Gestational Diabetes and Labour Induction: Why It Matters

During pregnancy, certain hormones wreak havoc and do not allow your body to use insulin to keep your blood sugar levels under control. Insulin is what helps convert sugar to energy, and sometimes, pregnancy does not allow this to happen, which leads to high blood sugar levels. This, unfortunately, leads to gestational diabetes. Gestational Diabetes among pregnant women means that labour has to be induced around 39-40 weeks of gestation, failing which it could have adverse impacts on the unborn baby and the mother. Gestational diabetes and induction of labour is a complicated situation in the case of pregnancy. Find out more information about the same and how to induce labour as one of the methods to ensure no neonatal complications.

Is Induction of Labour Necessary When You Have Gestational Diabetes?

Some women have symptoms of GD, whereas others don’t. Some can also fix it just by managing diet and some exercise, whereas others need shots of insulin. A lot of healthcare providers recommend around 39–40 weeks for inducing childbirth. The WHO recommends not before 41 weeks, if gestational diabetes is the only medical condition; although this is backed up by weak evidence (1). Guidelines for GD according to the American Congress of Obstetricians and Gynaecologists recommend induced labour not before 39 weeks of gestation with controlled gestational diabetes (2).

Each case is treated individually based on the patient’s medical analysis and requirements. For many women, if diabetes develops during pregnancy, they can most likely have labour deliveries. However, inducing labour becomes important when diabetes is not controlled to maintain the health and safety of both the baby and the mother.

The NHS suggests that if your blood sugar level is under control and there seems to be no concern or pregnancy complication about you or your baby’s health, it is best to wait for labour to start naturally. However, if you have not given birth by 40 weeks and six days, you’ll most probably be suggested labour induction or a caesarean section. Early delivery is usually recommended when there are maternal and fetal health concerns or the blood sugar has not been in control (3).

Why Is Labour Induction Important in the Case of Gestational Diabetes?

What used to be a relatively rare condition is now becoming more and more common. Having GD can negatively impact the health of both the mother and the unborn child, but it does not affect the way you give birth. You can still give birth vaginally and can also have an uncomplicated delivery. Here are some reasons why inducing labour is a good option.

1. Stillbirth

One of the main reasons for inducing childbirth in women who have GD is to prevent stillbirth. The chances of stillbirth increase significantly after the 40-week benchmark for women with GD. Therefore, sometimes, labour is induced, usually before 39 weeks, to make sure the mother and the child are safe (4).

2. Larger Than a Normal Baby

Women with GD usually have babies that are slightly larger, which is termed as macrosomia. The extra sugar crosses paths with the placenta and makes your baby fatter due to the storage of insulin. Inducing labour would be important because babies can weigh up to 4.5 kg sometimes.

3. Other Complications

Macrosomia or a large baby can lead to other complications as well, including damage to the tailbone, blood loss, tearing, etc. Inducing childbirth can help avoid these complications.

4. Preeclampsia

Preeclampsia is a condition which is characterised by high blood pressure and the presence of protein in the urine during pregnancy. This can lead to complications such as preterm labour, abruptions or even seizures that can prove to be fatal for mother and child (5). A study showed that induction of labor for women with mild preeclampsia between 34–37 weeks helped reduce the risk of the outcome by a little bit.

5. Mother-Baby Health

During childbirth, the most critical part is to keep the mother and baby as safe as possible. GD occurs in a lot of women nowadays, and scientists say that the number might go up. Monitor your blood sugar levels continuously, and if induction is required, ensure you are well-informed about it.

How Will You be Induced?

There are multiple ways to induce labour, but if you have to go through it, you should understand it completely, including all the benefits and risks involved.  Each way of inducing childbirth has its pros and cons. You should make sure to talk to your doctor in depth and understand which method is best suited for you after a thorough medical analysis. Here are some ways in which you can be induced.

