The Firm You Go to When the 
Stakes Are High

Gestational Diabetes During Pregnancy Increases Risk of Shoulder Dystocia & Erb’s Palsy


Excessive weight gain during pregnancy is a significant risk factor for gestational diabetes. It is a well-known aspect of prenatal care for obstetricians to advise their patients regarding weight gain, blood glucose (blood sugar) levels, diet, exercise and medical treatment for this condition. However, a recent study found that despite guidelines issued in 2009, few women report being counseled correctly about weight gain during pregnancy1.

Gestational diabetes starts when the mother’s body is not able to make and use all the insulin it needs during the pregnancy. Without enough insulin, glucose cannot leave the mother’s blood and be changed to energy, and thus glucose builds up in her blood to high levels. This is called hyperglycemia. The extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby’s pancreas to make extra insulin to process the extra blood glucose. Since the baby is getting more energy (glucose) than it needs to grow and develop, the extra energy is stored as fat.

This extra fat can lead to a condition called macrosomia. Fetal macrosomia has been defined in several different ways, including birth weight of 4000-4500 g (8 lb 13 oz to 9 lb 15 oz) or greater than 90% for gestational age.

Babies with macrosomia face a risk of injury to their shoulders during birth if the delivery is not properly managed. This birth injury is caused by improper management of a condition called shoulder dystocia. Shoulder dystocia occurs when a baby’s shoulder becomes lodged behind a mother’s pubic bone during delivery.

Shoulder dystocia is an obstetrical emergency and must be quickly and appropriately treated by the obstetrician to enable the delivery of the baby’s shoulders and body without injuring the brachial plexus nerves.

The brachial plexus is a group of nerves near the shoulder that control movement to the arm and hand. When these nerves are damaged, weakness, numbness or full paralysis can ensue.

Erb’s palsy (also called brachial plexus palsy) is a birth injury that is caused by damage to these nerves. It typically affects the upper portion of the arm, and results from too much pressure and pulling on a baby’s head during delivery.

The rate of shoulder dystocia has increased over the past two decades2. Proper training in the management of this obstetrical emergency is critical to preventing birth injury.

A recent study found that the incidence of Erb’s palsy were significantly decreased when a hospital put in place a shoulder dystocia training program3. The program involved in the study included training regarding the risk factors (including gestational diabetes), early recognition, and proper management of shoulder dystocia. It also included mandatory, individual hands-on simulated shoulder dystocia training, including repeat training sessions for physicians whose performance in the training was unsatisfactory. This study shows that Erb’s palsy can be avoided by proper training of health care providers, including the assessment and treatment of risk factors such as gestational diabetes and proper management during delivery.

Other risks faced by a macrosomic baby include brain damage due to hypoxia (decreased oxygen supply) during a difficult or prolonged labor and delivery. Proper assessment, counseling and treatment of gestational diabetes can significantly reduce these risks of injury.

Therefore, throughout pregnancy obstetricians have a continuing role in the prevention and treatment of gestational diabetes and its associated risks to the baby. First, gestational diabetes must be timely diagnosed with periodic prenatal testing. Once a diagnosis of gestational diabetes is made, the condition must be treated in such a way as to keep the blood glucose under control to prevent macrosomia from developing. Should the baby become macrosomic, proper planning for the delivery must be undertaken, including an assessment of whether the mother’s pelvis can accommodate delivery of the baby. In some cases a primary caesarian section may be indicated. If a vaginal delivery is attempted, the baby must be closely monitored for signs of shoulder dystocia, fetal distress and hypoxia. If signs of these conditions arise, they must be properly and promptly addressed to avoid damage to the brachial plexus nerves or injury to the baby’s brain.

ATTENTION: If you had gestational diabetes during pregnancy that was not kept under control, and your baby has been diagnosed with brachial plexus injury, Erb’s palsy, or brain damage, you may have legal recourse to compensate your child for those injuries. For a free consultation with the medical malpractice lawyers at Levy Konigsberg LLP please call our 24/7 toll-free hotline at (800) 315-3806 or submit an email inquiry.

