Induction After 40 Weeks In Women With Gestational Diabetes Associated With Cesarean Delivery
Induction after 40 weeks in women with gestational diabetes associated with Cesarean delivery 1. Compared to women with mild gestational diabetes (GDM) induced at 39 weeks, those induced at 41 weeks were three times as likely to undergo Cesarean delivery (CD). 2. At 40 weeks, women with GDM who underwent induction of labor were more likely to undergo CD than those who were expectantly managed. Evidence Rating Level: 2 (Good) Study Rundown: This study found that in women with GDM, labor induction was not associated with increased odds of CD until after 40 weeks gestational age. Prior studies have shown that lower rates of CD are associated with spontaneous labor and elective induction. The results of this analysis suggest that when indicated, labor induction prior to 40 weeks may decrease risk of CD among women with mild GDM. Limitations include post-hoc analysis and generalizability, as women with GDM are more likely to have labor complications necessitating CD. Strengths of this landmark study include RCT design and use of two sets of gestational-age matched controls: those undergoing induction and those expectantly managed. Future RCTs or prospective cohort studies are merited to inform ideal timing of induction for the larger population. Relevant Reading: Systematic review: elective induction oflabor versus expectant management of pregnancy Study Author, Dr.Amelia Sutton, MD, PhD, talks to 2 Minute Medicine:University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Fellow in the Division of Maternal-Fetal Medicine Induction of labor, compared to expectant management, prior to 40 weeks does not increase cesarean delivery risk in women with mild gestational diabetes (GDM). Large RCTs are warranted to fully evaluate the maternal and neonatal risks as Continue reading >>
- Does Gestational Diabetes always mean a Big Baby and Induction?
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making
Induction Of Labour
In order for a baby to be born the cervix (neck of the uterus) has to shorten, soften and open and there needs to be contractions. In most pregnancies this process happens naturally between 38 - 42 weeks and is known as 'spontaneous labour'. Induction of labour is the process of starting labour artificially. Reasons for induction Prolonged pregnancy - where pregnancy continues after 41 weeks Pre labour rupture of membranes - where the waters surrounding the baby break and labour does not start within 24 hours and there is a risk of infection Medical reasons - where it is felt there is increased risk to the health of your baby or you should the pregnancy continue Does a diagnosis of gestational diabetes mean induction? For many ladies with gestational diabetes, we may fall into the 3rd reason stated above (Medical reasons). According to the current NICE guidelines induction (or elective caesarean section) should only be considered before 40+6 weeks for women with gestational diabetes if there are maternal or fetal complications. NICE (English & Welsh) guidelines: Timing and mode of birth 1.4.1Discuss the timing and mode of birth with pregnant women with diabetes during antenatal appointments, especially during the third trimester. [new 2015] 1.4.2 Advise pregnant women with type 1 or type 2 diabetes and no other complications to have an elective birth by induction of labour, or by elective caesarean section if indicated, between 37+0 weeks and 38+6 weeks of pregnancy. [new 2015] N/A for gestational diabetes 1.4.3 Consider elective birth before 37+0 weeks for women with type 1 or type 2 diabetes if there are metabolic or any other maternal or fetal complications. [new 2015] N/A for gestational diabetes 1.4.4 Advise women with gestational diabetes to give birth no later th Continue reading >>
Going Over 40 Weeks With Gd
