Managing Labor and Delivery of the Diabetic Mother

Hen Y. Sela, MD; Itamar Raz, MD; Uriel Elchalal, MD

Disclosures

Expert Rev of Obstet Gynecol. 2009;4(5):547-554. 

In This Article

Abstract and Introduction

Abstract

Diabetes mellitus during pregnancy is classified as Type 1, Type 2 and gestational. The incidence of diabetes during pregnancy is increasing worldwide. Complications during pregnancy diverge according to the classification of diabetes and its severity. The fact that the definition can include various patient populations could clarify some of the variations in pregnancy outcomes. This review details the data that have been accumulated regarding the management of labor and delivery of diabetic mothers. One of the most common complications of gestational diabetes is macrosomia, which is related to shoulder dystocia and brachial plexus injury during delivery. We review the data regarding fetal weight estimation and its relevance to the decision-making process. It is important to tailor the management of labor and delivery in the diabetic patient according to fetal weight estimation, gestational age, maternal glycemic control and other maternal and fetal complications in order to achieve the most desirable results for both the mother and her offspring.

Introduction

Diabetes mellitus (DM) during pregnancy is classified as Type 1 (insulin dependent), Type 2 or gestational DM (GDM). GDM is defined as:[1,2]

"...glucose intolerance with onset or first recognition during pregnancy."

Most cases of diabetes diagnosed during pregnancy are GDM (90%), but rarely, it is due to formerly unrecognized pre-GDM. Complications during pregnancy diverge according to the classification of diabetes and the severity of the disease.[3,4,5,6] Pre-GDM and GDM increase the risks of complications for both the mother and fetus. The fact that the definition of GDM includes diverse patient populations may clarify some of the variation in the results of different studies with regards to pregnancy outcomes.

In this review, we aim to assess the data that have been accumulated regarding the management of labor and delivery of diabetic mothers in order to help to deliver optimal care during labor and delivery for these high-risk patients and, hopefully, to reduce the incidence of complications of both the mother and the fetus.

Comments

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