Late onset GD question

I've been a lurker here for a while, and I know there is lots of
knowledge here about GD, so I've got some questions, hoping someone can
help me sort through a few things. I'm 37 weeks pregnant with my third
child, and based on her measurements at an u/s yesterday, I'm being
recommended for the 3 Hour glucose test (she's approx. 7lbs12oz). My
first two were 9lbs2oz and 8lbs6oz respectively, so while on the big
side, she doesn't seem to me to be that far off track for me. I had the
1 Hour test at 26 weeks, which was fine, a bit on the low side, and have
had the urine dips at every appointment, including the past two
Tuesdays. From what I've read online, I don't see any serious
complications that really can arise at this point, even if I do happen
to test positive with the 3 hour test, which seems unlikely in and of
itself. My first two were also born right at 40 weeks, didn't go over.

From what the nurse said yesterday when I called, the doctor said that
"serious complications" (which remained nameless) can arise, even with
late onset GD, and that if I test positive, they will want extra
monitoring and possibly to take the baby out sooner (c-section or
induction). I'm fearful of the intervention path- I've had two mostly
simple vaginal births, and would like a third. I really don't want to go
through an induction or a c-section, unless there is really some risk to
the baby that would require it. Obviously, her health and safety are
paramount, but I'm just not hearing evidence that she's in any kind of
danger.

Any thoughts and advice are greatly appreciated,
JP

JP wrote:
I've been a lurker here for a while, and I know there is lots of
knowledge here about GD, so I've got some questions, hoping someone can
help me sort through a few things. I'm 37 weeks pregnant with my third
child, and based on her measurements at an u/s yesterday, I'm being
recommended for the 3 Hour glucose test (she's approx. 7lbs12oz). My
first two were 9lbs2oz and 8lbs6oz respectively, so while on the big
side, she doesn't seem to me to be that far off track for me. I had the
1 Hour test at 26 weeks, which was fine, a bit on the low side, and have
had the urine dips at every appointment, including the past two
Tuesdays. From what I've read online, I don't see any serious
complications that really can arise at this point, even if I do happen
to test positive with the 3 hour test, which seems unlikely in and of
itself. My first two were also born right at 40 weeks, didn't go over.

From what the nurse said yesterday when I called, the doctor said that
"serious complications" (which remained nameless) can arise, even with
late onset GD, and that if I test positive, they will want extra
monitoring and possibly to take the baby out sooner (c-section or
induction). I'm fearful of the intervention path- I've had two mostly
simple vaginal births, and would like a third. I really don't want to go
through an induction or a c-section, unless there is really some risk to
the baby that would require it. Obviously, her health and safety are
paramount, but I'm just not hearing evidence that she's in any kind of
danger.

Any thoughts and advice are greatly appreciated,

I'd push them to give more information on just what they
think might happen. It seems to me that the only thing that can
come out of this is pressure for an induction or c-section. By
the time you get results, you'll practically be in labor. Unless
they can show you some credible evidence that there's a significant
risk of Something Bad Happening that would cause you to agree to
induction or c-section, I'd likely refuse.
The bad news is that your doctor is now expecting you
to have a big baby and will interpret everything that happens
in your labor in that light. If anything deviates from textbook,
even if it's perfectly normal, you're likely to be pressured for
interventions because, you know, it must be due to a large baby
and there might be further complications. If you go past your
due date, you'll likely get a lot of pressure as well. So,
prepare now. Think about what questions you'll ask and what
you'll do if you start getting that pressure, and have a really
good discussion with your partner about what kind of support
you need and what kind of decisions you want to make if this
comes up.

