(110) Expectant management of diet controlled gestational diabetes mellitus

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Alesha M. White, MD (she/her/hers)

Fellow
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Coauthor(s)

DM

Donald D. McIntire, PhD

University of Texas Southwestern Medical Center
Dallas, Texas, United States
Anne M. Ambia, MD

Assistant Professor
University of Texas Southwestern
Dallas, TX, United States
Elaine L. Duryea, MD

Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Objective: Gestational diabetes is one of the most common diseases in pregnancy and is associated with increased maternal and neonatal morbidity. There is not enough data to support or discourage a specific delivery time for patients with diet controlled gestational diabetes mellitus (A1GDM). Our objective was to compare differences in outcomes for patients with A1GDM based on increasing gestational age.

Study Design: This is a retrospective cohort study that included deliveries of singleton live born term infants to patients with A1GDM. Diagnosis and treatment of A1GDM, including expectant management until 42 wks, was uniform. Delivery and neonatal outcomes for patients with A1GDM were compared with advancing gestational age and were then compared to the non-diabetic population. Neonates with known anomalies were excluded from analysis of neonatal outcomes. The Mantel-Haenszel and Breslow-day tests were used for statistical analysis.

Results: 4467 patients with A1GDM at 39 wks or greater delivered between November 2010 and February 2024. The rate of primary cesarean delivery (CD) increased with increasing gestational age (p< 0.001). Rates of forceps delivery, 3rd and 4th degree lacerations and shoulder dystocia demonstrated a worsening trend with advancing gestational age but did not reach significance. Neonatal outcomes were not significantly different. When compared to non-diabetic patients, all examined outcomes were increased in the A1GDM cohort except for forceps deliveries, hyperbilirubinemia and TTN (Table). The rates of increase for each outcome were not substantially higher in the A1GDM cohort when compared to non-diabetics, except in the case of primary CD (Breslow-day p</span>=0.03).

Conclusion: In patients with A1GDM and advancing gestational age, there are increased risks for the mother and neonate when compared to non-diabetics. The rate at which these risks increase is not more rapid than in patients without diabetes, except in the case of rate of primary CD. Although expectant management does not result in a greater overall incremental risk, delivery at 39 wks may be associated with lower rates of CD.