Meeting paperSMFM paperWhat is the optimal gestational age for women with gestational diabetes type A1 to deliver?
Section snippets
Materials and Methods
A decision-analytic model was created using TreeAge software (TreeAge Pro 2013; TreeAge Software, Inc., Williamstown, MA) to compare the outcomes of planning to deliver at 37-41 weeks in a theoretical cohort of 100,000 women with A1GDM (Figure 1). Strategies involving expectant management until a later GA accounted for probabilities of spontaneous delivery, indicated delivery, and IUFD during each successive week. GA-associated risks of neonatal complications included cerebral palsy, infant
Results
Both maternal and neonatal outcomes were predicted in our theoretical model of 100,000 women with A1GDM. We found that planned delivery of these women at 38 weeks’ gestation was the optimal timing of delivery, which maximized QALYs. In our theoretical cohort, delivering at 38 weeks resulted in 48 fewer stillbirths but 12 more infant deaths compared to delivery at 39 weeks (Table 2). Additionally, delivering women at 38 weeks compared to 39 weeks reduced the maternal death rate from 16.2 per
Comment
Our model, based on a theoretical cohort of 100,000 women with A1GDM, demonstrated that the optimal time to plan to deliver these women was 38 weeks to minimize adverse perinatal maternal and neonatal outcomes. Delivering at 38 weeks’ gestation remained the optimal strategy until infant death rates increased to a threshold of 3.73 times above our baseline assumptions, cerebral palsy rates increased to 3.79 times above our baseline assumptions, or IUFD rates increased to 1.90 times above our
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2024, European Journal of Obstetrics and Gynecology and Reproductive BiologyOptimizing Term Delivery and Mode of Delivery
2020, Clinics in PerinatologyCitation Excerpt :A decision analysis by Niu and colleagues34 (2014) examining delivery timing ofs patients with GDM concluded that 38 weeks was the ideal time for delivery in order to balance the risks of diabetes and neonatal mortality and morbidity. When adjusting for the baseline stillbirth rate, these data could be extrapolated to suggest that delivery at 39 weeks for patients with well-controlled GDM is optimal.32,34 The recommendation for early term delivery for medically managed patients with GDM comes primarily from a prospective, randomized controlled trial by Kios (1993) comparing induction at 39 weeks to expectant management.
Guideline No. 393-Diabetes in Pregnancy
2019, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :When including only stillbirths occurring after 28 weeks, many studies to date have shown a trend or a statistically significant increased risk of stillbirth attributable to GDM.2,8,13 The specific excess risk of stillbirth in relation to week of gestation has recently been shown in a cohort13 and simulation study derived from this cohort.14 This retrospective analysis of population-based data from California, showed that the overall risk of stillbirth from 36-42 weeks was higher in women with GDM when compared with women without GDM (17.1 vs. 12.7/10,000 deliveries; relative risk (RR) 1.34 (95% CI 1.2–1.5).14
Guideline No. 393 - Diabetes in Pregnancy
2019, Journal of Obstetrics and Gynaecology CanadaTiming of delivery and pregnancy outcomes in women with gestational diabetes
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This publication was supported by the Oregon Clinical and Translational Research Institute (OCTRI), grant number (TL1TR000129) from the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH) (B.N.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
The authors report no conflict of interest.
Cite this article as: Niu B, Lee VR, Cheng YW, et al. What is the optimal gestational age for women with gestational diabetes type A1 to deliver? Am J Obstet Gynecol 2014;211:418.e1-6.