Every obstetrician should evaluate their pregnant patients for gestational diabetes Gestational diabetes is a form of insulin resistance that develops in a pregnant person during pregnancy. Gestational diabetes can increase the risk of complications of pregnancy. These complications could threaten the life of the fetus or newborn. Gestational diabetes also increases the risk of harm to the pregnant patient.
Doctors are expected to screen all pregnant patients for gestational diabetes between 24 and 28 weeks of pregnancy. During this period of gestation, blood tests are more likely to detect elevated levels of glucose. However, doctors should identify those patients at increased risk for gestational diabetes, as these patients may need screening earlier in pregnancy. Risk factors which may require early screening for gestational diabetes include obesity, a history of gestational diabetes with prior pregnancies, and a family history of gestational diabetes.
Once a pregnant person is diagnosed with gestational diabetes, their doctor or other health care provider should take steps to control the pregnant patient’s glucose levels. Management strategies typically include dietary counseling, exercise or medication such as insulin. It is also essential that doctors perform ongoing monitoring of the patient to determine whether the changes to diet or medications are helping to control glucose levels.
Gestational Diabetes and Harm to the Newborn – Failure to diagnose large for gestational age newborn or fetal macrosomia
The American College of Obstetrics and Gynecologists (ACOG) recommends fetal surveillance at 32 weeks of gestation for pregnancies complicated by gestational diabetes. The type of testing used to evaluate the fetus might vary depending on the doctor, hospital or practice in the local medical community. However, the goal of most testing is to diagnose conditions which threaten the health of the fetus in utero or which could pose a threat of injury to the baby at the time of delivery.
Conditions which can threaten harm to the fetus or newborn include large for gestational age status and macrosomia. A newborn is large for gestational age when their weight is at or above the 90% percentile for their gestational age. A fetus with macrosomia weighs greater than or equal to 4500 grams, regardless of the gestational age.
Regrettably, large for gestational age status and macrosomia can increase the chances of trauma or distress at the time of birth, including a condition known as shoulder dystocia. During shoulder dystocia, the baby’s shoulder is stuck within the mother’s pelvis at the time of delivery. Because of the increased risk of harm to the baby at birth, it is crucial for doctors to identify babies at risk of shoulder dystocia before delivery so the mother can be offered the option of having a C-section and avoid the risks associated with delivering a large for gestational age baby.
Babies large for gestational age or with macrosomia are also at increased risk of respiratory distress, hypoglycemia (low blood sugar), and preterm birth.
The failure to properly diagnose and manage large for gestational age status or fetal macrosomia can arise in the following situations:
- Failure to screen for gestational diabetes
- Failure to estimate fetal weight
- Failure to recommend cesarean section (C-Section) for a known risk of shoulder dystocia
- Failure to diagnose and treat neonatal hypoglycemia
- Failure to properly plan for and manage resuscitation of a newborn born in distress.
When a family is challenged by injuries to a newborn related to conditions like gestational diabetes, the law firm of Lupetin & Unatin can help. Our lawyers have the knowledge and experience to complete a thorough investigation of prenatal and postnatal care and uncover missteps which may have increased the risk of harm to the baby. If you or a loved one is coping with the aftermath of an injury to a newborn which you think may be related to malpractice, please contact our offices for a free consultation.
