Categories
Prevention of diabetes

Understanding Gestational Diabetes during Pregnancy

The manuscript was written by Li X, Li TT, and Tian RX, who also prepared the researched data and contributed to the discussion. All authors have approved the final version of the manuscript.

This research was supported by the National Natural Science Foundation of China under grant numbers 82071679 and 82271721, as well as the Basic and Clinical Cooperative Research Promotion Program of Anhui Medical University under grant number 2019xkjT020.

Important dates for this research include receiving it on December 25, 2022, revising it on January 17, 2023, accepting it on February 22, 2023, and officially publishing it on March 15, 2023.

Our article is open-access and has undergone rigorous peer review. It is distributed under the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, allowing others to share, adapt, and build upon our work non-commercially with proper citation.

Additional information: The research findings were presented at the International Conference on Biomedical Sciences in Shanghai, China on April 5, 2023.

This study was conducted in collaboration with researchers from several other institutions, including Peking University and Fudan University.

New_H2_1

Gestational diabetes mellitus (GDM) is a common complication during pregnancy that is closely linked to negative outcomes for both mothers and babies. As the incidence of GDM rises, it is crucial to understand the impact of delivery time on these outcomes. This review categorizes GDM patients based on their treatment response and explores the optimal timing of delivery for each category to provide evidence-based recommendations for clinical practice.

Keywords: Diabetes, Glucose, Pregnancy, Delivery, Optimal time, Maternal-fetal outcomes

Key Point: With the increasing global incidence of GDM, it is essential to determine the best delivery time for women with different classes of GDM to improve maternal and fetal outcomes.

New_H2_2

Gestational diabetes mellitus (GDM) can have serious implications for both the mother and the baby. Women with GDM are at higher risk of developing type 2 diabetes later in life. Babies born to mothers with GDM are more likely to have macrosomia (large birth weight), hypoglycemia (low blood sugar), and respiratory distress syndrome. Proper management of GDM through diet, exercise, and sometimes medication is crucial to ensure a healthy pregnancy and delivery.

New_H2_3

Research indicates a direct correlation between high blood glucose levels during pregnancy and adverse maternal-fetal outcomes later on. Screening for Gestational Diabetes Mellitus (GDM) is recommended for all pregnant women, and different diagnostic methods, such as the “one-step” and “two-step” approaches, are utilized. GDM is typically diagnosed through a glucose tolerance test, where blood glucose levels are measured at specific intervals after consuming a glucose solution. Understanding the diagnostic criteria and classification of GDM is crucial for making informed decisions regarding maternal and fetal health. Proper management of GDM can reduce the risk of complications for both the mother and baby, ensuring a healthy pregnancy and birth.

New_H2_4

When it comes to concluding a pregnancy affected by GDM, the choice between vaginal delivery and cesarean section can be a complex one. Factors that may influence this decision include the health of the mother and baby, the baby’s size, the mother’s blood sugar levels, and the overall progress of the pregnancy.

For women with well-controlled GDM and no other complications, a vaginal delivery may be a safe option. However, if there are concerns about the baby’s size or the mother’s blood sugar levels, a cesarean section may be recommended to reduce the risks of complications during delivery.

In either case, it is important for healthcare providers to closely monitor the mother and baby throughout labor and delivery to ensure the best possible outcomes. Regular blood sugar monitoring, fetal heart rate monitoring, and other tests may be necessary to make informed decisions about the timing and method of delivery.

Ultimately, the goal of managing GDM is to achieve a safe and healthy delivery for both mother and baby. By working closely with healthcare providers and following recommended guidelines for monitoring and control, women with GDM can increase their chances of a positive outcome for themselves and their baby.

New_H2_5

New_H3_1

A1 GDM, the most common type, poses significant concerns regarding the best delivery timing. National guidelines vary in their recommendations, with some suggesting waiting until 40 + 6 weeks for spontaneous delivery, while others advocate for induction at 40 weeks. This lack of consensus highlights the need for more research in this area.

New_H3_2

Patients with A1 GDM face risks of maternal-fetal complications, emphasizing the importance of careful management. Studies comparing outcomes in A1 GDM, well-controlled GDM, and normal pregnancies provide valuable insights for clinical decision-making.