• A common question is, “Will I be induced if I have Gestational Diabetes?” The answer is yes because that is a safer option for you and your baby. Gestational diabetes can lead to a lot of complications, so it is better to induce labour than try natural methods.
• Artificial Rupture of Membrane of ARM, where an amnihook is inserted to pierce the water bag surrounding your baby to help the baby crown. Many women opt for this option.
• Oxytocin is another method to induce labour wherein synthetic oxytocin is inserted via an IV drip. This will engage your hormones and trigger your system into labour. Some childbirths are induced at 38 weeks due to gestational diabetes, which is earlier than what the WHO recommends.
• A low-risk option is a Foley Balloon catheter, which is placed in the vagina and inflated in the hope that the baby’s head will help encourage dilation. Since there are no drugs involved, this is a low-risk way to induce labour.
• Prostaglandin gel is used to encourage contractions. The doctor will insert the gel to soften and dilate the cervix. Although it is a synthetic hormone, it is useful for inducing labour.

FAQs

1. Can you have a natural delivery with gestational diabetes?

Yes, it is possible to have a natural delivery for women with gestational diabetes with the implementation of some precautions, including close monitoring of the mother and the baby, controlling the blood sugar levels of the mother throughout labour and delivery, monitoring the position of the baby for a smooth delivery, and having an assisted birth. Gestational diabetes may impact maternal and fetal health, but it doesn’t prevent a natural vaginal birth (6).

2. Does gestational diabetes always mean early delivery?

Being pregnant with gestational diabetes does not always mean that you’ll deliver early. As each pregnancy is unique, he decision to deliver early or wait till the term depends upon various factors, especially the health of the mother and the baby. Since the ultimate goal of managing gestational diabetes is delivering the baby safely and healthily without compromising on the maternal health and minimal medical invasions, doctors will assess each situation accordingly and make a decision for the well-being of the mother and the baby.

3. Can early delivery be avoided if a pregnant woman has gestational diabetes?

The best a mother can do to prevent delivering early with gestational diabetes is by keeping her blood sugar levels under strict check. Women can consult their doctors for personalised care and a tailored meal plan during their pregnancy to help maintain stable blood sugar levels. For instance, this can be done by monitoring blood sugar levels regularly, eating a healthy diet that includes foods with a low glycemic index, exercising regularly and moderately, taking doctor-prescribed glucose-lowering medications or insulin on time (7).

4. What are the chances of a normal delivery with gestational diabetes?

Yes, there are food chances of having a vaginal delivery with gestational diabetes with a few precautions and essential things in check. Doctors will make sure that your diabetes is well-controlled and you are under no other pregnant complications that could be hindering a normal delivery.

5. Is it safe to have an assisted home birth in pregnancy with gestational diabetes?

Women with gestational diabetes require high-level care. Thus, having a home birth with gestational diabetes can be very dangerous for both the mother and the baby. Health experts do not recommend home birth for pregnant women with gestational diabetes due to the lack of necessary facilities for the monitoring of the mother and the baby, and the chances of life-threatening complications post-delivery (8).

Although natural childbirth is the best way to go, sometimes circumstances are unpredictable. In those situations, one should not worry and find a solution instead. If your condition can be managed, you should ideally have a normal birth. However, GD can be controlled as well, so don’t worry, follow your doctor’s advice and you will have a safe delivery for you and your baby. GD can be prevented by following a healthy diet and lifestyle. Regular check-ups can also be helpful in keeping your blood sugar levels in a safe range. Make an informed decision after consulting your doctor, and all the best!

References/Resources:

1. WHO – WHO recommendations for Induction of labour

2. American Family Physician – ACOG Releases Guideline on Gestational Diabetes

3. NHS – Gestational Diabetes

4. PubMed Central – The Risk of Stillbirth and Infant Death Stratified by Gestational Age in Women with Gestational Diabetes

5. PubMed Central – Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors

6. Gale Onefile – Maternal and fetal outcome in gestational diabetes mellitus

7. PubMed Central – Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus

8. Wiley Online Library – Infant Death Following Home Birth: A Case Report of Fatal Neonatal Hypoglycemia*

Also Read:

Is Vomiting While Labour Beneficial
Induce Labour Using Acupuncture
Timing Contractions While Labour
Foods That Induce Labor Quickly

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