1 McDonald SD, et al. American Journal of Obstetrics & Gynecology, 205:333.e1-6 (October 2011);
2 Dandolu V., Lawrence L., Gaughan J.P., et al. Journal of Maternal-Fetal and Neonatal Medicine, 18.305-310. 2005;
3 Inglis SR, Feier N, et al. American Journal of Obstetrics & Gynecology, 204:322.e1-6 (2011).



Find out whether you have a case by speaking to one of our experienced lawyers via our 24/7 toll-free hotline or by submitting an email inquiry. Our attorneys will be quick to respond to you and happy to answer all of your questions.

Know the Difference

Committed to Doing What's Right
  • Over $3 Billion Won

    We have represented numerous individuals and groups of workers, winning for them multi-million-dollar settlements and verdicts.

  • There's No Case Too Big

    Our team has achieved groundbreaking victories in highly complex cases and has gone up against some of the toughest defendants in the country.

  • Trial Attorneys

    Our attorneys excel in the courtroom and are not afraid to bring a case in front of a jury if a fair settlement for the client has not been reached.

  • A Thought Leader in the Industry

    Our firm's knowledge and experience are in high demand, and many news outlets have asked us to share our legal expertise.

  • Access to World Class Resources

    Our experienced attorneys use cutting-edge technology and highly regarded experts to help us achieve the best possible result for our clients.

  • Changing the World for Good

    We not only want to achieve the best possible results for our clients, but we also strive to prevent future harm by changing public health policies.

Thousands of Clients Helped

Hear What They Have to Say
  • Professional, responsive and very good at their jobs.

    “From the first visit to my home, to my last visit to the office to collect my settlement, I was very happy with the services provided by this firm. They are professional, very responsive and very good ...”

    - Lisa Ross
  • They have truly gone above and beyond.

    “I have been beyond pleased how Levy Konigsberg is handling my matter. They answer my questions in a timely matter and when warranted, ease my worries and concerns. They have truly gone above and ...”

    - Anne Fahey
  • I put my Faith and Trust into Corey Stern!

    “Selecting a Law firm to represent me was one of the biggest decisions I've had to make in my life. I put my Faith and Trust into Corey Stern, and he exceeded all my expectations.”

    - Dennis McGowan
  • With this team on my side we came out on top.

    “Levy Konigsberg and team are a group of men and women that give their all, down to the receptionist. I had a case that was almost unbeatable but with this team on my side we came out on top. They keep ...”

    - Angie Garrido
  • Very happy with our settlement.

    “My husband and I were VERY happy with our experience with this firm. They were always caring and really helped us go through this in a very hard time in our lives .We continue to be in touch with the ...”

    - Lori Rosa
  • Wow is all I can say.

    “It has been a few years now but I needed to post this. My dad suffered so much from Mesothelioma. My brother looked into the law and our rights. Unfortunately he died also before anything was done. It ...”

    - Carol N.
  • Their dedication to receive the highest results for their clients was amazing.

    “Working with Levy Koningsberg LLP was a very positive experience. Their professionalism and curiosity was outstanding. I was a pleasure working with this firm. Their dedication to receive the highest ...”

    - Emily DeRogatis
  • Such a great team!

    “The whole team at Levy, Konigsberg LLP have been extremely professional and kind during our most difficult time. They keep you informed during the process, check in often asking if there are any ...”

    - Kevin Kober
  • We definitely got the right law firm!

    “Levy Konigsberg represented my daughter Linda, who was diagnosed with mesothelioma at 16 years old. She endured many surgeries and chemotherapy including HIPEC. She traveled the country seeking ...”

    - Mark Wells
  • Levy Konigsberg continued to help my family fight for the justice my father deserves.

    “Levy Konigsberg was there for my father as soon as he was diagnosed with mesothelioma they helped him get medical treatment in another state that specializes in his condition and even provided housing ...”

    - Stephanie Vitale


Start with a FREE Consultation
  • Please enter your first name.
  • Please enter your last name.
  • Please enter your phone number.
    This isn't a valid phone number.
  • Please enter your email address.
    This isn't a valid email address.
  • Please make a selection.
  • Please enter a message.