title: Elective induction of labor in women with gestational diabetes mellitus: an intervention that modifies the risk of cesarean section.
abstract: OBJECTIVE
  To evaluate the effect of elective induction at term for women with gestational diabetes mellitus (GDM) on the risk for cesarean delivery.
  
  
  METHODS
  This is a retrospective case-control matched study, based on a single-center computerized database, 2005-2011. The medical records were reviewed for GDM management and glycemic control. For the study, two groups were defined: Group 1, women diagnosed with GDM with an estimated fetal weight <4,000 g, electively induced at term; Group 2, women induced due to Term-PROM, an indication for term induction in normoglycemic women with uncomplicated pregnancies, matched for age and parity (ratio 1:2). The primary outcome was cesarean delivery and secondary outcomes included other maternal and neonatal events. Descriptive analyses and multivariate analyses models were fitted.
  
  
  RESULTS
  GDM was diagnosed in 1,873 (2.6 %) women of 72,374 births; 227 (12.1 %) were eligible for inclusion in Group 1 and matched with 454 women in Group 2. GDM management included diet in 103 (45.4 %), insulin in 81 (35.7 %), and oral hypoglycemic agents in 43 (18.9 %).The cesarean delivery rate was significantly higher in Group 1, 17.1 vs. 11.2 % (p = 0.02). Three out of four births complicated by shoulder dystocia and BW <4,000 g, occurred in Group 1 (p = 0.076) and were associated with no glycemic control. Other obstetrical-related outcomes such as instrumental birth, severe perineal tears, early postpartum hemorrhage and peripartum transfusion were similar between groups.
  
  
  CONCLUSIONS
  Elective induction at term for women with GDM is associated with an increased risk for cesarean delivery as compared to other elective induction of labor.
authors: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine, Jerusalem, Israel, orenandmaayan@gmail.com.
authors: Maayan
authors: M
authors: Bas-Lando
authors: Naama
authors: N
authors: Srebnik
authors: Rivka
authors: R
authors: Farkash
authors: Alexander
authors: A
authors: Ioscovich
authors: Arnon
authors: A
authors: Samueloff
authors: Sorina
authors: S
authors: Grisaru-Granovsky
mesh_terms: D000328:Adult; D001786:Blood Glucose; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000503:physiopathology; D004420:Dystocia; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007557:Israel; D007751:Labor, Induced / Q000706:statistics & numerical data*; D016015:Logistic Models; D008499:Medical Records; D015999:Multivariate Analysis; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose