What are the benefits of expectant management of woman with gestational diabetes mellitus (GDM)?

Updated: Apr 29, 2020
  • Author: Thomas R Moore, MD; Chief Editor: George T Griffing, MD  more...
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Answer

Answer

By comparing the outcomes associated with labor induction in patients with gestational diabetes at 38 weeks versus expectant management with fetal testing, Kjos et al found that expectant management increased the gestational age at delivery by 1 week, but it did not significantly reduce the cesarean delivery. [100] However, the prevalence of macrosomia was significantly greater among infants in the expectantly managed group (23%) than among those in the active induction group (10%). This suggests that routine induction of women with diabetes on or before 39 weeks' gestation does not increase the risk of cesarean delivery and may reduce the risk of macrosomia. [100]

However, results from a study by Worda et al were somewhat different from those in the Kjos study. The investigators found that in women with insulin-controlled gestational diabetes mellitus, there was no significant difference in the rate of large for gestational age newborns associated with those who had labor induced at 38 weeks’ gestation compared with those who had labor induced at 40 weeks. In addition, the rate of neonatal hypoglycemia appeared to increase in association with induction at 38 weeks. [101]


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