Timing of delivery in women with diabetes: A population‐based study

Abstract

Introduction Women with diabetes, and their infants, have an increased risk of adverse events due to excess fetal growth. Earlier delivery, when fetuses are smaller, may reduce these risks. This study aimed to evaluate the week‐specific risks of maternal and neonatal morbidity/mortality to assist with obstetrical decision making. Material and methods In this population‐based cohort study, women with type 1 diabetes (n = 5889), type 2 diabetes (n = 9422) and gestational diabetes (n = 138 917) and a comparison group without diabetes (n = 2 553 243) who delivered a singleton infant at ≥36 completed weeks of gestation between 2004 and 2014 were identified from the Canadian Institute of Health Information Discharge Abstract Database. Multivariate logistic regression was used to determine the week‐specific rates of severe maternal and neonatal morbidity/mortality among women delivered iatrogenically vs those undergoing expectant management. Results For all women, the absolute risk of severe maternal morbidity/mortality was low, typically impacting less than 1% of women, and there was no significant difference in gestational age‐specific severe maternal morbidity/mortality between iatrogenic delivery and expectant management among women with any form of diabetes. Among women with gestational diabetes, iatrogenic delivery was associated with an increased risk of neonatal morbidity/mortality compared with expectant management at 36 and 37 weeks’ gestation (76.7 and 27.8 excess cases per 1000 deliveries, respectively) and a lower risk of neonatal morbidity/mortality at 38, 39 and 40 weeks’ gestation (7.9, 27.3 and 15.9 fewer cases per 1000 deliveries, respectively). Increased risks of severe neonatal morbidity following iatrogenic delivery compared with expectant management were also observed for women with type 1 diabetes at 36 (98.3 excess cases per 1000 deliveries) and 37 weeks’ gestation (44.5 excess cases per 1000 deliveries) and for women with type 2 diabetes at 36 weeks’ gestation (77.9 excess cases per 1000 deliveries) weeks. Conclusions The clinical decision regarding timing of delivery is complex and contingent on maternal‐fetal wellbeing, including adequate glycemic control. This study suggests that delivery at 38, 39 or 40 weeks’ gestation may optimize neonatal outcomes among women with diabetes.

Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol

“…Given that neonatal morbidity did not appear to be higher at 39 weeks as compared with 40 weeks, the authors suggested that 39 weeks may be the best timing There is insufficient evidence on timing of delivery for women with pregestational diabetes. A recent populationbased study [33] further supported delivery at 38, 39, or 40 weeks of gestation for women with diabetes. The authors found no maternal benefit and little or no additional neonatal benefit for scheduled delivery at 39 rather than 38 weeks of gestation for women with type 1 or type 2 diabetes.…”

“…One more strength is the fact that we analyzed both maternal and infant complications. This is particularly important, as often, in obstetric decision-making benefits for the infant may increase the chance of harm to the mother, and vice versa [33].…”

Состояние Плода И Новорожденных, Родившихся От Беременных С Сахарным Диабетом 1-Го Типа, В Зависимости От Вида Анестезии При Операции Кесарева Сечения

“…Важным фактором, определяющим состояние новорожденных, является оперативное родоразрешение и метод анестезиологического обеспечения. Неблагоприятное влияние компонентов различных методов анестезии на гомеостаз беременной, различная эффективность по купированию операционного стресса и влияние на углеводный обмен диктуют необходимость исследования данной медицинской проблемы с целю определения оптимального метода анестезии, обеспечивающего наиболее благоприятные условия для сохранения здоровья новорожденных при операции кесарева сечения у беременных с сахарным диабетом 1-го типа [2,3,8].…”

Predictors of a successful vaginal delivery in women with type 1 diabetes: a retrospective analysis of 20 years

“…Nowadays, due to new treatment options and substantially improved diabetic control there is a continuous increase of women with type 1 diabetes getting pregnant, reaching term and delivering healthy newborns. Although complications decreased, C-Sections (CS) rates remain high, exceeding 60% [1][2][3][4][5]. As a vaginal delivery is the most desired birth experience in the vast majority of women, this obvious disproportion compared to healthy non-diabetic women is extremely relevant.…”

“…Worldwide guidelines for women with pregestational diabetes recommend delivery at 38 to 40 weeks of gestation to prevent the risk of macrosomia and still birth. This management results in a high number of women who undergo induction of labor (IOL) [ 1 , 4 ]. IOL is controversially discussed as a potential risk factor for emergency CSs [ 16 , 17 ].…”