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Delivery in diabetic pregnancy

O Jardim1, E Sobral, E C Branco

  • 1Department of Obstetric Clinic, University Hospital, Coimbra, Portugal.

Annali Dell'Istituto Superiore Di Sanita
|January 1, 1997
PubMed
Summary

Diabetic pregnancies show higher rates of cesarean sections, planned deliveries, and complications like macrosomia and shoulder dystocia compared to non-diabetic pregnancies. Intensive care did not fully mitigate risks such as large for gestational age infants.

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Area of Science:

  • Obstetrics
  • Endocrinology
  • Perinatology

Background:

  • Diabetes in pregnancy, including gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM), presents significant risks.
  • Maternal hyperglycemia can lead to adverse fetal outcomes, necessitating careful management and monitoring.

Purpose of the Study:

  • To investigate delivery outcomes in diabetic pregnancies compared to a control population.
  • To assess the incidence of cesarean sections, planned deliveries, macrosomia, large for gestational age (LGA), and shoulder dystocia in relation to maternal diabetes status.

Main Methods:

  • Retrospective study of 220 diabetic deliveries (186 GDM, 34 PGDM) from 1990-1994.
  • Comparison with a control group of 3615 non-diabetic deliveries from 1994.
  • Analysis of delivery mode, planned delivery, gestational age, shoulder dystocia, macrosomia, and LGA.

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Main Results:

  • Diabetic women had higher rates of cesarean sections (39% vs 20.5%) and planned deliveries (51.6% vs 16%).
  • Macrosomia (17.7% vs 8%) and shoulder dystocia (3.6% vs 0.3%) were significantly more frequent in diabetic pregnancies.
  • Deliveries after 40 weeks were 29% in GDM and 3% in PGDM, versus 50% in controls, indicating altered delivery timing strategies.

Conclusions:

  • Diabetic pregnancies are associated with increased rates of cesarean delivery, planned interventions, macrosomia, LGA, and shoulder dystocia.
  • Allowing delivery at term or near term was insufficient to normalize macrosomia and LGA rates, suggesting suboptimal glycemic control during pregnancy.
  • Despite intensive care, risks associated with diabetes in pregnancy persist, highlighting the need for improved management strategies.