Best wishes,
Ericka

The hormones implicated in pregnant women becoming tolerant to insulin do
peak at different points, a group of them at arouns 26-28 weeks and another
at 32 weeks. I'm surprised you were first tested at 26 weeks, 28 weeks is
more common. But, with one of the hormones not peaking until later, it's
entirely possible that GD develops later. But it's not that uncommon either,
I'd guess that you'd pass this test and though your care providers will
likely act in the way Ericka describes in reacting to large babies, you
might have them off your case slightly with a pass on this test. On the
other hand if you fail, they are likely to be very much on your case, but
most likely without any reason, chances are you had GD last 2 times as well,
yet got on fine. If you refuse the test, they will likely treat it as if you
had failed, so it makes more sense to take the test, but do as Ericka says,
find out what risks they are worried about, what your responses to them are,
what questions you'll need to ask to find out whether it's a genuine risk,
and even if something is an increased risk, it could still be low enough
risk that it's below your threshold, even if not your care providers.

Cheers

Anne

Anne Rogers wrote:
The hormones implicated in pregnant women becoming tolerant to insulin do
peak at different points, a group of them at arouns 26-28 weeks and another
at 32 weeks. I'm surprised you were first tested at 26 weeks, 28 weeks is
more common. But, with one of the hormones not peaking until later, it's
entirely possible that GD develops later. But it's not that uncommon either,
I'd guess that you'd pass this test and though your care providers will
likely act in the way Ericka describes in reacting to large babies, you
might have them off your case slightly with a pass on this test. On the
other hand if you fail, they are likely to be very much on your case, but
most likely without any reason, chances are you had GD last 2 times as well,
yet got on fine.

Why would one assume she had GD previously? She screened
negative, even if a tad early, and the significant majority of
macrosomic babies are born to women who do *not* have GD. There
simply is no reason to think that she had it during the last
two pregnancies, even if the babies were on the larger side.
Heck, the last one wasn't even macrosomic. And that's even before
one gets into the issue of the lack of accuracy of late term
u/s in estimating weight (and its tendency to overestimate weight).

Best wishes,
Ericka

Why would one assume she had GD previously? She screened
negative, even if a tad early, and the significant majority of
macrosomic babies are born to women who do *not* have GD. There
simply is no reason to think that she had it during the last
two pregnancies, even if the babies were on the larger side.
Heck, the last one wasn't even macrosomic. And that's even before
one gets into the issue of the lack of accuracy of late term
u/s in estimating weight (and its tendency to overestimate weight).

If she screened positive this time then I'd guess she'd have it previously,
not on the basis that they babies were big or anything, just that I'd
question what had changed to make this pregnancy suddenly screen positive
for GD (if it did, that is). I know no it's not one of those hard and fast
things that once you have it in one pregnancy you'll have it every
pregnancy, or something that if it appears it will appear in a first
pregnancy, but when you do come across someone with a GD pregnancy, a large
proportion of the time they will have had it previously, or if they didn't,
they won't have been tested for it (or passed a less reliable screening
test, or one done at the wrong time), either that, or there has been a
significant time gap between pregnancies. So my best guess is she doesn't
have GD this time, nor in previous pregnancies, but on the off chance this
3hr test comes back positive, it doesn't seem unreasonable that it would be
more likely than not that they were also GD pregnancies and that the history
would be better outcome predictor than raw statistics alone.

Cheers

Anne

Anne

Anne Rogers wrote:
Why would one assume she had GD previously? She screened
negative, even if a tad early, and the significant majority of
macrosomic babies are born to women who do *not* have GD. There
simply is no reason to think that she had it during the last
two pregnancies, even if the babies were on the larger side.
Heck, the last one wasn't even macrosomic. And that's even before
one gets into the issue of the lack of accuracy of late term
u/s in estimating weight (and its tendency to overestimate weight).

If she screened positive this time then I'd guess she'd have it previously,
not on the basis that they babies were big or anything, just that I'd
question what had changed to make this pregnancy suddenly screen positive
for GD (if it did, that is).

But she didn't screen positive. She screened negative
(even a bit low). It just seems to me that there's not much to
disprove the theory that she just tends to grow *slightly* larger
babies, and she's got another one one the way that's perfectly
normal for her. Whatever the case, she didn't have any
complications with her previous babies, so having another
one that seems to be following suit hardly seems reason for
much concern.

