title: Delivery timing and cesarean delivery risk in women with mild gestational diabetes mellitus.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the relationship between gestational age (GA) and induction of labor (IOL) and the rate of cesarean delivery in women with mild gestational diabetes mellitus.
  
  
  METHODS
  We conducted a secondary analysis of data from a multicenter randomized controlled trial of mild gestational diabetes mellitus treatment. Cesarean delivery rate of women delivering at term (≥37 weeks' gestation) was evaluated by 2 complementary approaches: (1) IOL vs spontaneous labor: women who were induced at each GA compared with those who spontaneously labored at the same GA and (2) IOL vs expectant management: women who delivered after IOL at each GA compared with those who delivered after spontaneous labor at the same GA or subsequently after spontaneous or induced labor (outcome at each week compared with expectant management at that week). Logistic regression adjusted for potential confounders.
  
  
  RESULTS
  The overall cesarean delivery rate was 13%. When compared with 39 weeks' gestation (either IOL or spontaneous labor) as the referent, there was no significant difference in the cesarean delivery rate in women who delivered at 37, 38, or 40 weeks' gestation. However, IOL was associated with a 3-fold increase in cesarean delivery rate at 41 weeks' gestation and beyond, as compared with IOL at 39 weeks' gestation. Similarly, there was a 3-fold increase in the cesarean delivery rate in women who were induced when compared with those who were treated expectantly at 40 completed weeks' gestation.
  
  
  CONCLUSIONS
  Induction of labor in women with mild gestational diabetes mellitus does not increase the rate of cesarean delivery at <40 weeks' gestation.
authors.affiliation: Departments of Obstetrics and Gynecology of the University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Amelia L
authors.initials: AL
authors.lastname: Sutton
authors.affiliation: George Washington University Biostatistics Center, Washington, DC.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mele
authors.affiliation: The Ohio State University, Columbus, OH.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.affiliation: University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ramin
authors.affiliation: University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.affiliation: University of North Carolina, Chapel Hill, School of Medicine, Chapel Hill, NC.
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.affiliation: Drexel University, Philadelphia, PA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Sciscione
authors.affiliation: Case Western Reserve University School of Medicine-MetroHealth Medical Center, Cleveland, OH.
authors.forename: Patrick
authors.initials: P
authors.lastname: Catalano
authors.affiliation: Wake Forest University Health Sciences, Winston-Salem, NC.
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
authors.affiliation: University of Texas Medical Branch School of Medicine, Galveston, TX.
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.affiliation: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.affiliation: Wayne State University, Detroit, MI.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects*; D016015:Logistic Models; D011247:Pregnancy; D012306:Risk; D013997:Time Factors
keywords: cesarean delivery; gestational diabetes mellitus; induction of labor