GESTATIONAL DIABETES: MALPRACTICE DURING PREGNANCY

Gestational Diabetes Mellitus (GDM) is an intolerance of carbohydrates that appears during pregnancy.  In simpler terms, it is diabetes while being pregnant which can complicate child birth. The most common concern is the size of the child. Delivering large children can lead to a more difficult labor and delivery that can lead to shoulder dystocia or a brachial plexus injury.

A recent study using new diagnostic criteria found that 18% of pregnancies are affected by gestational diabetes, much higher than previous estimates of 1-14%.  Think about that. Almost one in five pregnant women. Doctors should be on the lookout. Still, misdiagnosis of gestational diabetes is all too common, carrying risks to both mother and fetus.  Children born to mothers with GDM may have excessive birth weights resulting in high rates of cesarian delivery which carries the risk of trauma to both mother and child.  Babies also have a risk of hypoglycemia (low blood sugar) and hyperinsulinemia (high blood insulin).  They are also at risk for glucose intolerance and long-term obesity.

Following pregnancy, women who have gestational diabetes have a 40 to 60% chance of developing diabetes in the following 10 to 20 years and an estimated 5 to 10% of women who have had GDM develop diabetes immediately following pregnancy.  Current practice has been under recent review to properly diagnose GDM, with a goal of increasing the proportion of women diagnosed.

Guidelines and Testing

Canadian healthcare guidelines suggest that HbA1c levels be ≤6.0% (normal), fasting blood glucose 3.8 to 5.2mmol/L, one hour post-prandial (post meal/glucose challenge) glucose of 5.5 to 7.7mmol/L and two hour post-prandial glucose of 5.0 to 6.6mmol/L.  Similar guidelines are used in the U.S., but do not normally - for whatever reason - include HbA1c targets.

A two-step approach (glucose challenge test + oral glucose tolerance test) is recommended by the American Diabetes Association to help prevent missed opportunities for diagnosis and is reported to increase diagnosis rates from 80% to 90% although at least many of the doctors defending other doctors in medical malpractice cases sometimes disagree.

Others have suggested that glucose testing at 16 weeks of pregnancy has a high predictive rate (up to 96%) to detect those women at risk of developing GDM during the third trimester.  Although there are additional costs associated with glucose challenge, due to the high rate of missed diagnoses of GDM, it may be best practice to test all women during pregnancy and not select those that should undergo a glucose challenge and OGTT based on risk factors.  This is further supported by a study in Belgium that found that over half of the cases of GDM were missed when only subjects with risk factors were tested.  Furthermore, testing during each trimester may be indicated to prevent missed diagnosis.

Who Is at Risk for Gestational Diabetes?

Any woman can get gestational diabetes. Doctors should not stereotype who may have it based on anything other than proper assessment, evaluation and testing.   A study published in 2005 found that in a group of 532 patientst tested for GDM without consideration of risk factors found that 47% of the women with GDM would have been missed if screened only based on risk factors. That said, women of Native-American/Aboriginal, Hispanic, South Asian, Asian and African descent are at increased risk.  Other risk factors include age, obesity, use of corticosteroids and polycystic ovary syndrome. 

Treating Gestational Diabetes

There are two types of gestational diabetes malpractice cases. The first is failing to realize the woman has gestational diabetes. The second is not properly treating the patient who has it. Doctors must monitor a woman with gestational diabetes to make sure the child is growing at the appropriate rate and that the woman's glucose levels are under control. Insulin shots are sometimes necessary to keep the diabetes under control so that it does not interfere with the pregnancy.

Malpractice Settlements and Lawsuits Involving Gestational Diabetes

Gestational diabetes is a challenge to a pregnancy. But with good care and treatment, it can usually be managed in such a way that mother and child emerge unharmed. If you believe you had gestational diabetes but were not properly diagnosed and treated and there is an injury to you or your baby, you may have a medical malpractice case for which you and your child could receive compensation. If you believe this was the case with you, call 800-553-8082 or get a free online consultation.