1127 Trial of labor and neonatal outcomes in pregnancies complicated by diabetes

Abstract

Diabetes is associated with increased risk of both cesarean delivery and neonatal morbidity. We evaluated the impact of a trial of labor on the risk of neonatal respiratory morbidity and NICU admission among women with pre-gestational and gestational diabetes. Secondary analysis of women from the Consortium on Safe Labor Study (CSL) who delivered at 19 hospitals across the United States. Women with singleton, liveborn, non-anomalous infants with diabetes (gestational and pre-gestational) who delivered at or after 36 0/7 weeks were included. Women who received steroids for fetal benefit at any time during pregnancy were excluded. A trial of labor was defined as at least 2 cervical exams in the CSL database. Our primary outcome was neonatal respiratory morbidity, which included transient tachypnea of the newborn and respiratory distress syndrome. The secondary outcome was NICU admission. We tested for an interaction between labor and diabetes type. Multivariable logistic regression was used to assess the relationship between a trial of labor and neonatal outcomes. Analyses were also stratified by gestational age at delivery. Of the 11,510 women included, 8,755 (76%) had a trial of labor. The majority of women had GDM (81%). There was no interaction between a trial of labor and maternal diabetes type (p=0.47). Compared with pre-labor or scheduled cesarean, delivery after a trial of labor was associated with lower risks of both neonatal respiratory morbidity (0.52, 95%CI 0.41-0.65) and NICU admission (0.68, 95%CI 0.57 - 0.80) after adjusting for covariates (Table). The lower risks of respiratory morbidity and NICU admission associated with a trial of labor was seen at all gestational ages (Table). These data suggest that a trial of labor may reduce the risk of neonatal morbidity compared to scheduled or pre-labor cesarean delivery in pregnancies complicated by diabetes. Further studies are needed to determine optimal timing of delivery for women with gestational and pre-gestational diabetes.