Delivery (timing, route, peripartum glycemic control) in women with gestational diabetes mellitus.

OBJECTIVES

To provide management guidelines for labour and delivery in women with gestational diabetes.

MATERIALS AND METHODS

A literature search was performed using the PubMed and Cochrane databases. Foreign societies guidelines were also consulted.

RESULTS

There is no additional information from recent studies that supports changing current French guidelines about timing of delivery in gestational diabetes. The incidence of shoulder dystocia is increased in women with gestational diabetes, especially when infants weigh more than 4500 g. Elective caesarean-section when the foetal weight is greater than or equal to 4250 to 4500 grams may reduce the risk of shoulder dystocia. Meticulous attention to avoiding maternal hyperglycaemia during labour can prevent neonatal hypoglycaemia. There is no significant role for x-ray pelvimetry in the management of gestational diabetes.

CONCLUSION

Management of labour and delivery in women with gestational diabetes will mainly depend on estimated foetal weight, especially when macrosomia is present.