title: Diabetes in pregnancy: timing and mode of delivery.
abstract: Diabetes in pregnancy represents a risk condition for adverse maternal and feto-neonatal outcomes and many of these complications might occur during labor and delivery. In this context, the obstetrician managing women with pre-existing and gestational diabetes should consider (1) how these conditions might affect labor and delivery outcomes; (2) what are the current recommendations on management; and (3) which other factors should be considered to decide about the timing and mode of delivery. The analysis of the studies considered in this review leads to the conclusion that the decision to deliver should be primarily intended to reduce the risk of stillbirth, macrosomia, and shoulder dystocia. In this context, this review provides useful information for managing specific subgroups of diabetic women that may present overlapping risk factors, such as women with insulin-requiring diabetes and/or obesity and/or prenatal suspicion of macrosomic fetus. To date, the lack of definitive evidences and the complexity of the problem suggest that the "appropriate" clinical management should be customized according with the clinical condition, the type and mode of intervention, its consequences on outcomes, and considering the woman's consent and informed decisions.
authors.affiliation: Department of Obstetrics and Gynecology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, 34137, Italy, gianpaolo.maso@burlo.trieste.it.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Maso
authors.forename: Monica
authors.initials: M
authors.lastname: Piccoli
authors.forename: Sara
authors.initials: S
authors.lastname: Parolin
authors.forename: Stefano
authors.initials: S
authors.lastname: Restaino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Alberico
mesh_terms: D036861:Delivery, Obstetric; D003920:Diabetes Mellitus; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications