Timing of Delivery in Women with Pre-Pregnancy Diabetes Mellitus - DOH-Net
The Diabetes, Obesity and Hypertension in Pregnancy Research Network (DOH-Net) is a multi-disciplinary research team of obstetrical, midwifery and maternal-fetal medicine specialists.
DOH-Net, research, diabetes, hypertension, obesity, pregnancy, gestational diabetes, diabetes, obesity and hypertension in pregnancy research network, Sunnybrook Health Sciences Centre, St. Michael's Hospital, McMaster University, obstetrics, midwife, maternal-fetal medicine, specialists, researchers, Toronto, Ontario, Canada, Hamilton, Greater Toronto Area, GTA
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Timing of Delivery in Women with Pre-Pregnancy Diabetes Mellitus

Objective: Controversy exists about the timing of delivery of women with pre-pregnancy type 1 and 2 diabetes mellitus (pre-pregnancy DM). This study compared maternal and neonatal outcomes after induction of labour (IOL) at 38 weeks’ gestation vs. expectant management from 39 weeks onward. Methods: A retrospective population-based cohort study was performed in Ontario, Canada, using the Better Outcomes Registry & Network dataset. Included were all women with pre-pregnancy DM, and who had a singleton hospital birth at ≥ 380/7 weeks’ gestation, The primary outcome was all-cause caesarean delivery. Multivariable modified Poisson regression was performed to generate adjusted relative risks (aRR) and 95% confidence intervals (CI), adjusted for parity, maternal age, pre-pregnancy body mass index (BMI), insulin treatment, and pre-pregnancy DM type. Other outcomes included instrumental delivery, NICU admission, and newborn metabolic disturbances. Results: Caesarean delivery occurred in 269 women (28.7%) in the 38-IOL group vs. 333 women (26.1%) in the EM group – an aRR 1.07 (95% CI 0.94-1.22). The respective rates of instrumental delivery were 11.2% and 10.2% (aRR 1.25, 95% CI 0.98-1.61). NICU admission was more common in the 38-IOL group (27.6%) than in the EM group (16.8%) (aRR 1.61, 95% CI 1.36-1.90), as were jaundice requiring phototherapy (12.4% vs. 6.2%) (aRR 1.93, 95% CI 1.46-2.57) and newborn hypoglycemia (27.3% vs. 14.7%) (aRR 1.74, 95% CI 1.46-2.07). Conclusion: In pregnant women with pre-pregnancy DM, IOL at 380/7 to 386/7 weeks was not associated with a higher risk of caesarean delivery, compared to expectant management, but was associated with a higher risk of certain adverse neonatal outcomes.

Contact for this study:
Karizma Mawjee, mawjeek@smh.ca