Obstetrical care in gestational diabetes and management of preterm labour

Abstract

Aim: To investigate data enabling the development of guidelines for obstetrical monitoring and management of the threat of preterm labour in gestational diabetes.

Methodology: Systematic literature review.

Results: With gestational diabetes and the absence of other disorders or associated risk factors, there is no argument justifying a systematic clinical monitoring schedule different from other pregnancies. The relevance of ultrasound weight estimations is limited. No formula has emerged as being superior to the others or to the simple measurement of abdominal circumference for the prediction of macrosomia (EL3). The usefulness of testing for asymmetric septal hypertrophy has not been demonstrated (EL4). The routine performance of umbilical artery Doppler has no demonstrated utility in the absence of growth restriction or associated hypertension (EL4). Monthly ultrasound monitoring can be proposed for poorly-controlled diabetes or that requiring insulin. With gestational diabetes that is well-controlled with diet, foetal heart rate recording has no demonstrated use. The recording is debatable for poorly-controlled diabetes or that requiring insulin, while taking associated risk factors into consideration. Weekly recording of the foetal heart rate is often advised for type 2 diabetes diagnosed during pregnancy. If there is a threat of preterm labour, calcium channel blockers and oxytocin receptor antagonists may be used without special precautions. The risk-benefit ratio does not appear favourable for the β2-adrenergic agonists. Lung maturation with corticosteroids may be done in parallel with glycaemic testing and insulin therapy if necessary. Diabetic screening tests should be done several days after the last injection of corticosteroid.