I know no it's not one of those hard and fast
things that once you have it in one pregnancy you'll have it every
pregnancy, or something that if it appears it will appear in a first
pregnancy, but when you do come across someone with a GD pregnancy, a large
proportion of the time they will have had it previously, or if they didn't,
they won't have been tested for it (or passed a less reliable screening
test, or one done at the wrong time), either that, or there has been a
significant time gap between pregnancies. So my best guess is she doesn't
have GD this time, nor in previous pregnancies, but on the off chance this
3hr test comes back positive, it doesn't seem unreasonable that it would be
more likely than not that they were also GD pregnancies and that the history
would be better outcome predictor than raw statistics alone.

I don't know that this reasoning holds up. Many risk factors
for GD increase with age. It's entirely possible to not have
GD and then get it later.

Best wishes,
Ericka

But she didn't screen positive. She screened negative
(even a bit low).

I realise this, but it was a screen at 26 weeks, which is pretty early to
screen when 4 of the implicated hormones peak at 26-28 weeks and the 5th at
around 32 weeks. I can't find any figures on number of GD cases that occur
after that 32 week peak, but they do happen. But with screening on the low
side, it would be a bit of surprise if it suddenly it flipped over the
threshold.


It just seems to me that there's not much to
disprove the theory that she just tends to grow *slightly* larger
babies, and she's got another one one the way that's perfectly
normal for her. Whatever the case, she didn't have any
complications with her previous babies, so having another
one that seems to be following suit hardly seems reason for
much concern.

I entirely agree.

I don't know that this reasoning holds up. Many risk factors
for GD increase with age. It's entirely possible to not have
GD and then get it later.

True, but what proportion of cases, I only said more likely than not,
obviously I don't know the pregnancy gap here, but if a figure was available
for women with a previous pregnancy in the last 2yrs, still aged under, say,
35, that had screened positive for GD in the current pregnancy, I'd put
money on more than half of them having done so in the previous pregnancy, I
suspect some kind of figure like that is available somewhere deep in
someones research paper! But of course we don't know all those factors here,
maybe JP is past 35, has had a long gap since the previous pregnancy and has
gained weight in that time, in which case it wouldn't surprise me at all.

Of course it's all pretty irrelevant as everything points to not screening
positive, I'm just trying to figure out helpful things to talk to the doctor
about if it comes back positive, with all the facts in front of them,
knowing what the pregnancy gap is, what screening was done previously and so
on, it may be that the doctor would come to the conclusion that GD was
reasonably likely in the previous pregnancies and that the outcomes were
good, so no reason for excessive concern before 40 weeks here. Of course the
opposite may occur and the doctor may freak out that it was not spotted and
that it was luck not judgement that everything went fine!

I wonder if they will ever increase the threshold for macrosomia, or at
least modify it to take into account maternal (and paternal) race and some
kind of factor for maternal health. It seems an awful lot of my friends have
been producing first babies above the 4kg threshold, but they are white,
middle class, educated, healthy and it would seem an entirely normal thing
for them to do. Doing similar things for picking out small babies has been
very helpful in some parts of the UK, instead of plotting measurements on a
standard centile chart, a personalised chart is produced (I think they call
them GROW charts), based on many factors. The results are very promising,
less still births due to ones not spotted and less unnecessary inductions.
But one of the foundations underlying the usage of such charts is that they
are not looking for big babies, only small ones. Overall though, I get the
impression there is much less concern about large size babies in the UK,
probably the difference in litigation culture. On the other hand, maybe such
a tool would be largely irrelevant, because it seems to me, that whilst any
tool that can get a reasonable sucess rate for shoulder dystocia would be a
Good Thing, that though it is size linked, the link isn't strong enough that
having a size for that person rather than a size for general population
would help much, or maybe it would, if it was predictated that a baby was
above 90th (or whatever) centile for the expected size for that person it
might have a stronger predictive value than just above that centile in the
general population. However, I suspect such a tool could be dangerous as it
could actually start picking out more large babies in women who previously
were deemed to be having normal size babies and when they'd previously been
left unhindered and having sucessful deliveries, then falling into the
caregiver anxiety you described earlier. It's a tricky one, I just can't see
any tool for SD prediction not involving size, but any concern about size
seems to be collecting an awful lot more people to be worried about than
seems really necessary.