Would anybody with experience of going over 40 weeks with GD be free (and willing) to have a chat? We've had a horrible experience at my appointment today. After being told all pregnancy that my GD is extremely well controlled and poses virtually no risk to myself or baby as a result, that scans and CTGs have showed baby is very happy and healthy and that my placenta is functioning well, we went to my appointment today at 39+6 and they were originally talking about induction at 41 weeks. Then suddenly they said "oh wait, GD, we need to induce at 40 weeks". We were suddenly told that all of these risks apply to me purely because I "have the label of GD" and that I should be induced ASAP. I asked if we could have extra scans or monitoring from now on and was told that they would essentially be worthless. We were made to feel like absolute crap for not wanting to accept an induction date straight away. We asked questions that were fobbed off and when I asked what risks were involved with continuing the pregnancy past 40 weeks, the midwife said "well you tell me!" To which I responded with "I don't know - you're the midwife!" We are feeling completely misinformed and essentially bullied. They dismissed any research/information I had read or been told by other doctors and basically just stated hospital policy. We have now ended up with an induction booked in at 40+3 that we feel incredibly uncomfortable about because we don't feel like we understand the risks either way (eg. continuing past 40 weeks vs induction etc). I'd just really love to talk to somebody else who has gone over 40 weeks about how we're feeling. Xx Continue reading >>
Induction Of Labor Before 40 Weeks Is Associated With Lower Rate Of Cesarean Delivery In Women With Gestational Diabetes Mellitus - Sciencedirect
Volume 214, Issue 3 , March 2016, Pages 364.e1-364.e8 Induction of labor before 40 weeks is associated with lower rate of cesarean delivery in women with gestational diabetes mellitus Presented at the 36th annual meeting of the Society for Maternal-Fetal Medicine, Atlanta, GA, February 1-6,2016. Author links open overlay panel NirMelamedMDa Get rights and content In women with gestational diabetes mellitus, it is not clear whether routine induction of labor at <40 weeks of gestation is beneficial to mother and newborn infant. The purpose of this study was to compare outcomes among women with gestational diabetes mellitus who had induction of labor at either 38 or 39 weeks with those whose pregnancy was managed expectantly. We included all women in Ontario, Canada, with diagnosed gestational diabetes mellitus who had a singleton hospital birth at 38+ 0 weeks of gestation between April 2012 and March 2014. Data were obtained from the Better Outcomes Registry & Network Ontario, which is a province-wide registry of all births in Ontario, Canada. Women who underwent induction of labor at 38+ 0 to 38+ 6 weeks of gestation (38-IOL; n= 1188) were compared with those who remained undelivered until 39+ 0 weeks of gestation (38-Expectant; n= 5229). Separately, those women who underwent induction of labor at 39+ 0 to 39+ 6 weeks of gestation (39-IOL; n= 1036) were compared with women whoremained undelivered until 40+ 0 weeks of gestation (39-Expectant; n= 2162). Odds ratios and 95% confidence intervals were adjusted for maternal age, parity, insulin treatment, and prepregnancy body mass index. Of 281,480 women who gave birth during the study period, 14,600 women (5.2%) had gestational diabetes mellitus; of these, 8392 women (57.5%) metall inclusion criteria. Compared with the 38-E Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Does Gestational Diabetes always mean a Big Baby and Induction?
- Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making
Gestational Diabetes Versus Unwanted Interventions
Deborah is 36 weeks pregnant and has gestational diabetes. She’s been careful about diet and exercise and has maintained very stable blood sugar levels. Her doctor, however, is warning her she’ll probably need to be induced at 39 weeks and may need a c-section. He wants her to get an early epidural so she’ll be ready for surgery, “just in case.” Deborah’s warning bells are going off because that’s not the labor she had in mind. She’s hoping for a spontaneous and un-medicated labor and worries her doctor is setting her up for interventions she doesn’t want. Gestational diabetes (GD) can have a big impact on mothers’ and babies’ health, but it doesn’t always have to be a big deal that requires all the tools in the medical toolbox. Often times, complications like GD can be managed carefully without making major diversions from the patient’s hoped-for birth plan. Deborah’s doctor told her that GD babies have to be induced at 39 weeks because sometimes they “just don’t come” until they’re two or three weeks past their due date. Deborah, that doesn’t sound quite right to me. GD babies are at somewhat higher risk to come earlier than their due date, not later. If mom’s blood sugars aren’t well controlled, babies can get too much glucose through the placenta and grow too big. That can trigger premature labor, damage the placenta and bump up risks for delivering a baby whose lungs aren’t fully developed. Premature and super-sized babies tend to have more respiratory problems and a tough time stabilizing their own blood sugars too. That doesn’t mean these problems are guaranteed to happen to you and your baby, Deborah. It means there’s a greater risk. Many GD babies are born healthy with normal weights and perfect birthdays and neve Continue reading >>
