Journal of Diabetes Research

Research Article

Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol

Table 5

Comparison of different international guidelines regarding the optimal time of delivery in women with diabetes in pregnancy. GDM: gestational diabetes mellitus.


Authority	Recommendation

National Institute for Health and Clinical Excellence (2015) [2]	Advise pregnant women with type 1 or type 2 diabetes and no other complications to have an elective birth by induced labor or (if indicated) caesarean section, between 37 weeks and 38 weeks plus 6 days of pregnancy.
	Consider elective birth before 37 weeks for women with type 1 or type 2 diabetes who have metabolic or other maternal or fetal complications.
	Advise women with gestational diabetes to give birth no later than 40 weeks plus 6 days. Offer elective birth by induced labor or (if indicated) by caesarean section to women who have not given birth by this time.
	Consider elective birth before 40 weeks plus 6 days for women with gestational diabetes who have maternal or fetal complications.

Canadian Diabetes Association (2019) [15]	Pregnant women with either gestational or pre-gestational diabetes should be offered induction between 38 to 40 weeks gestation depending on their glycemic control and other comorbidity factors.
	In the view that the risk of intrauterine fetal death appears to outweigh the risk of infant death after 39 weeks, induction of labor at 39 weeks could be considered in insulin-treated GDM patients.
	In women with diet-controlled GDM induction by 40 weeks may be beneficial.

American College of Obstetricians and Gynecologists (2018) [16, 17]	Delivery of women with GDM at 38 weeks or 39 weeks of gestation would reduce overall perinatal mortality without increasing cesarean delivery rates.
	For women with pregestational diabetes early delivery (36 0/7 weeks to 38 6/7 weeks of gestation, or even earlier) may be indicated in some patients with vasculopathy, nephropathy, poor glucose control, or a prior stillbirth.
	In contrast, women with well-controlled diabetes with no other comorbidities may be managed expectantly to 39 0/7 weeks to 39 6/7 weeks of gestation as long as antenatal testing remains reassuring.
	Expectant management beyond 40 0/7 weeks of gestation generally is not recommended.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2021) [18]	If well managed with medical nutrition therapy and no fetal macrosomia or other complications, wait for spontaneous labor (unless there are other indications for induction of labor).
	If suspected fetal macrosomia or other complications, consider birth from 38⁺⁰ to 39⁺⁰ weeks’ gestation.
	Suspected fetal macrosomia alone is not an indication for induction of labor before 39⁺⁰ weeks’ gestation.
	In most cases, women with optimal blood glucose levels who are receiving pharmacological therapy do not require expedited birth before 39⁺⁰ weeks gestation.

The Australasian Diabetes in Pregnancy Society (2019) [19]	Women with preexisting diabetes should be advised to give birth by the end of 38 completed weeks’ gestation, depending on the presence of fetal macrosomia, glycemic levels and any other complicating factors.