How to manage type 1 diabetes during 24th week of gestation?

Hello doctor,

My 29‑year‑old daughter has had type 1 diabetes since age 12, and she is having trouble managing it during pregnancy. She is 24 weeks pregnant, and her A1C increased to 8.2 percent despite being on an insulin pump. Her endocrinologist increased her basal rates, but she is still getting high readings, especially after meals. She had severe morning sickness in the first trimester, which made blood sugar control even more difficult.

Her diabetic retinopathy worsened during pregnancy, and her eye doctor performed laser treatment last month. She also developed diabetic gastroparesis, accompanied by constant nausea and vomiting, which has made it impossible to count her carbohydrate intake properly. Kidney function tests showed microalbumin at 45, which is concerning.

The doctor said the baby is measuring large for gestational age and wants to deliver early. She has gained only 8 pounds so far because of the gastroparesis, but the baby’s weight is in the 90th percentile. Her blood pressure is also elevated at 145/90 mm of Hg, and there is protein in her urine. She is worried about preeclampsia in addition to diabetes complications.

1. What are the risks to the baby of poorly controlled diabetes?
2. Should she be hospitalized for better monitoring?

Please help.