Planned Birth At Or Near Term For Pregnant Women With Gestational Diabetes And Their Infants
Planned birth at or near term for pregnant women with gestational diabetes and their infants The aim of this Cochrane review was to find out if planning an elective birth at or near the term of pregnancy, compared to waiting for labour to start spontaneously, has an impact on the health of women with gestational diabetes and the health of their babies. Planned early birth means either induction of labour or caesarean birth, and 'at or near term' means 37 to 40 weeks' gestation. To answer this question, we collected and analysed all relevant studies conducted up to August 2017. Women with gestational diabetes (glucose intolerance arising during pregnancy) and their babies are at increased risk of health complications (e.g. high blood pressure, bigger babies). Because of the complications sometimes associated with birthing a big baby, many clinicians have recommended that women with gestational diabetes have an elective birth (generally an induction of labour) at or near term (37 to 40 weeks' gestation) rather than waiting for labour to start spontaneously, or until 41 weeks' gestation if all is well. Induction has disadvantages of increasing the incidence of forceps or ventouse births, and women often find it difficult to cope with an induced labour. Caesarean section is a major operation which can lead to blood loss, infections and increased chance of problems with subsequent births. Early birth can increase the chance of breathing problems for babies. It is important to know which approach to birth has a better impact on the health outcomes of women with gestational diabetes and their babies. Our search identified one trial involving 425 women and their babies. In this trial , 214 women had an induction of their labour at term, the other 211 women waited for a spontan Continue reading >>
Gestational Diabetes & Induction?
I have GD and when I first went to the diabetes clinic at around 28 weeks they said because of the risk of stillbirth they won't let me go over 38 weeks. When I had my obstetrician appointment I asked when they would induce me and he said " why on earth would we do that? Maybe when you get to 40 weeks" I explained that I've had 3 miscarriages before and how scared I am that I will lose this one at close to term because of the GD but he wouln't listen and said that nothing will be done till 40 weeks and that baby's lungs won't be ready till at least 37 weeks. I'd rather take the chances on baby's lungs rather than a stillbirth. I'm completely terrified something will go worng. I've joked I'm going to do my own c-section on myself or camp out at the hospital until they see it my way. Even the NICE guidelines say 38 weeks with GD! When have or are others with GD being induced if baby hasn't arrived naturally? It all depends how good your control is. Do you know your hba1c? If it is low enough there is no reason to worry. Ask them why in your case it is ok. It may well be. As far as I know I haven't had an hba1c done. They didn't deem it necessary. So I have no idea what he is basing his 40 week opinion on. Hi, my GD is well controlled through metformin and HBA1C nice and low. I had my last growth scan yesterday and was offered an induction which I have accepted, when I will be 39 weeks. Following the guidelines, like you say, it specifically states that when you get to 36 weeks with good glycaemic control you'll be offered Induction of Labour at 38 weeks or every week up to 41 weeks if you prefer to go into labour spontaneously, whereas if not good control and particularly if you're on insulin and baby's measurements way off the chart, they offer induction of labour/c-sec Continue reading >>
- Does Gestational Diabetes always mean a Big Baby and Induction?
