Timing of delivery in women with pre-pregnancy diabetes mellitus: a population-based study
Objectives Controversy exists about the timing of delivery of women with pre-pregnancy type 1 and 2 diabetes mellitus (PDM). This study aims to compare maternal and neonatal outcomes after induction of labor (IOL) at 38 weeks’ gestation versus expectant management from 39 weeks onward.Research desig...
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| Format: | Article |
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BMJ Publishing Group
2019-05-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/7/1/e000758.full |
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| author | Nir Melamed Jon Barrett Michael Geary Meghan Brown Haroon Hassan Karizma Mawjee Sarah D McDonald Joel G Ray Howard Berger |
| author_facet | Nir Melamed Jon Barrett Michael Geary Meghan Brown Haroon Hassan Karizma Mawjee Sarah D McDonald Joel G Ray Howard Berger |
| author_sort | Nir Melamed |
| collection | DOAJ |
| description | Objectives Controversy exists about the timing of delivery of women with pre-pregnancy type 1 and 2 diabetes mellitus (PDM). This study aims to compare maternal and neonatal outcomes after induction of labor (IOL) at 38 weeks’ gestation versus expectant management from 39 weeks onward.Research design and methods This was a retrospective population-based cohort study using data from the Better Outcomes Registry and Network in Ontario Canada. Included were all women with PDM, who had a singleton hospital birth at ≥380/7 weeks’ gestation from 2012 to 2017. Maternal and perinatal outcomes were compared between 937 pregnancies that underwent IOL at 380/7–386/7 weeks (‘38-IOL group’) versus 1276 pregnancies expectantly managed resulting in a birth at ≥390/7 weeks (‘39-Exp group’). The primary outcome was all-cause cesarean delivery. Multivariable modified Poisson regression was performed to generate adjusted relative risks (aRR) and 95% CIs, adjusted for parity, maternal age, pre-pregnancy body mass index and PDM type. Other outcomes included instrumental delivery, neonatal intensive care unit (NICU) admission, and newborn metabolic disturbances.Results Cesarean delivery occurred in 269 women (28.7%) in the 38-IOL group versus 333 women (26.1%) in the 39-Exp group—aRR 1.07 (95% CI 0.94 to 1.22). The respective rates of instrumental delivery were 11.2% and 10.2% (aRR 1.25, 95% CI 0.98 to 1.61). NICU admission was more common in the 38-IOL group (27.6%) than in the 39-Exp group (16.8%) (aRR 1.61, 95% CI 1.36 to 1.90), as were jaundice requiring phototherapy (12.4% vs 6.2%) (aRR 1.93, 95% CI 1.46 to 2.57) and newborn hypoglycemia (27.3% vs 14.7%) (aRR 1.74, 95% CI 1.46 to 2.07).Conclusion In pregnant women with PDM, IOL at 380/7–386/7 weeks was not associated with a higher risk of cesarean delivery, compared with expectant management, but was associated with a higher risk of certain adverse neonatal outcomes. |
| format | Article |
| id | doaj-art-1aa511ed668e4aa489a45f4bdb4a02f7 |
| institution | OA Journals |
| issn | 2052-4897 |
| language | English |
| publishDate | 2019-05-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-1aa511ed668e4aa489a45f4bdb4a02f72025-08-20T02:35:50ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972019-05-017110.1136/bmjdrc-2019-000758Timing of delivery in women with pre-pregnancy diabetes mellitus: a population-based studyNir Melamed0Jon Barrett1Michael Geary2Meghan Brown3Haroon Hassan4Karizma Mawjee5Sarah D McDonald6Joel G Ray7Howard Berger82 Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, CanadaDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, CanadaDepartment of Obstetrics & Gynaecology, Rotunda Hospital, Dublin, IrelandObstetrics and Gynecology, University of Toronto, Toronto, Ontario, CanadaBetter Outcomes Registry and Network, Children’s Hospital of Eastern Ontario (CHEO), Toronto, Ontario, CanadaDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Unity Health Toronto, Toronto, Ontario, CanadaDivision of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, CanadaMedicine, St. Michael`s Hospital, Toronto, Ontario, CanadaDepartment of Obstetrics and Gynecology, St Michael`s Hospital, Toronto, Ontario, CanadaObjectives Controversy exists about the timing of delivery of women with pre-pregnancy type 1 and 2 diabetes mellitus (PDM). This study aims to compare maternal and neonatal outcomes after induction of labor (IOL) at 38 weeks’ gestation versus expectant management from 39 weeks onward.Research design and methods This was a retrospective population-based cohort study using data from the Better Outcomes Registry and Network in Ontario Canada. Included were all women with PDM, who had a singleton hospital birth at ≥380/7 weeks’ gestation from 2012 to 2017. Maternal and perinatal outcomes were compared between 937 pregnancies that underwent IOL at 380/7–386/7 weeks (‘38-IOL group’) versus 1276 pregnancies expectantly managed resulting in a birth at ≥390/7 weeks (‘39-Exp group’). The primary outcome was all-cause cesarean delivery. Multivariable modified Poisson regression was performed to generate adjusted relative risks (aRR) and 95% CIs, adjusted for parity, maternal age, pre-pregnancy body mass index and PDM type. Other outcomes included instrumental delivery, neonatal intensive care unit (NICU) admission, and newborn metabolic disturbances.Results Cesarean delivery occurred in 269 women (28.7%) in the 38-IOL group versus 333 women (26.1%) in the 39-Exp group—aRR 1.07 (95% CI 0.94 to 1.22). The respective rates of instrumental delivery were 11.2% and 10.2% (aRR 1.25, 95% CI 0.98 to 1.61). NICU admission was more common in the 38-IOL group (27.6%) than in the 39-Exp group (16.8%) (aRR 1.61, 95% CI 1.36 to 1.90), as were jaundice requiring phototherapy (12.4% vs 6.2%) (aRR 1.93, 95% CI 1.46 to 2.57) and newborn hypoglycemia (27.3% vs 14.7%) (aRR 1.74, 95% CI 1.46 to 2.07).Conclusion In pregnant women with PDM, IOL at 380/7–386/7 weeks was not associated with a higher risk of cesarean delivery, compared with expectant management, but was associated with a higher risk of certain adverse neonatal outcomes.https://drc.bmj.com/content/7/1/e000758.full |
| spellingShingle | Nir Melamed Jon Barrett Michael Geary Meghan Brown Haroon Hassan Karizma Mawjee Sarah D McDonald Joel G Ray Howard Berger Timing of delivery in women with pre-pregnancy diabetes mellitus: a population-based study BMJ Open Diabetes Research & Care |
| title | Timing of delivery in women with pre-pregnancy diabetes mellitus: a population-based study |
| title_full | Timing of delivery in women with pre-pregnancy diabetes mellitus: a population-based study |
| title_fullStr | Timing of delivery in women with pre-pregnancy diabetes mellitus: a population-based study |
| title_full_unstemmed | Timing of delivery in women with pre-pregnancy diabetes mellitus: a population-based study |
| title_short | Timing of delivery in women with pre-pregnancy diabetes mellitus: a population-based study |
| title_sort | timing of delivery in women with pre pregnancy diabetes mellitus a population based study |
| url | https://drc.bmj.com/content/7/1/e000758.full |
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