Timing of delivery and pregnancy outcomes in women with gestational diabetes

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d8242848e127">Background</h5> <p id="P1">Women with gestational diabetes commonly undergo induction of labor at term, but the risks and benefits of induction of labor are incompletely understood. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d8242848e132">Objective</h5> <p id="P2">We examined the relationship between gestational age, induction of labor and the rate of cesarean delivery in women with gestational diabetes. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d8242848e137">Materials and Methods</h5> <p id="P3">We identified 863 women with gestational diabetes who underwent either induction of labor or spontaneous labor at or beyond 37 0/7 weeks. Demographic, cervical favorability and outcome data were abstracted from the medical record. We compared the cesarean delivery rate in women undergoing induction of labor at each week of gestation with expectant management to a later gestational age. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d8242848e142">Results</h5> <p id="P4">When compared to women who were expectantly managed, induction of labor at 37 weeks (aOR 1.53, 95% CI 0.76-3.06, p=0.23), 38 weeks (aOR 2.07, 95% CI 0.89-4.80, p=0.09) and 39 weeks (aOR 0.79, 95% CI 0.44-1.42, p=0.43)) was associated with similar risk for cesarean delivery as expectant management after adjustment for nulliparity, body mass index, baseline simplified Bishop score, and maternal age. Cesarean delivery rates were higher in nulliparous women, but did not differ significantly in those undergoing IOL or experctant management. In multiparous women, induction of labor was significantly associated with an increased risk for CD at 38 weeks (aOR 7.47, 95%CI 1.6-34.8, p=0.01) and rates of CD (17.39% vs. 2.2%, p=0.001) were significantly higher in multiparous women with an unfavorable Bishop score induced before 39 weeks. Neonatal morbidity was similar across gestational ages after adjustment for maternal body mass index and maternal glycemic control. </p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d8242848e147">Conclusion</h5> <p id="P5">Induction of labor results in similar risk for cesarean delivery as expectant management between 37 and 40 weels of gestation. Rates of cesarean delivery differed based on cervical exam and parity. These findings suggest that gestational age alone does not significantly impact maternal and neonatal outcomes, but that decisions regarding delivery in women with GDM should take into account cervical exam and parity. </p> </div>