Diabetes in pregnancy: Timing and mode of delivery

Gianpaolo Maso, Monica Piccoli, Sara Parolin, Stefano Restaino, Salvatore Alberico

Research output: Contribution to journalArticle

Abstract

Diabetes in pregnancy represents a risk condition for adverse maternal and feto-neonatal outcomes and many of these complications might occur during labor and delivery. In this context, the obstetrician managing women with pre-existing and gestational diabetes should consider (1) how these conditions might affect labor and delivery outcomes; (2) what are the current recommendations on management; and (3) which other factors should be considered to decide about the timing and mode of delivery. The analysis of the studies considered in this review leads to the conclusion that the decision to deliver should be primarily intended to reduce the risk of stillbirth, macrosomia, and shoulder dystocia. In this context, this review provides useful information for managing specific subgroups of diabetic women that may present overlapping risk factors, such as women with insulin-requiring diabetes and/or obesity and/or prenatal suspicion of macrosomic fetus. To date, the lack of definitive evidences and the complexity of the problem suggest that the "appropriate" clinical management should be customized according with the clinical condition, the type and mode of intervention, its consequences on outcomes, and considering the woman's consent and informed decisions.

Original languageEnglish
Article number506
JournalCurrent Diabetes Reports
Volume14
Issue number7
DOIs
Publication statusPublished - 2014

Keywords

  • Birth injuries
  • Cesarean delivery
  • Delivery
  • Excessive fetal growth
  • Gestational diabetes
  • Induction of labor
  • Labor
  • Macrosomia
  • Obesity
  • Pregestational diabetes
  • Pregnancy
  • Review
  • Shoulder dystocia
  • Type 1 diabetes
  • Type 2 diabetes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Medicine(all)

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