The Effect of Delivery Timing on Cesarean Delivery Rate in Pregnancies Complicated by Pregestational Diabetes and Large-for-Gestational-Age Neonate

Objective: The Big Baby Trial found that early induction in patients with suspected large-for-gestational-age (LGA) fetuses reduced shoulder dystocia and prelabor cesarean rates. However, it excluded patients with pregestational diabetes mellitus (PGDM), who are at increased risk of adverse outcomes. We sought to evaluate delivery outcomes by gestational week in patients with PGDM and LGA fetuses. Study Design: weeks). The primary outcome was cesarean delivery rate and the secondary outcome was a composite of adverse neonatal outcomes (5-min Apgar score < 7, assisted neonatal ventilation > 6 hours, neonatal seizures, 10-min Apgar score of 0, and neonatal death). Outcomes were compared between groups at each week using multivariable logistic regression. Results: There were 9,805 births analyzed. Cesarean delivery rate ranged from 77 to 87%. After adjusting for baseline differences between groups, planned delivery at 39 weeks was associated with decreased odds of cesarean delivery than expectantly managed pregnancies. After 38 weeks, planned delivery and expectant management had similar odds of cesarean delivery and neonatal morbidity. Conclusion: In pregnancies complicated by PGDM and LGA, planned delivery after 39 weeks was associated with lower odds of cesarean delivery compared with expectant management. Planned delivery at 38 weeks had similar odds of cesarean delivery and neonatal morbidity. These data suggest that providers should be cautious expectantly managing these pregnancies past 38 weeks. Key Points: · Pregnancies complicated by PGDM and LGA are associated with higher risk of cesarean delivery.. · Across all gestational ages, planned delivery group was more likely to deliver by cesarean delivery than those expectantly managed.. · Planned delivery after 39 weeks was associated with lower odds of cesarean delivery compared with expectant management.. · Planned delivery prior to 38 weeks (36-37 weeks) is associated with increased cesarean delivery rates and higher neonatal morbidity..