In a nutshell
This article investigated whether the induction of labor (IOL) in mothers with gestational diabetes (GDM) at term decreases cesarean section (CS) rate and the rate of adverse neonatal outcomes compared with expectant management (EM).
The authors concluded that IOL in GDM mothers at term does not reduce CS rate and is associated with an increased risk of adverse neonatal outcomes.
Some background
GDM develops in women during pregnancy because the mother's body is not able to produce enough insulin. This puts both the baby and mother at risk during pregnancy and delivery. Currently, IOL after 37-38 weeks is done if the risks of continuing the pregnancy are greater than the risks of pre-term delivery (having the baby before term). It is not known whether IOL is better than EM in terms of safety.
Methods & findings
The study involved 2472 mothers with GDM having a singleton (one baby) pregnancy. The main outcomes measured were CS rate and adverse neonatal outcomes. There were two groups. Group 1 had IOL between weeks 37 and 40 of pregnancy. Group 2 had EM.
The CS rate was not significantly different between the two groups. IOL at 37 weeks was associated with adverse neonatal outcomes. Group 1 were 2.2 times more likely to have adverse neonatal outcomes and 2.5 times more likely to have their babies admitted to NICU (neonatal intensive care unit) if they had IOL at 37 weeks. Patients in group 1 were twice as likely to have their babies admitted to NICU if they had IOL at 38 weeks. Their babies were more likely to have fractured clavicles with IOL at 39 weeks.
The bottom line
The authors concluded that IOL in GDM mothers at term does not reduce CS rate and is associated with an increased risk of adverse neonatal outcomes.
The fine print
This study was based on medical records. Some information such as blood glucose control or body mass index were missing. This might have influenced the results.
Published By :
Archives of Gynecology and Obstetrics
Date :
May 07, 2019
