What is the issue?
The aim of this Cochrane review was to find out if planning an elective birth at or near the term of pregnancy, compared to waiting for labour to start spontaneously, has an impact on the health of women with gestational diabetes and the health of their babies. Planned early birth means either induction of labour or caesarean birth, and ‘at or near term’ means 37 to 40 weeks gestation. To answer this question, we collected and analysed all relevant studies conducted up to August 2017.
Why is this important?
Women with gestational diabetes (glucose intolerance arising during pregnancy) and their babies are at increased risk of health complications (e.g. high blood pressure, bigger babies). Because of the complications sometimes associated with birthing a big baby, many clinicians have recommended that women with gestational diabetes have an elective birth (generally an induction of labour) at or near term (37 to 40 weeksgestation) rather than waiting for labour to start spontaneously, or until 41 weeks gestation if all is well. Induction has disadvantages of increasing the incidence of forceps or ventouse births, and women often find it difficult to cope with an induced labour. Caesarean section is a major operation which can lead to blood loss, infections and increased chance of problems with subsequent births. Early birth can increase the chance of breathing problems for babies. It is important to know which approach to birth has a better impact on the health outcomes of women with gestational diabetes and their babies.
What evidence did we find?
Our search identified one trial involving 425 women and their babies. In this trial, 214 women had an induction of their labour at term, the other 211 women waited for a spontaneous onset of their labour.
The findings of this trial highlighted no clear difference between the babies of women in either group in relation to the number of large babies, baby’s shoulder getting stuck during birth or babies with breathing problems, low blood sugar and admission to a neonatal intensive care unit. No baby in the trial experienced birth trauma. In the group of women whose labour was induced, there were more incidences of jaundice in the babies. There was no clear difference between women in either group in relation to serious health problems for women, caesarean section, instrumental vaginal birth, postpartum haemorrhage, admission to an intensive care unit and intact perineum. There were no reports in either group of maternal deaths. It should be noted that most of the evidence was found to be of very low quality.
The following outcomes were not reported: postnatal depression, maternal satisfaction, length of postnatal stay (mother), babies with high blood acid, bleeding in the baby’s brain, other brain problems for the babies, babies small-for- gestational age and length of baby’s postnatal stay.
What does this mean?
There is insufficient evidence to clearly identify if there are differences in health outcomes for women with gestational diabetes and their babies when elective birth is undertaken compared to waiting for labour to start spontaneously or until 41 weeks gestation if all is well. More research is needed to answer this question.
There is limited evidence to inform implications for practice. The available data are not of high quality and lack power to detect possible important differences in either benefit or harm. There is an urgent need for high-quality trials evaluating the effectiveness of planned birth at or near term gestation for women with gestational diabetes compared with an expectant approach.