ACOG-Gestational Diabetes

[Ken Levine]

The American College of Ob/GYN has issued a new Practice Bulletin concerning gestational diabetes. The new Bulletin dated September, 2001 replaces the prior Bulletin dated December, 1994.

The new Bulletin has some important information. For example, many hospital and doctors office labs have a normal value of 70-140 for the one hour glucose screen.t has long been my position that the 140 is too high as it does not factor in the pregnancy. Many physicians and some important medical texts list the range as 70-105/110. This has been an issue with women who had numbers in the 130's but were not provided three hour glucose testing because they were in the "normal" range.

The new Bulletin acknowledges that the 140 number may be too high, and that women with numbers in the 130's should receive follow up testing. The new Bulletin does not go far enough, but it is a start.

The new Bulletin also has a more definite statement that gestational diabetes is limked to greated likelihood of shoulder dystocia. The Bulletin says that it may be reasonable to recommend cesearian delivery without a trial of labor at some particular threshold of fetal weight. The suggested weight is 4500 grams. The Bulletin also says that from 4000-4500 grams the past delivery history, clinical pelvimetry(type of pelvis) and progress of labor should be considered. This is important as many women do not have their type of pelvis evaluated at the start of the pregnancy.

Most important, the Bulletin does highlight a prolonged second stage of labor with a 4500 gram baby as indication alone of cesearian section. The Bulletin then seems to contradict itself by stating that because of the higher likelihood of shoulder dystocia with gestational diabetic mothers, it may be best to apply the cesearian section recommendation to babys of 4000 grams also.

Also, the Bulletin says that operative deliveries -Forceps and Vacuum extraction- SHOULD BE AVOIDED when there is a prolonged second stage of labor and a estimated fetal weight of more than 4000 grams.

The new Bulletin clearly calls on ob/gyns to do all they can to estimate fetal weight as so mnay decisions will rely on that. As manual palpation can be a difficult way to estimate fetal weight, and ultrasound can be unreliable, ob/gyns must fall on the side of caution when the various risk factors are present.

If you would like a copy of the ACOG Bulletin please call or write and I will send it to you free of cost.

Ken Levine
ANNENBERG & LEVINE, LLC.
370 Washington Street
Brookline, Massachusetts 02445
617-566-2700
BRL77@world.std.com

[Bridget]

Thanks for this encouraging information, Ken. Undiagnosed (and therefore untreated) gestational diabetes has undoubtedly been a factor in many our pregnancies and subsequent difficult deliveries. I hope that the publication of this information by ACOG represents at the very least a tiny step forward in preventing brachial plexus injuries.

Bridget