Thinking back to the original case, induction for GD is highly
controversial, though with the doctor feeling the need to find out, it
sounds like he'd be in the camp for inducing at some point! The shoulder
dystocia concern is genuine, it roughly triples for GD mothers compared to
non GD mothers with the same weight babies (actual not predicted), but the
ACOG is only suggesting the c-section be considered for babies predicted to
be over 4500g to diabetic mother (5000g for non diabetic mothers) and the
predicted weight at this stage would appear to point to in the 4000-4500g
range, not above that.

Ultimately for me the question is why did the care providers scan at 37
weeks, it's told them nothing, that weight appears to me to be entirely
consistent with previous history. If you're going for interventionalist
care, it would seem more logical in the light of previous biggish babies to
redo the GD screen at 32 weeks as then if it was a rare case of late onset
GD at least you have time to deal with it, because if you're going to screen
for it, you're going to treat it.

It's just yet another example of an apparently "risk free" test, suddenly
throwing everything into disarray, I mean what were they expecting to find,
that suddenly, out of the blue, JP's having an average rather than a large
baby? Yet on finding what it would make sense to expect to find, panic
follows! I know the research points to routine scanning not improving
outcomes, but I wonder about late scanning, maybe that harms outcomes!

Ok, I'll get off my horse now, congratulations if you got this far!
Anne

"Anne Rogers" wrote in message
...

Snip

It's just yet another example of an apparently "risk free" test, suddenly
throwing everything into disarray, I mean what were they expecting to
find, that suddenly, out of the blue, JP's having an average rather than a
large baby? Yet on finding what it would make sense to expect to find,
panic follows! I know the research points to routine scanning not
improving outcomes, but I wonder about late scanning, maybe that harms
outcomes!

This is my exact thought. JP makes big babies (not huge, just good sized),
and we scan towards the very end of her pregnancy, and what do we find? A
big baby! Oh lord, quick, induce, induce! Test for something that gives us
a reason to induce! Yikes! This baby may be 8 pounds! Oh lord!
--

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BABY SIZE: "THE SHOULDER DYSTOCIA CONCERN IS GENUINE"

Anne Rogers wrote:

snip
The shoulder
dystocia concern is genuine, it roughly triples for [gestational diabetes] GD mothers compared to
non GD mothers with the same weight babies (actual not predicted), but the ACOG is only suggesting...
snip

Todd D. Gastaldo, DC remarks:

Speaking of ACOG and shoulder dystocia.

The ACOG Shoulder Dystocia video purports to show MD-obstetricians how
to allow the birth canal to open maximally when shoulders get stuck -
an indirect admission by ACOG that MD-obstetricians are routinely
closing birth canals up to 30%.

In actuality, the ACOG Shoulder Dystocia video teaches MD-
obstetricians to KEEP the birth canal closed (up to 30%) when
shoulders get stuck. (See below.)

In actuality, MD-obstetrician experts have been LYING to cover-up the
birth-canal-closing. (See below.)

And MDs who read my posts have been - LYING BY OMISSION - silently
failing to help publicize and stop the obvious massive birth-canal-
closing crime.

The MD lying is buttressed by posters on misc.kids.pregnancy.

Neither Ericka Kammerer nor Anne Rogers even mention the birth-canal-
closing as they discuss concern about big babies.

Ericka once assured everyone that MDs aren't "trying to lie."

When I protested, Anne came to Ericka's defense....

