title: Timing of Medically Indicated Delivery in Diabetic Pregnancies: A Perspective on Current Evidence-Based Recommendations.
abstract: Diabetes complicates 6 to 7% of all pregnancies in the United States. Poor glycemic control is associated with multiple immediate and long-term adverse effects on both the mother and fetus. Although uniformity exists in the antenatal management of this disease, there is a paucity of evidence-based studies upon which to dictate the optimal time of delivery among affected women. The potential risks of delayed neonatal pulmonary maturation including respiratory distress syndrome and transient tachypnea of the newborn associated with early delivery must be balanced with the increased incidence of fetal demise, overgrowth, and birth injury related to diabetes in late gestations. Even among diabetic women with optimal glycemic control, the risk of stillbirth in the third trimester is considerably higher than their normal counterparts. The current paradigm of delaying delivery to 39 weeks in women with controlled and uncomplicated diabetes has been challenged by recent evidence advocating delivery by 38 weeks to improve perinatal outcomes. However, additional well-designed and adequately powered prospective studies are needed to better understand the short- and long-term implications of the optimal timing of delivery in this high-risk population. This article reviews the most current literature regarding the optimal timing of delivery in pregnancies complicated by diabetes mellitus and gestational diabetes mellitus.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Oscar A
authors.initials: OA
authors.lastname: Viteri
authors.affiliation: Department of Obstetrics and Gynecology, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Dinis
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Tania
authors.initials: T
authors.lastname: Roman
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational / Q000453:epidemiology*; D055317:Evidence-Based Practice; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D050497:Stillbirth / Q000453:epidemiology*; D013997:Time Factors