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
Gestational Diabetes And Induction Of Labour – What You Should Know
Gestational Diabetes and Induction Gestational diabetes (GD) was once a relatively rare condition, occurring in about 4% of pregnancies. In recent years, the rate of women developing GD has doubled, and experts believe the incidence of the disease will keep increasing. Most women with GD are told by their care providers they will need to be induced before their due date, destroying their hopes for a natural and intervention free birth. Having GD can have a big impact on mothers’ and babies’ health during pregnancy, but does it really need to change how we give birth? What Is Gestational Diabetes? Gestational diabetes is a condition that only occurs during pregnancy. Certain pregnancy hormones interfere with your body’s ability to use insulin. Insulin converts blood sugar into usable energy, and if this doesn’t happen, blood sugar levels rise. Insulin resistance can cause high blood glucose levels and can eventually lead to gestational diabetes. Some women will have symptoms of GD, while others will have none. Many women can manage the condition without treatment other than dietary and exercise changes. Around 20% of women will need insulin injections. So for many women, well managed diabetes means they can still have healthy babies and normal births. Induction Of Labour Many care providers routinely recommend that women with gestational diabetes be induced around 38-39 weeks. The most common reasons given for induction at this gestation are to prevent stillbirth, and to prevent babies growing too large for vaginal birth. However, the evidence related to induction for women with GD comes from the review of one trial, which looked at 200 women who had either GD, Type 1 or Type 2 diabetes. The World Health Organization states this evidence for induction before 41 w Continue reading >>
Timing Of Delivery In Gestational Diabetes Mellitus: Need For Person-centered, Shared Decision-making
Go to: Abstract Gestational diabetes mellitus (GDM) is a medical as well as obstetric challenge, which needs person-centered management. The timing of delivery of women with GDM is discussed by various obstetric professional bodies. We highlight pertinent medical, obstetric, and psychosocial factors which may influence the timing of delivery in women with GDM. This commentary proposes a person-centered approach to decide the delivery timing in GDM and supports shared decision-making based upon the individual’s biopsychosocial characteristics and environmental factors. Keywords: Antenatal corticosteroid therapy, Cephalopelvic disproportion, Diabetes, Fetomaternal distress, Labor, Macrosomia Go to: Introduction The prevalence of gestational diabetes mellitus (GDM) is rapidly increasing across the world and it is a common endocrine complication in obstetric practice today [1–3]. GDM, as a syndrome, is marked by controversy related to virtually every facet, ranging from its nomenclature, screening tools, and diagnosis to management strategies [4, 5]. Most debate on GDM management centers on medical issues, such as appropriateness of oral hypoglycemic agents. In this communication, we discuss the timing of delivery in GDM and emphasize the need for person-centered, shared decision-making in this regard. Compliance with Ethics Guidelines This article does not contain any new studies with human or animal subjects performed by any of the authors. Go to: Current Recommendations Expert recommendations suggest that women with uncomplicated GDM take their pregnancies to term, and deliver at 38 weeks gestation [6]. Such a decision is not as simple as it seems. These recommendations differ from earlier findings, which suggested earlier induction of labor [7], but are consonant wi Continue reading >>
- Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
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Does Gestational Diabetes Always Mean A Big Baby And Induction?
July 3, 2012 by Rebecca Dekker, PhD, RN, APRN © Copyright Evidence Based Birth®. Please see disclaimer and terms of use. This question was submitted to me by one of my readers, Sarah. “I have a question about gestational diabetes. It seems like everyone I know who has had it has ended up being induced. Does gestational diabetes automatically mean induction? Does it automatically mean big babies? It seems like people get diagnosed and then give up on a natural childbirth and are treated as a sick person.” I talked to Dr. Shannon (a family medicine physician), and she echoed Sarah’s perceptions about gestational diabetes: “I would say that ‘routine care’ in the U.S. is to induce at 38 to 39 weeks for gestational diabetes (leaning towards 39 weeks nowadays) if the mom’s glucose is uncontrolled or if she is controlled on medication. However, women can technically be treated as ‘normal’ if their gestational diabetes is well controlled and baby’s growth looks normal on a 32 week scan. So people just might want to know they will get major push back from their provider if they refuse induction. It’s tough. Many OB’s cite the risk of stillbirth as a reason for induction, because the risk of stillbirth in women with regular diabetes is higher. However, there is no evidence that the risk of stillbirth goes up in gestational diabetes.” Evidence Based Birth® offers an online course on Big Babies and Gestational Diabetes (3 contact hours)! To learn more, click here! Dr. Shannon brings up several good points. First, she is talking about “routine care,” which is very different from “evidence-based care.” Routine care means that this is what everyone is doing—it’s routine, it’s standard. Evidence-based maternity care means offering care that is Continue reading >>
Induction At 40 Weeks?
