265: Induction at term for women with gestational diabetes mellitus (GDM): safe for the mother but questionable for the neonate

Abstract

diabetes mellitus (GDM): safe for the mother but questionable for the neonate Maayan Bas-Lando, Naama Srebnik, Arnon Samueloff, Rivka Farkash, Sorina Grisaru-Granovsky Shaare Zedek MC, Affiliated to the Hebrew University Medical School, Obstetrics and Gynecology, Jerusalem, Israel, Shaare Zedek MC, Affiliated to the Hebrew University Medical School, Computerized Database Systems, Jerusalem, Israel OBJECTIVE: Induction at term is considered the mainstream for women with GDM in order to decrease macrosomia related complications. However, it is likely to increase the cesarean section (CS) rate. We aimed to evaluate the influence of this approach on the cesarean section rate. STUDY DESIGN: Cohort study of 73,800 births at a tertiary center, between 2005-2011 based on computerized perinatal database. The study group (Group 1) included all women with singleton, head presentation, EFW 4,000 gms, for which a diagnosis of GDM was the indication for induction (38-41 wks). GDM diagnosis was based on all criteria: National Diabetes Data Group, Carpenter & Coustan and OGTT 1 abnormal value. The control group (Group 2) included all healthy women admitted for induction due to ruptured membranes at term, normoglycemic (GCT 130mg/dl or normal OGTT). The main outcome was the CS rate whilst secondary measurements were maternal and neonatal outcomes. Statistics analyses were descriptive as well as, univariate and multivariate comparisons OR (95%CI). RESULTS: We identified 240 women in Group 1 and 1690 in Group 2. Group 1 glycemic control (mean glucose 72 hrs (p 0.2 and 0.3 respectively). CONCLUSION: Induction at term for GDM is not associated with any increase in the maternal risks. Whether the risk of shoulder dystocia is augmented by induction of labor in women with GDM should be carefully evaluated in future multicenter studies.