Physicians have thought there was a relationship between gestational diabetes and stillbirth for years, but in the biggest study on gestational diabetes there was NO association with stillbirth. The risks of gestational diabetes were: C-section, pre-eclampsia, large-for-gestational-age baby, shoulder dystocia, prematurity, birth injury, stay in the NICU, and hyperbilirubinemia (jaundice). Keep in mind several of these problems are iatrogenic (caused by health care providers), and often are a result of trying to prevent other problems, like stillbirth.
As I heard an OB say, “Because of the risk of stillbirth with gestational diabetes we induce between 37 and 38 weeks.” I’m not sure who he meant by “we”, but that’s not a general recommendation. From the ACOG bulletin on gestational diabetes, “When glucose control is good and no other complications supervene, there is no good evidence to support routine delivery before 40 weeks of gestation.”
Another study published in 2012 looked at the risk between letting the pregnancy last another week and a stillbirth occurring and the risk of the newborn dying. It wasn’t until the 39th week of pregnancy that the risk of stillbirth became evident. But to understand if this applies to your situation, understand that “this study did not differentiate between those who were only diet controlled and those who required medical therapy; thus, it is likely that our study population could have more severe disease, representing a population at higher risk of stillbirth.” In other words, if your blood sugar levels are under control there is no evidence that you have a higher chance of stillbirth than someone without gestational diabetes. GD is also associated with preeclampsia, which would also might be responsible for some of these stillbirths. Research to tease out all these factors in ongoing.
According to the study who found an increase in stillbirth, it is of note that 1,518 women must be induced at 39 weeks (and take on the risks associated with that) to prevent 1 stillbirth. Also, with gestational diabetes even at 40 weeks only 4.4 stillbirths occur in every 10,000 pregnancies. Even the authors do not recommend that all women be induced at 39 weeks “Because the absolute risks of stillbirth and infant death are so low, an increase in short-term neonatal morbidities such as NICU admissions associated with a policy of early delivery may have a public health ramification that overshadows any small mortality benefit.”
Since many moms, especially those with gestational diabetes, are often advised to come in for tests such as an ultrasound and a biophysical profile, it is important to note that a Cochrane Review (that looks at all studies) has found no evidence that the test improves outcomes. ACOG also does not recommend testing when blood glucose is under control with diet. That's something parents have a very hard time understanding when faced with the pressure to undergo them. These tests increase Cesareans and inductions, but do not decrease death or low Apgar scores. This should be made clear to everyone choosing to undergo such a test. Ultrasounds are not reliable in determining the baby’s size, especially as the pregnancy progresses.
I would also like to add into the mix my perspective from a breastfeeding standpoint. There are many factors associated with Cesareans, inductions, and prematurity that negatively affect breastfeeding both for the baby and from the maternal side. These kinds of consequences are often not even considered when a family is deciding between an induction or a naturally starting labor.
To summarize (and I really tried to keep this short & sweet!), moms should ask their care provider:
*what their individual risk is with gestational diabetes based on their own blood sugar readings and personal history
*what they can do to keep their glucose levels low before resorting to medication
*what the side effects of any medication will be (insulin and related drugs often affect the baby after birth, necessitating more tests)
*why specifically an induction is being suggested. Is there any indication the baby is in trouble? How reliable is the test?
*if the baby is showing signs of distress, why an induction would be a better option than an emergency Cesarean?
*have they ever seen a shoulder dystocia? How did they handle it?
*how any intervention could affect your long-term goals, such as number of children or breastfeeding
If you’d like to read more on the subject, here is an excellent review that includes more relevant studies and information on treatment options for GD.