Insulin-requiring diabetes in pregnancy: A randomized trial of active induction of labor and expectant management

https://doi.org/10.1016/0002-9378(93)90631-RGet rights and content

OBJECTIVE: Our purpose was to assess whether a program of expectant management of uncomplicated pregnancies in mothers with insulin-requiring gestational or progestational class B reduces the incidence of cesarean birth.

STUDY DESIGN: Two hundred women with uncomplicated, insulin-requiring diabetes at 38 weeks' gestation who were compliant with care and whose infants were judged appropriate for gestational age were randomly assigned to (1) active induction of labor within 5 days or (2) expectant management. The expectant management group was monitored with weekly physical examination and twice-weekly nonstress tests and amniotic fluid volume estimation until delivery.

RESULTS: Expectant management increased the gestational age at delivery by 1 week. Approximately half (49%) of the mothers in the expectant management group required induction of labor for obstetric indications. The cesarean delivery rate was not significantly different in the expectant management group (31%) from the active induction group (25%). The mean birth weight (3672 ± 407 gm) and percentage large for gestational age, as defined by birth weight ≥ 90th percentile, of infants in the expectantly managed group (23%) was greater than those in the active induction group (3466 ± 372 gm, p < 0.0001, 10% large for gestational age). This difference persisted after controlling for gestational age and maternal age and body weight (p < 0.01).

CONCLUSION: In women with uncomplicated insulin-requiring gestational or class B pregestational diabetes, expectant management of pregnancy after 38 weeks' gestation did not reduce the incidence of cesarean delivery. Moreover, there was an increased prevalence of large-for-gestational-age infants (23% vs 10%) and shoulder dystocia (3% vs 0%). Because of these risks, delivery should be contemplated at 38 weeks and, if not pursued, careful monitoring of fetal growth must be performed.

References (15)

There are more references available in the full text version of this article.

Cited by (193)

  • Guideline No. 393-Diabetes in Pregnancy

    2019, Journal of Obstetrics and Gynaecology Canada
  • Guideline No. 393 - Diabetes in Pregnancy

    2019, Journal of Obstetrics and Gynaecology Canada
  • Diabetes and Pregnancy

    2018, Canadian Journal of Diabetes
    Citation Excerpt :

    There are additional potential benefits of induction of labour in diabetic pregnancies, including reduction of excess fetal growth, shoulder dystocia and caesarean section rate. One randomized controlled trial compared induction of labour with expectant management of labour at term (167). In this trial of insulin requiring GDM and pre-existing diabetes in pregnancies, expectant management after 38 weeks of gestation was associated with increased birthweight and macrosomia, but no change in caesarean section rate.

View all citing articles on Scopus

Reprints not available.

a

From the Department of Obstetrics and Gynecology, University of Southern California School of Medicine.

View full text