Induction after 40 weeks in women with gestational diabetes associated with Cesarean delivery

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1. Compared to women with mild gestational diabetes (GDM) induced at 39 weeks, those induced at 41 weeks were three times as likely to undergo Cesarean delivery (CD). 

2. At 40 weeks, women with GDM who underwent induction of labor were more likely to undergo CD than those who were expectantly managed.

Evidence Rating Level: 2 (Good)            

Study Rundown: This study found that in women with GDM, labor induction was not associated with increased odds of CD until after 40 weeks gestational age. Prior studies have shown that lower rates of CD are associated with spontaneous labor and elective induction. The results of this analysis suggest that when indicated, labor induction prior to 40 weeks may decrease risk of CD among women with mild GDM.

Limitations include post-hoc analysis and generalizability, as women with GDM are more likely to have labor complications necessitating CD. Strengths of this landmark study include RCT design and use of two sets of gestational-age matched controls: those undergoing induction and those expectantly managed. Future RCTs or prospective cohort studies are merited to inform ideal timing of induction for the larger population.

Click to read the study in AJOG

Relevant Reading: Systematic review: elective induction oflabor versus expectant management of pregnancy

Study Author, Dr. Amelia Sutton, MD, PhD, talks to 2 Minute Medicine: University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Fellow in the Division of Maternal-Fetal Medicine

“Induction of labor, compared to expectant management, prior to 40 weeks does not increase cesarean delivery risk in women with mild gestational diabetes (GDM). Large RCTs are warranted to fully evaluate the maternal and neonatal risks associated with induction of labor and to determine the optimal gestational age of delivery in women with mild GDM.”

In-Depth [randomized controlled trial]: This secondary analysis of an RCT compared rates of CD in 679 women with GDM by gestational age and by induction of labor (IOL) vs. expectant management. Outcomes evaluated include CD rate, composite perinatal outcome, NICU admission and large for gestational age status.

Women undergoing IOL at ≥41 weeks gestation were over three times as likely to undergo CD (OR 3.72, CI 1.23-11.24 respectively) compared to women undergoing IOL at 39 weeks. At 40 weeks, women undergoing IOL were more likely to have a CD than those who were managed expectantly (OR 3.11, CI 1.33-7.28). These trends held for women who received usual care for GDM; those receiving treatment did not have increased odds of CD at any gestational age. 

More from this author: Potential overuse of routine postpartum CBC, Poor fetal growth in overweight & obese with insufficient weight gain, Elective induction may increase risk of C-section in obese women, New method of cervicovaginal reconstruction piloted, Women electing abortion more likely to be victims of domestic abuse

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