Question for all of you that are diet controlled! Is your provider planning on inducing you at or shortly before 40 weeks if you haven't had baby yet? Originally, my provider told me even with diet controlled and good numbers, she wouldn't let me go past 40 weeks. Now, she is saying she wants to let me go into labor naturally even if I pass 40 weeks because my numbers have been good! She said she is going to check to see if protocol is to induce at 40 or not...I guess I'm just trying to figure out if most hospitals induce at 40 weeks. Thanks in advance!! Depends on doctor, I was diet controlled and mine let me go to 42 weeks. She would have scheduled induction if I wanted though. I also had NST every 3 days for those two weeks. I will be induced by 40 weeks by the latest might be at 38 or 39 weeks. I have diet controlled GD, and am 36 so because of those two factors they will induce. I am also starting biophysical ultrasounds next week once a week until he is born to see when to induce. I am 35 and 4 days along. Thanks for the feedback! I'll be 38 weeks on Saturday and have gained 22 pounds so far. My midwife says because of my weight gain being right where she wants it, and the baby measuring basically right on track (actually a little small), she doesn't think I need to be induced. I guess I am just skeptical because my gd class said I would be induced 39-40 weeks. Plus I'm anxious to meet my little one! I hope they monitor me a little more closely like they did with you if I do go past 40 weeks Thank you! I thought it was common to induce by 40 weeks even if gd was diet controlled! I feel like my midwife isn't taking it seriously because she thinks my lab results were wrong...I'm hoping I'll be induced right at 40 weeks if I haven't had her yet! Good luck to you and Continue reading >>
Gestational Diabetes But No Induction?
I was wondering if anyone has experience of having gestational diabetes but declining induction at 40 weeks? I was diagnosed with GD at 32 weeks. I have controlled it with diet. I had a difficult first birth after induction at 42 weeks, and am very unhappy about the idea of being induced at 40 weeks (which feels early for me). I have read all the NICE guidelines and understand the rationale for the policy. So dont need any replies focusing on that. I am just wanting to find anyone who as the experience of not being induced at 40 weeks - what happened? what led to your decision? Not the answer you want, so please don't flame me. Had 4 GD pregnancies. One went to 41 weeks, three induced at 38 weeks. I have 3 wonderful DC's. Induction not nice, but end results were better than stillborn dc at 41 weeks. Sorry. Go with medical advice. It is sound and it is based on very real concern for the outcome for the baby. Sorry to focus on that but it is a really important factor. I was induced bang on the dot of 40 weeks with DD4 after controlling GD with diet and it went slowly but smoothly. I had a pessary late in the evening of day one, then syntocinon about midday on day two, and DD4 was born in the wee small hours of day three. Altogether the experience took about 36 hours and I slept until about 2 am the morning she was born as well as sleeping the whole first night. I had been induced previously at 40+7 with DS, 40+7 with DD3. DD1 was a week late and DD2 was ten days late. With DS, I had a pessary the night before but had made no progress so they gave me syntocinon at 7 am and predicted the whole business would take 8 hours. They were off by only 6 minutes. With DD3, a pessary was all it took, and labour lasted about 9 hours start to finish. For a first induced birth, insist Continue reading >>
- Does Gestational Diabetes always mean a Big Baby and Induction?
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
Gestational Diabetes And Giving Birth
The latest guidance from NICE, published in 2015, has extended the time by which women with gestational diabetes should give birth to 40 weeks, 6 days – not much less than the general guidance for all pregnant women, which is 42 weeks. If you have not gone to birth at this point, induction of labour will be recommended. "When I was in the hospital, I felt I didn’t know what was going on. I would have liked more information about that part so I could have been better prepared." Gemma, mum of one The main reason for induction is to prevent stillbirth. For all women, the risk increases when their pregnancy goes past 42 weeks. However, one study has shown that women with gestational diabetes may be at risk earlier. So for this reason, the guidance in England and Wales states that if you have gestational diabetes, you should not go beyond 40 weeks, 6 days. An induction or caesarean may also be advised if your baby is very large (macrosomia) – as this may cause difficulties during the birth. On the other hand induction may also be recommended if the team detects poor growth in your baby. In Scotland, most women with diabetes in pregnancy are induced within 40 weeks. The guidance says that this decision should be determined on an individual basis. If you are taking diabetes medication or insulin, it recommends that you should be assessed at 38 weeks and delivered by 40 weeks. Choices you might need to make for labour and birth Most women with gestational diabetes have a healthy birth. But before you make your birth plan, you may need to take some things into account to make sure you and your baby are safe during and after the birth. If you have gestational diabetes, you will have less choice about where to deliver your baby. This is because you will need to deliver your Continue reading >>
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Lamaze For Parents : Forums : Gestational Diabetes - Induction At 39 Weeks?
