Timing of delivery for "poorly controlled" diabetes and associated neonatal outcomes

ACOG recommends delivery in the 39th week of pregnancy for pre-gestational and medication-controlled gestational diabetes with consideration for earlier delivery in those with poor glucose control. Although delivery before 39 weeks aims to reduce the risk of stillbirth, it is associated with increased neonatal morbidity. We examined the impact of delivery < 39 weeks performed solely for suboptimal glucose control on neonatal outcomes. This is a retrospective cohort study of all singleton, non-anomalous pregnancies with diabetes within a multi-institution health system, as identified via query of a comprehensive obstetric outcome database. Patients delivering at a given week gestation exclusively due to diabetes-related indications were compared to ongoing pregnancies (OP) (Figure 1). The primary outcome was NICU admission and secondary outcomes included stillbirth, neonatal death, hypoglycemia, respiratory distress syndrome (RDS), and NICU length of stay (LOS). Continuous and categorical variables were statistically compared. 4750 patients with perinatal diabetes met inclusion criteria. Of those, 30.5% delivered for a diabetes-related indication with 19.8% delivering before 39 weeks. Those delivering at 36 and 37 weeks for diabetes-related indications compared to OP had higher NICU admission (63% vs 9%, p< 0.001, median LOS 11.0 vs 2.8 days, p< 0.001 and 25% vs 7%, p< 0.001, median LOS 4.4 vs 2.6, p=0.026). There was no difference in NICU admission for delivery at 38 or 39 weeks compared to OP (Figure 2). There were significantly increased rates of neonatal hypoglycemia and RDS in the diabetes-related deliveries at 36, 37, and 38 weeks compared to OP. There were no differences in stillbirth or neonatal death. In pregnancies complicated by diabetes with suboptimal glucose control, early delivery is associated with increased NICU admissions, LOS, and neonatal morbidity. Optimal timing of delivery to balance the risk of stillbirth with neonatal morbidity remains undetermined. Our data suggest delivery at 38 weeks may be optimal.View Large Image Figure ViewerDownload Hi-res image Download (PPT)