second opinion

[expert on call]

I will try to be short, but will likely fail.

My wife is 38. She is 32 1/2 weeks with our fourth child. Dx with gestational diabetes 3 weeks ago. No previous diabetes. Sugars well controlled with diet; have never been over 120, average 95-100, and no insulin. BP fine at apprx 110/70 today at Dr. appt.

Daughter is 13 yrs, born on due date, 7# 3oz. Perfectly normal vaginal delivery.

First son is 4 yrs. Undiagnosed preeclampsia. My wife experienced severe swelling from at least 26 wks. At 37wks she had elevated blood pressure, a poor non-stress test and a C-section delivery. Our first son was 4# 06 with IUGR and in NICU for 10 days with slow weight gain. My wife had no milk.

Second son is 2 yrs. Different doctor from the first. No swelling until 33 weeks. Nothing significant until 36 weeks when water broke and slightly high BP. BP did elevate during vaginal delivery. He was 5# 14oz, in NICU for 10 days with poor self-warming. My wife again had no milk. Dr. said another pregnancy would not be a problem. Good chance of normal pregnancy.

Currently, OBGYN says not much we can do but hope for the best. Sonogram scheduled for next week. Will not do a non-stress unless small size.

Question: Should we be doing anything different? Get a second opinion? Keep praying? Lack of milk related to preeclampsia?

Thank you so much.

[expert on call]

I doubt that the lack of milk is related to preeclampsia.

She is now 32 weeks and is therefore beyond the risk of having a catastrophically preterm baby; infants born after 32 weeks generally do very well. If the baby is normally grown, then the prognosis is indeed very good. It does not mean that you will avoid preeclampsia, but if it developed it would be at a time that woud be manageable - IF identified promptly.

Weekly visits after 34 weeks are probably appropriate; NSTs if BP elevates of if there is IUGR.

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