Exploring the impact of early-term labor induction on cesarean section risk in gestational diabetes mellitus: insights from a tertiary care hospital study in Pakistan

Abstract

Background: Gestational diabetes mellitus (GDM) is the most common endocrine disorder in pregnancy. It is associated with significant perinatal morbidity and mortality, therefore, an early-term delivery by routine induction of labor is proposed by some societies, to prevent/reduce these complications. Methods: This cross-sectional study was conducted between 1st January 2019 and 30th June 2020 at Aga Khan University Hospital, Pakistan to compare the pregnancy outcomes of patients with GDM when induced at 37, 38, and 39 weeks in comparison to women with GDM managed expectantly. The study included all women with singleton pregnancy and vertex presentation. Women induced after 41 weeks, previous cesarean delivery, placenta previa, major fetal anomalies, chronic maternal medical conditions that necessitate delivery, and those women presenting with spontaneous onset of labor were excluded. Data was analyzed in SPSS v.19. Results: A total of 293 women were included. The mean age of women was 27 years, and the mean BMI was 27.8 kg/m2. We found that women who were induced at earlier gestational weeks were managed with a combination of diet and pharmacological therapy in comparison to those induced at later gestational weeks and achieved glycemic control with diet and lifestyle modifications only. Around 77% of women required pharmacological therapy. The mode of delivery was not significantly different for women induced at different gestational weeks after 37 completed weeks. For neonatal outcomes, the birth weight was significantly greater for women induced at later gestational weeks. Conclusions: In women with gestational diabetes induced after 37 weeks at various gestational weeks, the mode of delivery is not significantly different.