When to Deliver Women with Diabetes in Pregnancy?

Abstract

The prevalence of pregestational diabetes and the incidence of gestational diabetes have both increased over recent years. One component of the management of diabetes in pregnancy is the timing of delivery in the late-preterm, early-term, or full-term periods. Recent guidance from the National Institute for Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists has lacked specificity, for example, recommending delivery for women with pregestational diabetes with poorly controlled glucose levels to be from 34 to 39 weeks' gestation. This lack of specificity is predominant because of the large holes in existing data to guide clinical practice. This article reviews existing literature regarding diabetes in pregnancy and attempts to give an analytical framework and some clearer guidance around the timing of delivery.

Keywords

diabetes - pregnancy - term - timing - induction

• References

• 1 Vandorsten JP, Dodson WC, Espeland MA , et al. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements 2013; 29 (1) 1-31
• 2 DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis 2014; 11: E104
• 3 Peterson C, Grosse SD, Li R , et al. Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States. Am J Obstet Gynecol 2015; 212 (1) 74.e1-74.e9
• 4 Galerneau F, Inzucchi SE. Diabetes mellitus in pregnancy. Obstet Gynecol Clin North Am 2004; 31 (4) 907-933 , xi–xii
• 5 Kekäläinen P, Juuti M, Walle T, Laatikainen T. Pregnancy planning in type 1 diabetic women improves glycemic control and pregnancy outcomes. J Matern Fetal Neonatal Med 2016; 29 (14) 2252-2258
• 6 Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS ; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352 (24) 2477-2486
• 7 Spong CY. Defining “term” pregnancy: recommendations from the Defining “Term” Pregnancy Workgroup. JAMA 2013; 309 (23) 2445-2446
• 8 Reddy UM, Bettegowda VR, Dias T, Yamada-Kushnir T, Ko CW, Willinger M. Term pregnancy: a period of heterogeneous risk for infant mortality. Obstet Gynecol 2011; 117 (6) 1279-1287
• 9 Reddy UM, Ko CW, Raju TN, Willinger M. Delivery indications at late-preterm gestations and infant mortality rates in the United States. Pediatrics 2009; 124 (1) 234-240
• 10 Tita AT, Landon MB, Spong CY , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009; 360 (2) 111-120
• 11 Hibbard JU, Wilkins I, Sun L , et al; Consortium on Safe Labor. Respiratory morbidity in late preterm births. JAMA 2010; 304 (4) 419-425
• 12 Cheng YW, Nicholson JM, Nakagawa S, Bruckner TA, Washington AE, Caughey AB. Perinatal outcomes in low-risk term pregnancies: do they differ by week of gestation?. Am J Obstet Gynecol 2008; 199 (4) 370.e1-370.e7
• 13 Clark SL, Miller DD, Belfort MA, Dildy GA, Frye DK, Meyers JA. Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol 2009; 200 (2) 156.e1-156.e4
• 14 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 561: nonmedically indicated early-term deliveries. Obstet Gynecol 2013; 121 (4) 911-915
• 15 Oshiro BT, Henry E, Wilson J, Branch DW, Varner MW ; Women and Newborn Clinical Integration Program. Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstet Gynecol 2009; 113 (4) 804-811
• 16 Clark SL, Frye DR, Meyers JA , et al. Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth. Am J Obstet Gynecol 2010; 203 (5) 449.e1-449.e6
• 17 Ehrenthal DB, Hoffman MK, Jiang X, Ostrum G. Neonatal outcomes after implementation of guidelines limiting elective delivery before 39 weeks of gestation. Obstet Gynecol 2011; 118 (5) 1047-1055
• 18 Smith GC. Life-table analysis of the risk of perinatal death at term and post term in singleton pregnancies. Am J Obstet Gynecol 2001; 184 (3) 489-496
• 19 Caughey AB, Stotland NE, Escobar GJ. What is the best measure of maternal complications of term pregnancy: ongoing pregnancies or pregnancies delivered?. Am J Obstet Gynecol 2003; 189 (4) 1047-1052
