to a compromise and aim for 38 weeks, or maybe they will agree to do an amnio at 37 week and induce you if baby's lungs look ok. I am sure at the very least, they will do BPPs and NSTs to keep a close eye on baby until they feel it's safe to induce you.

blessedhope · December 2012

jbranden12:
I talked to my ob about this Wednesday. Although I actually passed my 1 hour this time, I had GD with my first and have been following a modified diet ever since so I'm telling myself that's why I passed so I have to keep it up! But due to my history, I think I will also get antsy around 37 weeks. My ob said that around 36 weeks, it is possible to do an amniocentesis to test lung maturity.
We didn't make any decisions yet but will continue to talk about it and research it. Starting at 28 weeks we will also be doing weekly BPPs and NSTs so hopefully we will have a pretty good idea of where she's at.

I'm glad you responded! i wonder why my OB and also the high risk OB never gave me the option of an amniocentesis?

Amanda&EricB · December 2012

I also hadn't heard about the lungs developing slower. I was induced at 38w 2d because he was not as reactive during a NST as they wanted. But at 37w or so, I got two steroid shots to speed up lung maturity as he was starting to show signs of needing to come out then (not as bad as it was at 38w though).

blessedhope · December 2012

Amanda&EricB:
I also hadn't heard about the lungs developing slower. I was induced at 38w 2d because he was not as reactive during a NST as they wanted. But at 37w or so, I got two steroid shots to speed up lung maturity as he was starting to show signs of needing to come out then (not as bad as it was at 38w though).

hmm... thanks for the response. I will be having weekly dr. visits starting at 32 weeks to listen to her heart. I wonder if the decision will be based more off of that.

Wally3 · December 2012

blessedhope:
kmc84:
First, I am so sorry for your loss.  I have never heard that the babies lungs develope slower. What they might be saying is that lung maturity compared to the size of the baby is going to be unproportioned, but this is with the assumption that the baby will be large due to poorly controlled diabetes. With your A1C, I really don't think that will be a problem.
What is true is that placentas of diabetic mom's  age faster at the end of pregnancy, even with good control. The plan for me is to deliver at 38 weeks. If everything looks perfect, my doctors will consider waiting until 39 weeks, but not a day later.
With your history, I would feel safer at 37-38 weeks. Is your doc willing to dicuss this with you? If they are worried about lung maturity, would they consider steroids before delivery? 
Thanks for the info. When I have this discussion again with my OB I will ask about both the placenta health and the steroids.

My Ob said steroids don't help after 34 wks and the shots only show improvement for up to 2 wks after given so not sure if they would be an option in your case.

waiting it out vs. inducing with diabetes

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