Delivery in diabetic pregnancy

Two hundred and twenty deliveries of diabetic pregnant women, occurring from 1990-1994 were studied: 186 gestational (GDM) and 34 pregestational diabetes (PGDM). Women who delivered during the year of 1994 were considered as control population (3615 births). Mode of delivery, planned delivery, delivery's gestational age, shoulder dystocia, macrosomia and large for gestational age (LGA) were investigated. Cesarean section and planned delivery were respectively 39% vs 20.5% and 51.6% vs 16% respectively in diabetic vs control women. Deliveries after 40 weeks were 29% in GDM, 3% in PGDM and 50% in control women. Macrosomia occurred in 17.7% of diabetic against the 8% of controls. Finally shoulder dystocia occurred in the 3.6% of diabetic women against the 0.3% of the control group. These data indicate that in our diabetic population there is a high rate of cesarean sections and planned deliveries, as well as macrosomia, LGA and shoulder dystocia. Obstetric decision to allow the delivery to term or near term was not enough to bring the rate of macrosomia and LGA close to the normal, which can be consequence of the diabetic control in pregnancy, in spite of intensive care intervention.