BEGIN excerpt Semmelweis vs. Anne Rogers (also: 'Sledging Ericka')
http://groups.google.com/group/sci.m...9b77995fe25481

When Chris in Oz (Nina Pretty Ballerina) wrote:

"oooooo todd, you arent going to win a lot of friends by sledging
Ericka....she is very generous with her very extensive knowledge
around here......"
http://groups.google.com/group/sci.m...6e6fef0f44636e

Anne Rogers of Britain added:

"...particularly as that comment was used out of context, I went to
read that post and it's a very recent on on c-sections..."

#### Here's Ericka's comment again...

"...The overwhelming majority of caregivers aren't
trying to *lie*..."
http://groups.google.com/group/misc....c7005a1d271cc0

#### Anne continued...

"...and I agree entirely with what
she meant and it's nothing to do with birth position etc."

#### With MD-obstetrician themselves saying they are performing
c-sections for "failure to progress" and/or "cephalopelvic
disproportion" - the sordid spectacle of MD-obstetricians lying and
closing birth canals up to 30% has a LOT to do with "birth position,
etc."

#### Anne continued...

"I also don't think that obstetricans are lying about the whole back
thing, I think they genuinely don't believe it..."

#### MD-obstetrician experts have most definitely been lying.

#### For the Four OB Lies (they are whoppers)...

See Dents in babies' skulls"
http://groups.google.com/group/
misc.kids.pregnancy/msg/08abfc7ff242150e

Alternate URL:
http://health.groups.yahoo.com/group...t/message/3897

#### Anne continued...

"...or [obstetricians don't] think it makes a difference..."

#### Obstetricians at ACOG OBVIOUSLY think keeping the birth canal
closed the "extra" up to 30% makes a difference. ACOG has a shoulder
dystocia video out that purports to show obstetricians how to allow
birth canals to open maximally - but the ACOG video actually shows
obstetricians how to keep the birth canal closed the "extra" up to
30%.
See OB Lie #4 at the URL above.

#### BTW, ACOG's shoulder dystocia video is a tacit ACOG admission
that
they know that obstetricians are ROUTINELY closing birth canals the
"extra" up to 30%. Why else would it be necessary for ACOG to make a
video about how to allow the birth canal to open maximally when
shoulders get stuck?

#### ANY OBSTETRICIANS READING? If you weren't taught that
semisitting
and dorsal CLOSE - you need to contact your medical school and demand
a
change. I should not be the only one protesting.

and
they don't see a labour not progressing on the back and then things go
well
when the women moves.

#### ???

I think they honestly believe they are helping by
making interventions available,

#### They ARE helping "by making interventions available" - when their
interventions are NECESSARY. They are NOT however helping when they
create a false need for their interventions by closing birth canals
the
"extra" up to 30%.

DEAD INFECTED WOMEN

##### Anne forgot to mention dead infected women...

#### Anne wrote:

knowing what large numbers of women died in
the past, problem is we forget why they died and in the main it was
bleeding
and infection, not stuck babies.

snip

#### Dr. Ignaz Semmelweis is famous for suggesting that it was OBs
working on dead infected women then attending births without washing
their hands that was causing the greatly increased mortality.

BEGIN excerpt of I ain't no Semmelweis, but...
http://health.groups.yahoo.com/group...t/message/2591

AM I BEING *UNREASONABLY* MONOMANIACAL ABOUT STOPPING OBs FROM CLOSING
BIRTH CANALS?

#### Dr. Richard Horton, editor of The Lancet writes of Semmelweis
being monomaniacal:

"There is nothing wrong with being monomaniacal."
http://www.nybooks.com/articles/17009

#### Dr. Ignac Semmelweis called obstetricians "murderers" because
they
went straight
from dissecting dead people to putting their hands in the vaginas of
mothers
giving birth - without washing their hands...

#### In large part because obstetricians refused to wash their hands,
as many as 60
times more women were dying in hospitals than at home.

#### Semmelweis was considered a "crackpot" for protesting - for
urging
obstetricians
to simply wash their hands in a chloride solution between working on
dead
patients and live patients.

