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

Published Guidelines for the Management of Labor & Delivery in Diabetics during Pregnancy

Both the American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association have provided guidance for labor management of pregnancies complicated by GDM.[24,65] The ACOG states the following:

  • Timing of delivery in patients with GDM remains relatively open. When glucose control is good and no other complications supervene, there is no good evidence to support routine delivery before 40 weeks of gestation;

  • Individuals whose metabolic control does not meet the goals described earlier or is undocumented, or those with risk factors, such as hypertensive disorders or previous stillbirth, should be managed the same as those with pre-existing diabetes;

  • Elective Caesarean delivery may be indicated in women with GDM whose EFW is 4500 g or greater;

  • When GDM is well controlled and the dates are well documented, the occurrence of respiratory distress syndrome (RDS) at or beyond 39 weeks of gestation is rare enough that routine amniocentesis for pulmonary maturity is not necessary.

The American Diabetes Association states that prolongation of gestation past 38 weeks increases the risk of fetal macrosomia without reducing Caesarean rates, so that delivery during the 38th week is recommended unless obstetric considerations dictate otherwise.

Regarding pre-GDM, the ACOG states that optimal timing of delivery relies on balancing the risk of IUFD with the risks of preterm birth. In poorly controlled DM pregnant patients, early delivery may be indicated, and amniocentesis for fetal lung maturity is advised.[66] By contrast, patients with well-controlled DM may be allowed to progress to their expected date of delivery, as long as antenatal testing remains reassuring.[55] Expectant management beyond the estimated due date is generally not recommended.

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