Maternal and neonatal outcomes of deliveries at 39 weeks compared to deliveries at 40 weeks in pregnant women with diet controlled gestational diabetes mellitus

Abstract

Objective

Current guidelines do not provide convincing conclusions for the ideal time of delivery in women with diet-controlled gestational diabetes mellitus (GDM). We aim to compare maternal and neonatal outcomes of deliveries at 39 weeks compared to deliveries at 40 weeks in pregnant women with diet-controlled gestational diabetes mellitus.

Methods

This prospective observational cohort study included 219 pregnant women with diet-controlled gestational diabetes who delivered at 39 weeks (106 patients) or 40 weeks (113 patients) in our center from January 2017 to January 2018. Maternal and neonatal characteristics and outcomes were collected and compared between these two groups based on gestational age.

Results

There was no statistically significant difference between these two groups in delivery mode (p = 0.581), macrosomia (6.6% vs. 10.6%, p = 1). The rate of postpartum hemorrhage, uterine atony, and perineal laceration (3rd and 4th grades) of the study groups was not significantly different. Considering neonatal outcomes, there were no significant differences in the incidence of intrauterine growth restriction, low Apgar score, neonatal intensive care unit admission, and thick meconium between two groups (p > 0.05). The incidence of shoulder dystocia and preeclampsia in women who delivered at 40 weeks was slightly higher than in women who delivered at 39 weeks (0% vs. 3.5% (p = 0.122) and 2.8% vs. 9.7% (p = 0.051), respectively). Neither of these differences was statistically significant.

Conclusion

There were no statistically significant differences in maternal and neonatal adverse outcomes in women with diet-controlled gestational diabetes who delivered at 39 weeks compared to women who delivered at 40 weeks. However, the observed higher rate of shoulder dystocia and preeclampsia among women who delivered at 40 weeks might need to be investigated further in larger studies while it might indicate the need for iatrogenic intervention at 39 weeks.