Objective: To assess neonatal and maternal morbidity at birth for each week of gestation among pregnancies complicated with gestational diabetes (GDM) to evaluate optimal timing of delivery.
Design: This was a population-based cohort study of non-anomalous, singleton, live births between 36 and 40 weeks complicated by GDM using data from the U.S. Natality Vital Statistics Database from 2015 to 2022. Planned delivery group included births at each completed week from 36 to 40 weeks that had a labor induction or scheduled cesarean delivery, excluding spontaneous labor. Expectant management group included all births that delivered on or after the following week (i.e., planned birth at 36 0/7-36 6/7 compared to all births ≥37 0/7 weeks). The primary outcomes were a neonatal and maternal adverse composite, compared between groups at each week using multivariable analyses.
Results: There were 1,324,559 births included. After adjusting for the differences between groups, planned delivery ≥39 0/7 had lower odds of composite neonatal morbidity than the expectant management group. After 39 weeks, planned delivery and expectant management had similar odds of maternal morbidity.
Conclusion: In pregnancies complicated by GDM, planned delivery after 39 weeks was associated with lower odds of neonatal morbidity compared to expectant management. This data suggests that providers should be cautious about expectant management past 39 weeks.
D. Buckley: None. K. Khanuja: None. H.B. Al-Kouatly: None. R. McLaren: None.
