Gestational Diabetes and Induction

[BellyBelly]

Just thought I would make you all aware of our induction article: https://www.bellybelly.com.au/birth/...-or-not-induce as many women with Gestational Diabetes have pressure to induce early being told you will have a macrosomic (large) baby, due to your condition. The article contains references to inductions and Gestational Diabetes and lots of info about the induction process.

It also tells of babies being born early from inductions, only to find that the baby was actually tiny - and one midwife shares a story of one being close to cut-off for ICU admittance. Fundal height does not have a great deal to do with size - it can vary depending on baby's position, amniotic fluid levels and of course size, but all these things combined do not make it a sure thing, nor does ultrasound.

The American College of Obstetricians and Gynaecologists did an analysis on 11 studies as below and concluded that they do not see the routine induction of macrosomic babies offering better outcomes (or reduce things like sholder dystocia, operative vaginal deliveries or abnormal apgar scores etc.), rather seeing it as more likely to end up with a caesarean or other problems, see below.

Just to clarify first:

ACOG - American College Obs & Gyns
fetal macrosomia - large baby i.e. as per often women with GD are told they may have.

PRINT THIS OFF AND GIVE TO YOUR OB!!!

Expectant Management Versus Labor Induction for Suspected Fetal Macrosomia: A Systematic Review

Luis Sanchez-Ramos, MD, Sara Bernstein, MD and Andrew M. Kaunitz, MD
From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, Jacksonville, Florida.

Address reprint requests to: Luis Sanchez-Ramos, MD, University of Florida, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 653-1 West 8th Street, Jacksonville, FL 32209; E-mail: luis.sanchez@jax.ufl.edu.

OBJECTIVE: To systematically review and summarize the medical literature regarding the effects of expectant management and labor induction on mode of delivery and perinatal outcomes in patients with suspected fetal macrosomia.

DATA SOURCES: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies assessing management of patients with suspected fetal macrosomia.

METHODS OF STUDY SELECTION: We evaluated, abstracted data, and performed quantitative analyses in studies assessing the outcome of patients with suspected fetal macrosomia. Observational studies and randomized trials were included in this systematic review.

TABULATION, INTEGRATION, AND RESULTS: Twenty-nine studies were identified, 11 of which met our criteria for systematic review and meta-analysis. These 11 studies included 3751 subjects. Of these, 2700 were managed expectantly, and 1051 underwent labor induction. We calculated an estimate of the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes, using random- and fixed-effects models for outcomes. Summary statistics for the nine observational studies showed that, compared with those whose labor was induced, women who experienced spontaneous onset of labor had a lower incidence of cesarean delivery (OR 0.39, 95% CI 0.30, 0.50) and higher rates of spontaneous vaginal delivery (OR 2.07, 95% CI 1.34, 3,19); however, significant differences in these outcomes were not noted when the two randomized trials were assessed. No differences were noted in rates of operative vaginal deliveries, incidence of shoulder dystocia, or abnormal Apgar scores in the analyses of the observational or randomized studies.

CONCLUSION: Based on data from observational studies, labor induction for suspected fetal macrosomia results in an increased cesarean delivery rate without improving perinatal outcomes.