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. 2000;2001(2):CD001997.
doi: 10.1002/14651858.CD001997.

Elective delivery in diabetic pregnant women

M Boulvain  1 , C Stan, O Irion
Affiliations

Elective delivery in diabetic pregnant women

M Boulvain et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: In pregnancies complicated by diabetes the major concerns during the third trimester are fetal distress and the potential for birth trauma associated with fetal macrosomia.

Objectives: The objective of this review was to assess the effect of a policy of elective delivery, as compared to expectant management, in term diabetic pregnant women, on maternal and perinatal mortality and morbidity.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (last searched July 1999).

Selection criteria: All available randomized controlled trials of elective delivery, either by induction of labour or by elective caesarean section, compared to expectant management in diabetic pregnant women at term.

Data collection and analysis: The reports of the only available trial were analysed independently by the three co-reviewers to retrieve data on maternal and perinatal outcomes. Results are expressed as relative risks (RR) and 95% confidence intervals (CI).

Main results: The participants in the one trial included in this review were 200 insulin-requiring diabetic women. Most had gestational diabetes, except 13 women with type 2 preexisting diabetes (class B). The trial compared a policy of active induction of labour at 38 completed weeks of pregnancy, to expectant management until 42 weeks. The risk of caesarean section was not statistically different between groups (RR 0.81, 95% CI 0.52 - 1.26). The risk of macrosomia was reduced in the active induction group (RR 0.56, 95%CI 0.32 - 0. 98) and 3 cases of mild shoulder dystocia were reported in the expectant management group. No other perinatal morbidity was reported.

Reviewer's conclusions: There is very little evidence to support either elective delivery or expectant management at term in pregnant women with insulin-requiring diabetes. Limited data from a single randomized controlled trial suggest that induction of labour in women with gestational diabetes treated with insulin reduces the risk of macrosomia. Although the small sample size does not permit one to draw conclusions, the risk of maternal or neonatal morbidity was not modified. Women's views on elective delivery and on prolonged surveillance and treatment with insulin should be assessed in future trials.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 1 Caesarean section.
1.6
1.6. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 6 Shoulder dystocia.
1.7
1.7. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 7 Birthweight > 4000 g (not prespecified).
1.8
1.8. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 8 Birthweight above or at the 90th percentile (not prespecified).
1.9
1.9. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 9 Fracture.
1.10
1.10. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 10 Brachial plexus injury.
1.11
1.11. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 11 Neonatal asphyxia.
1.12
1.12. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 12 Hypoglycaemia.
1.15
1.15. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 15 Perinatal mortality.
1.17
1.17. Analysis
Comparison 1 Induction of labour versus expectant management, Outcome 17 Caesarean section: subgroups (not prespecified).
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References

References to studies included in this review

Kjos 1993 {published data only}
    1. Henry OA, Kjos SL, Montoro M, Buchanan TA, Mestman JH. Randomized trial of elective induction vs expectant management in diabetics. American Journal of Obstetrics and Gynecology 1992;166:304. - PubMed
    1. 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. American Journal of Obstetrics and Gynecology 1993;169:611‐5. - PubMed

References to studies excluded from this review

Khojandi 1974 {published data only}
    1. Khojandi M, Tsai AY/M, Tyson JE. Gestational diabetes: the dilemma of delivery. Obstetrics & Gynecology 1974;43:1‐6. - PubMed

References to studies awaiting assessment

Ghosh 1979 {published data only}
    1. Ghosh S, Khakoo H, Pillari VT, Carmona RA, Rajegoda BK, Poliak A. Timing of delivery in rigidly controlled class B diabetes [abstract]. 9th World Congress of Gynecology and Obstetrics; 1979 October 26‐31; Tokyo, Japan. 1979:270‐1.

Additional references

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Coustan 1995
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Cunningham 1997
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Hanson 1993
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Johnstone 1990
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Macer 1992
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Pedersen 1986
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