The Timing of Delivery in Diabetic Pregnancy: A 10‐Year Review

Abstract

The approach of term in the pregnancy of a diabetic woman is a time of anxiety for patient and physician alike. The impact of a conservative approach to the timing of delivery is outlined in this review of the clinical course and outcome of 276 pregnancies of diabetic women, delivered at the National Maternity Hospital, Dublin between 1981 and 1990. The mean gestation at delivery was 39 weeks, 229 patients (83%) delivered at or beyond 38 weeks and 112 patients (41%) delivered at or beyond 40 weeks. The overall induction of labour rate was 27% and the elective Caesarean section rate was 19%. Sixty seven percent of patients achieved a normal delivery, the forceps rate was 5%, and 28% of patients were delivered by Caesarean section. There were 16 perinatal deaths in the series, with 7 due to lethal malformations. There were 5 deaths of normally formed infants occurring at or beyond 38 weeks' gestation. All of these 5 deaths had been preceded by clinically apparent polyhydramnios or macrosomia and recognized poor control. This study stresses the value of strict diabetic control in the management of diabetic pregnancy and highlights the significance of polyhydramnios and macrosomia as indicators of risk approaching term in diabetic pregnancy.

Prevalence of polyhydramnios in the third trimester in a population screened by first and second trimester ultrasonography

“…The establishment of prepregnancy counselling, and combined specialist diabetic antenatal clinics has had a positive impact on the management of pregnancies complicated by diabetes. It has also been reported that the severity of antenatal fetal complications decreases as glycaemic control is improved [11,35,36]. The small size of the current study limits any firm conclusions, but supports previously published work.…”

Antenatal management of gestational diabetes mellitus can improve neonatal outcomes

“…The GDM management guidelines from the Australasian Diabetes In Pregnancy Society (ADIPS), which is endorsed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), state that "childbirth before full term is not indicated unless there is evidence of macrosomia, polyhydramnios, poor metabolic control or other obstetric indications" (Rasmussen et al, 1992;Hoffman et al, 1998). Thus, induction of labour may be considered 'elective' (i.e.…”

Factors affecting fetal weight distribution in women with type I diabetes

“…A very big baby may reflect diabetic fetopathy and fetal hyperinsulinaemia, and hence may indicate a baby at risk in utero of hypoxia and acidosis 1,2 . All six late pregnancy stillbirths reported in one study were macrosomic with polyhydramnios 3 . A review of national data from Sweden found four ‘unexplained’ intrauterine deaths at > 34 weeks.…”