Consequences of routine delivery at 38 weeks for A-2 gestational diabetes.
OBJECTIVE
To report our intrapartum experience with routine delivery at 38 weeks of gestation of A-2 diabetic pregnancies requiring primarily oral hypoglycemic therapy.


METHODS
This retrospective study consisted of 143 consecutive women with gestational diabetes not controlled with diet alone (A-2). Each underwent a routine trial of labor at 38 weeks of gestation. The preinduction condition of the cervix, need for oxytocin, and primary cesarean rates were primary endpoints. For comparison, a control group during that same period consisted of 137 consecutive diet-controlled diabetic (A-1) pregnancies with the same eligibility criteria who underwent expectant management at 38 weeks.


RESULTS
The study group was more likely to have an unfavorable cervix (75% versus 45%; p < 0.001) and to require oxytocin (76% versus 56%; p < 0.001). Early onset meconium was less common in the study group (3.5% versus 13.1%; p < 0.01). Primary cesarean rates were low and not different between the study and control groups (12.7% versus 11.7%; p < 0.8). The only stillbirth was in the control group and was associated with a tight double nuchal cord encirclement. Mean birth weights and the frequency of birth weights > 4000 g were not different between groups. Shoulder dystocia, low Apgar scores, and admissions to the special care nursery were infrequent in either group. No respiratory difficulties requiring resuscitation or prolonged nursery care were encountered.


CONCLUSIONS
Routine delivery at 38 weeks in an A-2 diabetic population is not associated with additional intrapartum morbidity or a greater need for cesarean delivery.
Rayburn
William F
WF
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM 87131-0001, USA. wrayburn@salud.unm.edu
Sokkary
Nancy
N
Clokey
Diana E
DE
Moore
Lisa E
LE
Curet
Luis B
LB
D000284:Administration, Oral; D000328:Adult; D016022:Case-Control Studies; D020070:Cervical Ripening; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000628:therapy; D003927:Diet, Diabetic; D005260:Female; D005865:Gestational Age; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007751:Labor, Induced; D008470:Meconium; D016595:Misoprostol / Q000627:therapeutic use; D009516:New Mexico / Q000453:epidemiology; D010120:Oxytocics / Q000627:therapeutic use; D036801:Parturition; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
D007004:Hypoglycemic Agents; D010120:Oxytocics; D016595:Misoprostol