The beauty of this relationship between hemoglobin and glucose is that it's a firm interaction- meaning that it reflects how well the diabetes has been in control for a long time, usually months. So a normal HbA1c in the first trimester will be a very reassuring test for a pregnant diabetic patient. And the risk of congenital abnormalities and miscarriage is directly related to how abnormally high the HbA1c is. But even with good control preconception and during the first trimester, the two natural enemies, pregnancy and diabetes, begin to fight it out. The very thing that can cause that normal variation known as GDM can make insulin-dependent diabetes harder to manage, too, by driving up the insulin needs.
Large babies make for more difficult vaginal deliveries.
Since the C-section rate is higher in diabetic patients for all of the above reasons, it's important to know that Cesarean delivery is not the perfect answer to a pregnant diabetic's problems. Diabetic women don't heal well after surgery and their chances of infection are much greater. In spite of all of these concerns, a woman whose sugars are well controlled can stack the deck in her favor, especially if she is evaluated preconception. But diabetes is a definite problem in pregnancy that requires diligence on the part of the obstetrician and strict compliance on the part of the patient. Copyright Y2K Gerard M. DiLeo, M.D., F.A.C.O.G .