• 20 Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Caughey AB. Risk of stillbirth and infant death stratified by gestational age. Obstet Gynecol 2012; 120 (1) 76-82
• 21 Page JM, Snowden JM, Cheng YW, Doss AE, Rosenstein MG, Caughey AB. The risk of stillbirth and infant death by each additional week of expectant management stratified by maternal age. Am J Obstet Gynecol 2013; 209 (4) 375.e1-375.e7
• 22 Spong CY, Mercer BM, D'alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2 Pt 1): 323-333
• 23 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121 (4) 908-910
• 24 Coton SJ, Nazareth I, Petersen I. A cohort study of trends in the prevalence of pregestational diabetes in pregnancy recorded in UK general practice between 1995 and 2012. BMJ Open 2016; 6 (1) e009494
• 25 Sibai BM, Caritis S, Hauth J , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. Am J Obstet Gynecol 2000; 182 (2) 364-369
• 26 Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: a large, population-based study. Diabetes Care 2009; 32 (11) 2005-2009
• 27 Pilliod RA, Page JM, Burwick RM, Kaimal AJ, Cheng YW, Caughey AB. The risk of fetal death in nonanomalous pregnancies affected by polyhydramnios. Am J Obstet Gynecol 2015; 213 (3) 410.e1-410.e6
• 28 Niu B, Lee V, Cheng Y, Frias A, Nicholson J, Caughey AB. What is the optimal gestational age for women with diabetes mellitus type 1 (T1DM) to deliver?. Am J Obstet Gynecol 2014; 210: S172-S173
• 29 Rackham O, Paize F, Weindling AM. Cause of death in infants of women with pregestational diabetes mellitus and the relationship with glycemic control. Postgrad Med 2009; 121 (4) 26-32
• 30 Jensen DM, Damm P, Moelsted-Pedersen L , et al. Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care 2004; 27 (12) 2819-2823
• 31 Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Doss AE, Caughey AB. The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. Am J Obstet Gynecol 2012; 206 (4) 309.e1-309.e7
• 32 Niu B, Lee VR, Cheng YW, Frias AE, Nicholson JM, Caughey AB. What is the optimal gestational age for women with gestational diabetes type A1 to deliver?. Am J Obstet Gynecol 2014; 211 (4) 418.e1-418.e6
• 33 González-Quintero VH, Istwan NB, Rhea DJ , et al. The impact of glycemic control on neonatal outcome in singleton pregnancies complicated by gestational diabetes. Diabetes Care 2007; 30 (3) 467-470
• 34 Gyamfi-Bannerman C, Thom EA, Blackwell SC , et al; NICHD Maternal–Fetal Medicine Units Network. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016; 374 (14) 1311-1320
• 35 Gülmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2012; (6) CD004945
• 36 Caughey AB, Sundaram V, Kaimal AJ , et al. Systematic review: elective induction of labor versus expectant management of pregnancy. Ann Intern Med 2009; 151 (4) 252-263 , W53-63
• 37 Caughey AB, Nicholson JM, Cheng YW, Lyell DJ, Washington AE. Induction of labor and cesarean delivery by gestational age. Am J Obstet Gynecol 2006; 195 (3) 700-705
• 38 Stock SJ, Ferguson E, Duffy A, Ford I, Chalmers J, Norman JE. Outcomes of elective induction of labour compared with expectant management: population based study. BMJ 2012; 344: e2838
• 39 Darney BG, Snowden JM, Cheng YW , et al. Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes. Obstet Gynecol 2013; 122 (4) 761-769
• 40 Melamed N, Ray JG, Geary M , et al. Induction of labor before 40 weeks is associated with lower rate of cesarean delivery in women with gestational diabetes mellitus. Am J Obstet Gynecol 2016; 214 (3) 364.e1-364.e8
• 41 Kjos SL, Henry OA, Montoro M, Buchanan TA, Mestman JH. Insulin-requiring diabetes in pregnancy: a randomized trial of active induction of labor and expectant management. Am J Obstet Gynecol 1993; 169 (3) 611-615