#### Horton quotes the respected medical historian Owsei Temkin:

"The vision of a genius needs a certain single-mindedness to cut
through the
bewildering, contradictory evidence of contemporary life; it needs a
compulsion
to follow the vision and thus comes perilously close to the monomania
of the
crackpot. Semmelweis called the obstetricians who disregarded his work
murderers. To them in turn his zeal must have appeared that of a
fanatic."
http://www.nybooks.com/articles/17009

Excerpted from I ain't no Semmelweis, but...
http://health.groups.yahoo.com/group...t/message/2591

#### Thanks for reading everyone.

#### Sincerely,

#### Todd

#### Dr. Gastaldo
#### Hillsboro, Oregon
#### USA
####


END excerpt Semmelweis vs. Anne Rogers (also: 'Sledging Ericka')
http://groups.google.com/group/sci.m...9b77995fe25481

The shoulder dystocia concern is indeed genuine - but it may have been
inflated by the OB practice of keeping birth canals closed the "extra"
up to 30% when babies get stuck.

This post will be archived for global access in the Google usenet
archive. Search http://groups.google.com for "Baby size: 'The
shoulder dystocia concern is genuine.'"

Anne Rogers wrote:
But she didn't screen positive. She screened negative
(even a bit low).

I realise this, but it was a screen at 26 weeks, which is pretty early to
screen when 4 of the implicated hormones peak at 26-28 weeks and the 5th at
around 32 weeks. I can't find any figures on number of GD cases that occur
after that 32 week peak, but they do happen. But with screening on the low
side, it would be a bit of surprise if it suddenly it flipped over the
threshold.

But also ask yourself how important this is. Those
hormones perform a function--they're making nutrition more
available to the fetus. It's just that in some women, probably
those who are at risk for glucose metabolism issues when
not pregnant, it goes a bit over the top (with, of course,
all sorts of controversy over where the cutoffs should be
for diagnosing a problem anyway). Any problems that might
exist don't just come from the diagnosis. They come from
the baby being exposed to excess glucose, with exposure
in the *first* trimester being most problematic, and
complications getting less serious as time goes by. So,
to begin with, *if* she has GD, the baby has been exposed
to excess glucose for a short amount of time at a stage
when it is least concerning. So, one could wonder the
utility of a diagnosis *even if* she had GD. Obviously,
the likelihood is not so high that any body recommends a
second screening at 32 weeks just in case that's what puts
a woman over the edge. The *ONLY* "evidence" here is a
suspected *slightly* large baby, and there's nothing out there
suggesting that at this stage, that's accurate or warrants
testing or intervention.

Of course it's all pretty irrelevant as everything points to not screening
positive, I'm just trying to figure out helpful things to talk to the doctor
about if it comes back positive, with all the facts in front of them,
knowing what the pregnancy gap is, what screening was done previously and so
on, it may be that the doctor would come to the conclusion that GD was
reasonably likely in the previous pregnancies and that the outcomes were
good, so no reason for excessive concern before 40 weeks here. Of course the
opposite may occur and the doctor may freak out that it was not spotted and
that it was luck not judgement that everything went fine!

Sadly, I suspect that the latter was more likely than
the former. I think she's between a rock and a hard place.
Clearly the doctor is on the interventionist end with this
issue, and in that situation, there isn't really a good outcome
scenario. If she refuses the test, the doctor will be on a
hair trigger for interventions in labor, suspecting a large
baby (and if she goes past her due date, she'll likely get
pushed toward induction/c-section). If she tests positive,
the intervention push will start for early induction or
c-section. One might like to think that a negative test
will help, but frankly, all that will do is maybe take away
a fear of the neonatal hypoglycemia. The doctor will still
think there's a large baby in there, and that's what most of
GD complications are attributed to anyway. So, there will
still be the push for intervention and the judgments during
labor that every little thing that doesn't go exactly by
the book means that there's a problem because the baby is
too large.

