Gestational Diabetes and Induction

[BellyBelly]

Just thought I would make you all aware of our induction article: http://www.bellybelly.com.au/article...-or-not-induce as many women with Gestational Diabetes have pressure to induce early being told you will have a macrosomic (large) baby, due to your condition. The article contains references to inductions and Gestational Diabetes and lots of info about the induction process.

It also tells of babies being born early from inductions, only to find that the baby was actually tiny - and one midwife shares a story of one being close to cut-off for ICU admittance. Fundal height does not have a great deal to do with size - it can vary depending on baby's position, amniotic fluid levels and of course size, but all these things combined do not make it a sure thing, nor does ultrasound.

The American College of Obstetricians and Gynaecologists did an analysis on 11 studies as below and concluded that they do not see the routine induction of macrosomic babies offering better outcomes (or reduce things like sholder dystocia, operative vaginal deliveries or abnormal apgar scores etc.), rather seeing it as more likely to end up with a caesarean or other problems, see below.

Just to clarify first:

ACOG - American College Obs & Gyns
fetal macrosomia - large baby i.e. as per often women with GD are told they may have.

PRINT THIS OFF AND GIVE TO YOUR OB!!!

Expectant Management Versus Labor Induction for Suspected Fetal Macrosomia: A Systematic Review

Luis Sanchez-Ramos, MD, Sara Bernstein, MD and Andrew M. Kaunitz, MD
From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, Jacksonville, Florida.

Address reprint requests to: Luis Sanchez-Ramos, MD, University of Florida, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 653-1 West 8th Street, Jacksonville, FL 32209; E-mail: luis.sanchez@jax.ufl.edu.

OBJECTIVE: To systematically review and summarize the medical literature regarding the effects of expectant management and labor induction on mode of delivery and perinatal outcomes in patients with suspected fetal macrosomia.

DATA SOURCES: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies assessing management of patients with suspected fetal macrosomia.

METHODS OF STUDY SELECTION: We evaluated, abstracted data, and performed quantitative analyses in studies assessing the outcome of patients with suspected fetal macrosomia. Observational studies and randomized trials were included in this systematic review.

TABULATION, INTEGRATION, AND RESULTS: Twenty-nine studies were identified, 11 of which met our criteria for systematic review and meta-analysis. These 11 studies included 3751 subjects. Of these, 2700 were managed expectantly, and 1051 underwent labor induction. We calculated an estimate of the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes, using random- and fixed-effects models for outcomes. Summary statistics for the nine observational studies showed that, compared with those whose labor was induced, women who experienced spontaneous onset of labor had a lower incidence of cesarean delivery (OR 0.39, 95% CI 0.30, 0.50) and higher rates of spontaneous vaginal delivery (OR 2.07, 95% CI 1.34, 3,19); however, significant differences in these outcomes were not noted when the two randomized trials were assessed. No differences were noted in rates of operative vaginal deliveries, incidence of shoulder dystocia, or abnormal Apgar scores in the analyses of the observational or randomized studies.

CONCLUSION: Based on data from observational studies, labor induction for suspected fetal macrosomia results in an increased cesarean delivery rate without improving perinatal outcomes.

[Nicki47]

I would have loved to read the article but the link does not work :-(

[Hil444]

I'Ve just been to the hospital where I'll give birth and was told that I'll be induced if I go over my due date. They told me it's got nothing to do with the baby's size, but that gestational diabetes ages the placenta and therefore doesn't provide enough nutrition for the baby if you go over your date. Has anyone else heard of this and/or gone past their due date and delivered without problems? Obviously I'll do what's best for the baby, but I'Ve come away from the hospital feeling a bit uneasy about it all.

Good luck everyone x

[Artechim]

Hi. Properly controlled GD doesn't usually result in a large baby, but even with well controlled sugars there is a danger that the placenta may not function effectively towards the end of pregnancy. This risk is greater if you are on insulin. If you feel that you have good control of your diabetes, you can ask for extra monitoring instead of an induction - I had a CTG every second day to make sure bub wasn't distressed.

[Hil444]

Thanks for the feedback. I spoke to my own gyn regarding the induction situation. She's going to keep a closer eye on me, and like you said, do more CTGs. Apparently hospitals here in Germany are getting stricter with GDM mums and making induction part of their policy. My gyn says if everything looks good, she'll support me so we can probably allow nature to take its course. Luckily everything is good, baby is a good weight and the diabetes is well under control without insulin.

Cheers again x

[Becci]

I had had GD with my last two (of three) pregnancies and was routinely induced due to the possible deterioration of the placenta. I was also given a sizing scan with the first GD bubs which showed that he was measuring on the large size (8lb 3oz at 36 weeks). I had had a few problems delivering my first baby so was decided it was best to induce due to that aswell.
Both births went fine. Delivered naturally. I did not need an insulin drip either. Infact my levels were on the low side with the second and needed a glass of cordial to bring them back up.
Babies were good sizes 7lb 10oz (38 weeks) and 7lb 13oz (37+6 weeks). Neither had breathing difficulties however the both had low bsls but were fine within a few hours.