Skip to main content
Erschienen in: Wiener klinische Wochenschrift 17-18/2017

06.02.2017 | original article

Randomized controlled trial of induction at 38 weeks versus 40 weeks gestation on maternal and infant outcomes in women with insulin-controlled gestational diabetes

verfasst von: Katharina Worda, MD, Dagmar Bancher-Todesca, MD, Peter Husslein, MD, Christof Worda, MD, Heinz Leipold, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 17-18/2017

Einloggen, um Zugang zu erhalten

Summary

Objective

To compare the impact of induction of labor at 38 weeks of gestation with the induction of labor at 40 weeks of gestation in women with insulin-treated gestational diabetes on maternal and fetal outcome.

Study design

In this study 100 pregnant women with insulin-treated gestational diabetes were randomized to either induction of labor at 38 (group I) or 40 weeks (group II) to evaluate the rate of large for gestational age newborns, neonatal hypoglycemia, success rate of deliveries within 48 h and cesarean section rate after induction in both groups.

Results

The difference of large for gestational age newborns was not significant between the two groups (6.8% vs. 12.8%, p = 0.49), 16 (36.4%) newborns in group I and 8 (17.0%) newborns in group II developed hypoglycemia <35 mg/dl (p = 0.04). The success rate for deliveries within 48 h after induction of labor for groups I and II was 77.3% and 92.3%, respectively (p = 0.25). The cesarean section rate after induction of labor was not significantly different between the two groups (24.1% vs. 18.7%, p = 0.49).

