Elective delivery in diabetic pregnant women

Cochrane Database of Systematic Reviews

Last Updated on 2009-08-03

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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's Trials Register (24 July 2004). We updated this search on 24 July 2009 and added the results to the awaiting classification section.

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 pre-existing 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 (relative risk (RR) 0.81, 95% confidence interval (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 three cases of mild shoulder dystocia were reported in the expectant management group. No other perinatal morbidity was reported.

Authors' conclusions

The results of the single randomized controlled trial comparing elective delivery with expectant management at term in pregnant women with insulin-requiring diabetes show that induction of labour reduces the risk of macrosomia. The risk of maternal or neonatal morbidity was not different between groups, but, given the rarity of maternal and neonatal morbidity, the number of women included does not permit to draw firm conclusions. Women's views on elective delivery and on prolonged surveillance and treatment with insulin should be assessed in future trials.

[Note: The one citation in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

Plain Language Summary

Elective delivery in diabetic pregnant women

Induction of labour at 38 weeks pregnancy for women with diabetes treated with insulin lowers the chances of delivering a large baby.

Women with diabetes or gestational diabetes are more likely to have a large baby, which can cause problems around birth. Early elective delivery (labour induction or caesarean section) aims to avoid these complications. However, early elective delivery can also cause problems. The review found only one trial of labour induction for women with diabetes treated with insulin. Induction of labour lowered the number of large babies without increasing the risk of caesarean section. However, there was not enough evidence to definitively assess this intervention.

Citation

Boulvain, Michel; Stan, Catalin M; Irion, Olivier; Boulvain, Michel; Elective delivery in diabetic pregnant women (Cochrane Review). In: The Cochrane Library 2009 Issue 4. Chichester, UK: John Wiley and Sons, Ltd.