Labour in women with gestational diabetes mellitus

Abstract

Objectives: Gestational diabetes mellitus (GDM) constitutes one of the most common pregnancy complications and affects 3-5% of all pregnancies, with its incidence still growing. Due to possible maternal and fetal complications, the peripartum management of GDM patients continues to be a debatable issue. The aim of the study was to analyse the course and final way of delivery in women with gestational diabetes mellitus. The effectiveness of induction of labour (IOL) was also assessed and factors predisposing to cesarean section were identified. Material and methods:The study group consisted of 204 women with GDM who delivered in the Academic Centre for Woman's and Neonate's Health in Warsaw over the years 2013 and 2014. The indications and ratios of elective and intrapartum cesarean sections were analysed. Patients qualified for induction of labour were compared depending on their final way of delivery. Results:Over a half of all deliveries in the study group (53%) were cesarean sections. Elective surgeries accounted for 70% of all cesarean sections, predominantly due to a history of previous operational deliveries. Only 12% of the study group developed spontaneous uterine contractions and delivered vaginally. A comparison of the vaginal delivery group (n = 96) with cesarean section group (n = 108) pointed to high pregestational BMI value and advanced maternal age as factors increasing the patient's risk for surgical delivery (p = 0.0000 and p = 0.048 accordingly). The comparison of women undergoing IOL vs. omen with spontaneous uterine contractions showed no increase in the ratio of intrapartum cesarean sections in the IOL group -in both subgroups vaginal delivery was achieved in 75% of cases. Conclusions:Patients with GDM are more likely to undergo cesarean section, but the implementation of induction of labour at term does not further aggravate this risk. Major risk factors for operational delivery in GDM population included: advanced maternal age, high pregestational BMI value and undergoing insulin therapy.

Association between intrahepatic cholestasis in pregnancy and gestational diabetes mellitus. A retrospective analysis

“…Preterm delivery increases rate of cesarean sections. As other studies show GDM increases risk of CC instead of vaginal delivery in comparison to general population of pregnant women [16][17][18]. In our study the incidence of CC was over 70% percent in both studied groups.…”

A systematic scoping review of clinical indications for induction of labour

“…This study concluded that, in the absence of signs of fetal distress or macrosomia, planned early birth was not indicated. Similarly, Grabowska et al [149] compared CS rates for 96 women who underwent IOL with 32 women who had a spontaneous labour and found that IOL did not increase the risk of CS (25% versus 25%, p = 0.66). A cohort study by Melamed [150] compared outcomes associated with IOL at 38 or 39 weeks and EM for 6417 women with GDM, and found that IOL at 38 or 39 weeks was associated with a lower CS rates but higher risk of NICU admission, when done at <39 weeks gestation.…”

“…Nine studies in relation to diabetes were included, consisting of two Cochrane reviews [9,145], a secondary analysis of a trial that compared different treatments for mild gestational diabetes mellitus (GDM) [146] and six retrospective cohort studies [147][148][149][150][151][152]. With the exception of one study [145], all evaluated women with GDM, and excluded those with type I or II diabetes.…”

“…There were four retrospective cohort studies that compared outcomes for women with GDM who underwent IOL versus EM, with CS rates as a primary outcome [147,[149][150][151]. A retrospective cohort study by Bettikher et al [147] that compared outcomes for IOL (gestation not stated) in 43 women with EM until spontaneous labour in 188 women, found no significant difference between the two groups in terms of CS rate, or any of the other maternal or neonatal outcomes assessed (i.e.…”

IL16 and IL18 gene polymorphisms in women with gestational diabetes

“…The important risk factors of GDM include advanced maternal age, obesity and a family history of type 2 diabetes (T2DM) [1,2]. This disorder is associated with several maternal and neonatal metabolic and cardiovascular complications [3,4]. Recent studies suggest that genetic factors play important role in pathogenesis of GDM [5].…”