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Gestational Diabetes: The Dilemma of Delivery

From the Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Ballimore, Maryland

Abstract

A prospective study of 84 patients with gestational diabetes for whom the route of delivery was determined by the double-blind technic is presented. With strict attention to dietary management, it was possible to maintain the basal maternal plasma glucose concentrations below 100 mg/100 ml from the initiation of management until delivery. Under these circumstances, perinatal mortality and morbidity were not increased with advancing gestational age. Neonatal complications were minimal for either route of delivery. Maternal weight gain and weight at delivery were positively correlated with birthweight of the infant, yet the degree of abnormality in the glucose tolerance test had no influence on the outcome of the pregnancy. Postoperative maternal morbidity following cesarean section was of a minor nature. No advantage to preterm delivery by cesarean section was found in this study, since one of the contraindications to vaginal delivery—fetal macrosomia—was averted through maternal dietary control.