Guidelines for Induction of Labor in Diabetic Mothers
Timing of Delivery
- Prolongation of gestation past 38 weeks increases the risk of fetal macrosomia without reducing cesarean rates, so delivery during the 38th week is recommended unless obstetric considerations dictate otherwise 1
- There is no evidence supporting delivery before 38 weeks' gestation in the absence of objective evidence of maternal or fetal compromise 2
Indications for Earlier Delivery
- Delivery before 39 weeks may be indicated in cases of poor glycemic control (elevated blood glucose levels) 1
- Delivery before 39 weeks may be indicated in cases of hypertensive disorders 2
- Delivery before 39 weeks may be indicated in cases of evidence of fetal compromise 2
Fetal Surveillance
- Increased surveillance is appropriate for pregnancies at risk for fetal demise, particularly when fasting glucose levels exceed elevated levels 1
- Mothers should be taught to monitor fetal movements during the last 8-10 weeks of pregnancy and report any reduction immediately 2
Mode of Delivery
Intrapartum Management
- Blood glucose monitoring during labor is recommended for women treated with insulin or oral hypoglycemic agents to guide correction of maternal hyperglycemia, prevent fetal hypoxia, and prevent neonatal hypoglycemia 2
- Maintaining blood glucose levels between 5-10 mmol/L (90-180 mg/dL) during labor is generally recommended 3, 4
Special Considerations
- Use of corticosteroids for fetal lung maturity should not be withheld due to diabetes, but will require intensified monitoring of maternal glucose levels and possible temporary addition or increase of insulin doses 2
Postpartum Follow-up
- Women with diabetes should be tested for persistent diabetes at 4-12 weeks postpartum using a 75-g oral glucose tolerance test 5
- Lifelong screening for diabetes should be performed at least every 3 years 5
- Breastfeeding should be encouraged in women with diabetes 1