I wonder if they will ever increase the threshold for macrosomia, or at
least modify it to take into account maternal (and paternal) race and some
kind of factor for maternal health. It seems an awful lot of my friends have
been producing first babies above the 4kg threshold,

They already know that most macrosomic babies are
born to women without GD. That doesn't faze them in the
least. If they up the threshhold, it will just dilute
the concerns with GD.

but they are white,
middle class, educated, healthy and it would seem an entirely normal thing
for them to do. Doing similar things for picking out small babies has been
very helpful in some parts of the UK, instead of plotting measurements on a
standard centile chart, a personalised chart is produced (I think they call
them GROW charts), based on many factors. The results are very promising,
less still births due to ones not spotted and less unnecessary inductions.
But one of the foundations underlying the usage of such charts is that they
are not looking for big babies, only small ones. Overall though, I get the
impression there is much less concern about large size babies in the UK,
probably the difference in litigation culture. On the other hand, maybe such
a tool would be largely irrelevant, because it seems to me, that whilst any
tool that can get a reasonable sucess rate for shoulder dystocia would be a
Good Thing, that though it is size linked, the link isn't strong enough that
having a size for that person rather than a size for general population
would help much, or maybe it would, if it was predictated that a baby was
above 90th (or whatever) centile for the expected size for that person it
might have a stronger predictive value than just above that centile in the
general population. However, I suspect such a tool could be dangerous as it
could actually start picking out more large babies in women who previously
were deemed to be having normal size babies and when they'd previously been
left unhindered and having sucessful deliveries, then falling into the
caregiver anxiety you described earlier. It's a tricky one, I just can't see
any tool for SD prediction not involving size, but any concern about size
seems to be collecting an awful lot more people to be worried about than
seems really necessary.

I think they're a long way from having any tool that
will have any great specificity with shoulder dystocia. There
are some formulae that take into account the ratio between the
mother's size and the baby's size, but frankly, all of that is
suspect as well until they can better estimate fetal size/weight.
When you can easily be a pound off, it matters a *lot* in the
accuracy of any of these calculations.

Thinking back to the original case, induction for GD is highly
controversial, though with the doctor feeling the need to find out, it
sounds like he'd be in the camp for inducing at some point! The shoulder
dystocia concern is genuine, it roughly triples for GD mothers compared to
non GD mothers with the same weight babies (actual not predicted),

That actual vs. predicted is a very big deal...especially
since late term u/s tends to overestimate.

but the
ACOG is only suggesting the c-section be considered for babies predicted to
be over 4500g to diabetic mother (5000g for non diabetic mothers) and the
predicted weight at this stage would appear to point to in the 4000-4500g
range, not above that.

Ultimately for me the question is why did the care providers scan at 37
weeks, it's told them nothing, that weight appears to me to be entirely
consistent with previous history. If you're going for interventionalist
care, it would seem more logical in the light of previous biggish babies to
redo the GD screen at 32 weeks as then if it was a rare case of late onset
GD at least you have time to deal with it, because if you're going to screen
for it, you're going to treat it.

Why? Where is there any evidence that re-screening at
32 weeks is beneficial for women? If one hormone is peaking
then, the other *four* are on their way down by then. There's
precious little evidence that screening *earlier* helps when
compared with high quality, low intervention care (i.e., including
good nutritional information, good diet, better labor management).
It's hard to imagine that a second round of screening would
make the grade when the first round barely does (or doesn't,
depending on your interpretation ;-) ).

It's just yet another example of an apparently "risk free" test, suddenly
throwing everything into disarray, I mean what were they expecting to find,
that suddenly, out of the blue, JP's having an average rather than a large
baby? Yet on finding what it would make sense to expect to find, panic
follows! I know the research points to routine scanning not improving
outcomes, but I wonder about late scanning, maybe that harms outcomes!

Early scanning may have some harmful impacts as well.
People just can't distinguish them from the background noise
caused by an unnecessarily interventionist system.

Best wishes,
Ericka