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Delivery Timing and Cesarean Delivery Risk in Women with Mild Gestational Diabetes Mellitus

Citation

Sutton, Amelia L.; Mele, Lisa; Landon, Mark B.; Ramin, Susan M.; Varner, Michael W.; Thorp, John M., Jr.; Sciscione, Anthony C.; Catalano, Patrick M.; Harper, Margaret A.; & Saade, George R., et al. (2014). Delivery Timing and Cesarean Delivery Risk in Women with Mild Gestational Diabetes Mellitus. American Journal of Obstetrics & Gynecology, 211(3), 244.e1-7. PMCID: PMC4149809

Abstract

OBJECTIVE: To evaluate the relationship between gestational age (GA) and induction of labor (IOL) and the rate of cesarean delivery (CD) in women with mild gestational diabetes (GDM).
STUDY DESIGN: Secondary analysis of data from a multi-center RCT of mild GDM treatment. CD rate of women delivering at term (> 37 weeks) was evaluated using two complementary approaches: 1) IOL vs. spontaneous labor: women induced at each GA compared with those who spontaneously labored at the same GA, and 2) IOL vs. expectant management: women delivered after IOL at each GA compared with those delivering after spontaneous labor at the same GA or subsequently after spontaneous or induced labor (outcome at each week compared with expectant management at that week). Logistic regression adjusted for potential confounders.
RESULTS: The overall CD rate was 13%. When compared to 39 weeks (either IOL or spontaneous labor) as the referent, there was no significant difference in the CD rate in women delivered at 37, 38, or 40 weeks. However, IOL was associated with a 3-fold increase in CD rate at 41 weeks and beyond as compared with IOL at 39 weeks. Similarly, there was a 3-fold increase in CD rate in women who were induced when compared to those managed expectantly at 40 completed weeks.
CONCLUSIONS: Induction of labor in women with mild gestational diabetes mellitus (GDM) does not increase the rate of cesarean delivery prior to 40 weeks gestation.

URL

http://dx.doi.org/10.1016/j.ajog.2014.03.005

Reference Type

Journal Article

Year Published

2014

Journal Title

American Journal of Obstetrics & Gynecology

Author(s)

Sutton, Amelia L.
Mele, Lisa
Landon, Mark B.
Ramin, Susan M.
Varner, Michael W.
Thorp, John M., Jr.
Sciscione, Anthony C.
Catalano, Patrick M.
Harper, Margaret A.
Saade, George R.
Caritis, Steve N.
Sorokin, Yoram
Grobman, William A., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

PMCID

PMC4149809