New_H3_3

The timing of labor induction plays a crucial role in the rates of cesarean sections, fetal death, and neonatal complications in A1 GDM patients. Studies suggest specific gestational windows for induction to minimize risks.

New_H3_4

Outcomes in A1 GDM pregnancies are influenced not only by glycemic control but also by factors like cervical readiness. Tailoring induction decisions based on individual factors such as Bishop score can lead to better outcomes for both mother and baby.

New_H3_5

In A1 GDM patients, the ideal timing for labor induction falls between the 39th and 40th week, accounting for individual factors. Further research is needed to validate these findings through high-quality RCT studies with larger cohorts.

A2 GDM

A2 GDM

Pharmacotherapy

For individuals with A2 GDM, insulin is recommended as the primary treatment. However, insulin has its drawbacks, including hypoglycemia and excessive weight gain. Glibenclamide and metformin can serve as viable alternatives. Metformin has shown better perinatal outcomes compared to insulin, while glibenclamide is less effective. As a result, glibenclamide should not be the first choice in treating GDM when insulin or metformin are viable options.

Optimal time of delivery

When considering the timing of delivery for A2 GDM patients, the focus should be on balancing the risks associated with early delivery and appropriate management. The current recommendation is delivery at 39 weeks of gestation. Studies indicate a higher risk of perinatal death when delivery occurs later than 39 weeks compared to deliveries at 39 weeks. Inducing labor at 38 weeks in patients with insulin-dependent GDM has been shown to reduce the occurrence of shoulder dystocia. Therefore, the widely accepted delivery window for A2 GDM patients is currently between the 39th and 40th week of gestation.

Notes for future research

While the optimal delivery timing for A2 GDM patients is around the 39th week of gestation, new evidence is required. Factors such as cervical status and fetal lung maturity should be taken into consideration. Adjustments to the induction timeline should be made based on these factors. Further research is needed to determine if delivery timing should be personalized for individual cases.

A3 GDM

Guideline recommendations

Women with poor glycemic control during pregnancy are advised to consider delivery between 34 and 39 weeks plus 6 days of gestation. Delaying delivery for these women, especially in cases of poor control or complications, is recommended, with the ideal time falling between 37 and 38 weeks plus 6 days.

Predict pregnancy outcomes

Women with poor glycemic control face increased risks of maternal and neonatal complications. Maternal hyperglycemia can lead to various complications in infants. Adequate management of glycemic control is crucial in reducing these risks.

When making delivery decisions for women with poor glycemic control, it is essential to weigh the benefits and drawbacks of induction versus waiting for natural labor. Studies have shown that delivering at 38 weeks can reduce complications. More research is necessary to determine the optimal delivery time for this population.

Optimal time of delivery

For women with poor glycemic control, delivery before 39 weeks is recommended, considering factors like cervical status and fetal lung maturity. Tailored delivery times are advised for this group due to the heightened risks involved.

CONCLUSION

The optimal timing of delivery for patients with different classes of GDM should take into account maternal and fetal factors. Additional studies are needed to provide better data for decision-making regarding labor timing across various GDM classes.

Figure 1.

Recommendation for the optimal delivery timing in gestational diabetes mellitus cases. GDM: Gestational diabetes mellitus.

Footnotes

Conflict-of-interest statement: The authors declare no relevant conflicts of interest.

Provenance and peer review: Invited article; Externally peer-reviewed.

Peer-review model: Single blind

Peer-review started: December 25, 2022

First decision: January 9, 2023

Article in press: February 22, 2023

Specialty type: Endocrinology and metabolism

Country/Territory of origin: China

Peer-review report’s scientific quality classification

Grade A (Excellent): A

Grade B (Very good): 0

P-Reviewer: Adela R, India; Thandassery RB, United States S-Editor: Wang JJ L-Editor: A P-Editor: Wang JJ

Contributor Information

Xuan Li, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.

Teng-Teng Li, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.

Rui-Xian Tian, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.

Jia-Jia Fei, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.

Xing-Xing Wang, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.

Hui-Hui Yu, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.

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