gestational diabetes - induction at 39 weeks? gestational diabetes - induction at 39 weeks? I am 37 weeks pregnant with my third child. I was diagnosed withGD at 18 weeks; I had it with baby #2, which is why I was screenedearly. I began my pregnancy with normal BMI and have gained 32 poundsto date. I take 22u of NPH insulin at night to control my morningblood sugars (target below 95). I have successfully controlleddaytime blood sugars with diet. Baby has been monitored twiceweekly since 32 weeks (NST on Mondays, biophysicals on Thursdays)and has passed each test with flying colors. Last week, my OB told me she wanted to induce at 39 weeks. Sheindicated that this was "the standard of care" recommended by ACOGfor women with insulin-dependent GD. I protested, saying that Icarried my second child to term. (He weighed 8 lb 14 oz - Idelivered him without pain meds and with minimal pushing - hisblood sugar did crash following the birth, but I labored at homeand had not been instructed about how to monitor my glucose levelsduring labor.) At today's biophysical, baby measured 7 lb 4 oz. I'm aware ofthe high margin of error, but I'm worried this measurement is onlygoing to fuel my OB's fire. Can you please provide me with some studies and/or statistics Ican share with my OB,to support my desire to start labornaturally? I don't like the idea of laboring with Pitosin (whichwould likely equal pain meds), nor am I interested in forcing babyout before she's ready. RE: gestational diabetes - induction at 39 weeks? May 7, 2007 11:15 PM (in response to Archived User ) Asfar as I know, the only reason to induce a woman withwell-controlled diabetes is to reduce the likelihood of having abig baby and the problems that can go along with having a big baby,in particular, need for cesarean sur Continue reading >>
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Induction Of Labour For Low Risk Gestational Diabetes
In obstetrics the decision to induce Gestational Diabetes is the honour of the Obstetrician. Is rather individualised. In my experience, a woman who has been diet treated is placed in Midwife-led care pathway and care is provided in the community. The final review is at TERM with the Obstetrician who will make the decision for induction. Otherwise this woman has the choice of choosing to deliver in the Birth Centre. The normal plan of care for our ladies with diet controlled gestational diabetes is to stop blood sugar testing around 36 weeks and treat the lady as normal - IOL at T+14 - the same as any other low risk lady. The normal plan of care for our ladies with diet controlled gestational diabetes is to stop blood sugar testing around 36 weeks and treat the lady as normal - IOL at T+14 - the same as any other low risk lady. The Obstetrician at my unit will induce all women with gestational diabetes before term ,if diet managed then as close to term as possible , however if needs Metformin or insulin then from 38 weeks as with the women with Type 1 and 2. Hi, In my units women with gestational diabetes are all reviewed by theobstetrician and those who are diet / metformin controlled then have shared care for the remainder of their pregnancy. As in Heather's unit, if blood glucose is well controlled by diet and growth is anticipated to be normal, IOL normally takes place at around 40 weeks. If on metformin IOL is generally between 39-40 weeks and if on insulin 38-39 weeks. It is interesting to see that in Sue's unit women who are diet controlled stop testing their BG at 36 weeks and they revert back to midwifery led care. Are there any figures from this unit to support this pattern of care because it would be a very useful tool to use if they are all good! We are cur Continue reading >>
