Background Despite recent advances in the management of Gestational Diabetes (GDM), there is a paucity of evidence addressing the ideal timing of delivery in women who are well controlled. If recent proposed changes to diagnostic criteria were to be adopted¹, the incidence of GDM would increase up to 16%. This could potentially increase induction and caesarean section rate.

Objective To assess the safety of not routinely inducing well controlled gestational diabetic women at 38 weeks.

Methods Retrospective study in a district general hospital.

Outcomes Incidence of fetal macrosomia, stillbirth, caesarean section, shoulder dystocia, third degree tear, postpartum haemorrhage (PPH) and admission to SCBU in this population.

Results In 2012, 157 women were diagnosed as GDM according to WHO/NICE criteria; 47% were treated with Metformin and 15% with Insulin. 48 women, well-controlled on diet, Metformin, and/or Insulin, were allowed to go into spontaneous labour. 12 of these women were eventually induced for post-maturity.

The incidence of macrosomia, emergency caesarean section, third-degree tear, PPH, SCBU admission was 4%, 12.5%, 4%, 4% and 4% respectively. There were no cases of shoulder dystocia or stillbirth. These figures are well below the national average.

Conclusion Treating well-controlled gestational diabetics conservatively at term is a safe management option.

Reference

1. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva A, Hod M, Kitzmiler JL, et al, International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–682.