Conclusion

In a cohort of women with insulin-treated gestational diabetes, induction of labor at 38 weeks did not significantly reduce the rate of large for gestational age newborns compared to induction at 40 weeks but seems to increase the rate of neonatal hypoglycemia.
Literatur
1.
Zurück zum Zitat American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2004;27(Suppl 1):S88–S90. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2004;27(Suppl 1):S88–S90.
2.
Zurück zum Zitat American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2014;37(Suppl1):S81–S89.CrossRef American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2014;37(Suppl1):S81–S89.CrossRef
3.
Zurück zum Zitat HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.CrossRef HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.CrossRef
4.
Zurück zum Zitat Ignell C, Claesson R, Anderberg E, Berntorp K. Trends in the prevalence of gestational diabetes mellitus in southern Sweden 2003–2012. Acta Obstet Gynecol Scand. 2014;93:420–4.CrossRefPubMed Ignell C, Claesson R, Anderberg E, Berntorp K. Trends in the prevalence of gestational diabetes mellitus in southern Sweden 2003–2012. Acta Obstet Gynecol Scand. 2014;93:420–4.CrossRefPubMed
5.
Zurück zum Zitat Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339–48.CrossRefPubMedPubMedCentral Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339–48.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477–86.CrossRefPubMed Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477–86.CrossRefPubMed
7.
Zurück zum Zitat HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: associations with neonatal anthropometrics. Diabetes. 2009;58:453–9.CrossRef HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: associations with neonatal anthropometrics. Diabetes. 2009;58:453–9.CrossRef
8.
Zurück zum Zitat Pedersen J. Diabetes and pregnancy: blood sugar of newborn infants. Ph.D. thesis. Copenhagen: Danish Science Press; 1952. Pedersen J. Diabetes and pregnancy: blood sugar of newborn infants. Ph.D. thesis. Copenhagen: Danish Science Press; 1952.
9.
Zurück zum Zitat Gluckman PD, Pinal CS. Regulation of fetal growth by the somatotrophic axis. J Nutr. 2003;133:1741S–1746S.PubMed Gluckman PD, Pinal CS. Regulation of fetal growth by the somatotrophic axis. J Nutr. 2003;133:1741S–1746S.PubMed
10.
Zurück zum Zitat Lai FY, Johnson JA, Dover D, Kaul P. Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: a population-based study in Alberta, Canada, 2005–2011. J Diabetes. 2016;8:45–55.CrossRefPubMed Lai FY, Johnson JA, Dover D, Kaul P. Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: a population-based study in Alberta, Canada, 2005–2011. J Diabetes. 2016;8:45–55.CrossRefPubMed
11.
Zurück zum Zitat Christoffersson M, Rydhstroem H. Shoulder dystocia and brachial plexus injury: a population-based study. Gynecol Obstet Invest. 2002;53:42–7.CrossRefPubMed Christoffersson M, Rydhstroem H. Shoulder dystocia and brachial plexus injury: a population-based study. Gynecol Obstet Invest. 2002;53:42–7.CrossRefPubMed
12.
Zurück zum Zitat Jensen DM, Sorensen B, Feilberg-Jorgensen N, Westergaard JG, Nielsen H. Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar profile. Diabet Med. 2000;17:281–6.CrossRefPubMed Jensen DM, Sorensen B, Feilberg-Jorgensen N, Westergaard JG, Nielsen H. Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar profile. Diabet Med. 2000;17:281–6.CrossRefPubMed
13.
Zurück zum Zitat Sutton AL, Mele L, Landon MB, et al. Delivery timing and cesarean delivery risk in women with mild gestational diabetes mellitus. Am J Obstet Gynecol. 2014;211:244.e1–244.e7.CrossRef Sutton AL, Mele L, Landon MB, et al. Delivery timing and cesarean delivery risk in women with mild gestational diabetes mellitus. Am J Obstet Gynecol. 2014;211:244.e1–244.e7.CrossRef
15.
Zurück zum Zitat Committee on Practice Bulletins – Obstetrics. Practice Bulletin. No. 137 Gestational diabetes mellitus. Obstet Gynecol. 2013;122:406–16.CrossRef Committee on Practice Bulletins – Obstetrics. Practice Bulletin. No. 137 Gestational diabetes mellitus. Obstet Gynecol. 2013;122:406–16.CrossRef
16.
Zurück zum Zitat Witkop CT, Neale D, Wilson LM, Bass EB, Nicholson WK. Active compared with expectant delivery management in women with gestational diabetes: a systematic review. Obstet Gynecol. 2009;113:206–17.CrossRefPubMed Witkop CT, Neale D, Wilson LM, Bass EB, Nicholson WK. Active compared with expectant delivery management in women with gestational diabetes: a systematic review. Obstet Gynecol. 2009;113:206–17.CrossRefPubMed
17.
Zurück zum Zitat Kjos SL, Henry OA, Montoro M, Buchanan TA, Mestman JH. Insulin-requiring diabetes in pregnancy: a randomized trial of active induction of labor and expectant management. Am J Obstet Gynecol. 1993;169:611–5.CrossRefPubMed Kjos SL, Henry OA, Montoro M, Buchanan TA, Mestman JH. Insulin-requiring diabetes in pregnancy: a randomized trial of active induction of labor and expectant management. Am J Obstet Gynecol. 1993;169:611–5.CrossRefPubMed
18.
Zurück zum Zitat Kautzky-Willer A, Bancher-Todesca D, Birnbacher R. Gestational diabetes mellitus. Acta Med Austriaca. 2004;31:182–4.PubMed Kautzky-Willer A, Bancher-Todesca D, Birnbacher R. Gestational diabetes mellitus. Acta Med Austriaca. 2004;31:182–4.PubMed
19.
Zurück zum Zitat International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.CrossRefPubMedCentral International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.CrossRefPubMedCentral
20.
Zurück zum Zitat Voigt M. Methodische Aspekte der Berechnung von Normwertkurven für das Geburtsgewicht. 120. Tagung NGGG, Poster 50, Rostock. vol 50. 2004. Voigt M. Methodische Aspekte der Berechnung von Normwertkurven für das Geburtsgewicht. 120. Tagung NGGG, Poster 50, Rostock. vol 50. 2004.
21.
Zurück zum Zitat Hosmer DW, Lemeshow S. Applied survival analysis: regression modeling of time to event data. New York: John Wiley & Sons; 1999. Hosmer DW, Lemeshow S. Applied survival analysis: regression modeling of time to event data. New York: John Wiley & Sons; 1999.
22.
Zurück zum Zitat Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care. 2007;30(Suppl 2):S251–S260.CrossRefPubMed Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care. 2007;30(Suppl 2):S251–S260.CrossRefPubMed
23.
Zurück zum Zitat Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Doss AE, Caughey AB. The risk of stillbirth and infant death stratified by Gestational age in women with GDM. Am J Obstet Gynecol. 2012;206:309.e1–309.e7.CrossRef Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Doss AE, Caughey AB. The risk of stillbirth and infant death stratified by Gestational age in women with GDM. Am J Obstet Gynecol. 2012;206:309.e1–309.e7.CrossRef
Metadaten
Titel
Randomized controlled trial of induction at 38 weeks versus 40 weeks gestation on maternal and infant outcomes in women with insulin-controlled gestational diabetes
verfasst von
Katharina Worda, MD
Dagmar Bancher-Todesca, MD
Peter Husslein, MD
Christof Worda, MD
Heinz Leipold, MD
Publikationsdatum
06.02.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 17-18/2017
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-017-1172-4

Weitere Artikel der Ausgabe 17-18/2017

Wiener klinische Wochenschrift 17-18/2017 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.