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Planned birth at or near term for improving health outcomes for pregnant women with pre-existing diabetes and their infants
Biesty, Linda M.
Egan, Aoife M.
Dunne, Fidelma P.
Dempsey, Eugene M.
Ní Bhuinneain, G. Meabh
John Wiley & Sons, Ltd. for The Cochrane Collaboration.
Background: Pregnant women with pre-existing diabetes (Type 1 or Type 2) have increased rates of adverse maternal and neonatal outcomes. Current clinical guidelines support elective birth, at or near term, because of increased perinatal mortality during the third trimester of pregnancy. This review replaces a review previously published in 2001 that included "diabetic pregnant women", which has now been split into two reviews. This current review focuses on pregnant women with pre-existing diabetes (Type 1 or Type 2) and a sister review focuses on women with gestational diabetes. Objectives: To assess the effect of planned birth (either by induction of labour or caesarean birth) at or near term gestation (37 to 40 weeks’ gestation) compared with an expectant approach, for improving health outcomes for pregnant women with pre-existing diabetes and their infants. The primary outcomes relate to maternal and perinatal mortality and morbidity. Search methods: We searched Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (15 August 2017), and reference lists of retrieved studies. Selection criteria: We planned to include randomised trials (including those using a cluster-randomised design) and non-randomised trials (e.g. quasi-randomised trials using alternate allocation) which compared planned birth, at or near term, with an expectant approach for pregnant women with pre-existing diabetes. Data collection and analysis: Two of the review authors independently assessed study eligibility. In future updates of this review, at least two of the review authors will extract data and assess the risk of bias in included studies. We will also assess the quality of the evidence using the GRADE approach. Main results: We identified no eligible published trials for inclusion in this review. We did identify one randomised trial which examined whether expectant management reduced the incidence of caesarean birth in uncomplicated pregnancies of women with gestational diabetes (requiring insulin) and with pre-existing diabetes. However, published data from this trial does not differentiate between pre-existing and gestational diabetes, and therefore we excluded this trial. Authors' conclusions: In the absence of evidence, we are unable to reach any conclusions about the health outcomes associated with planned birth, at or near term, compared with an expectant approach for pregnant women with pre-existing diabetes. This review demonstrates the urgent need for high-quality trials evaluating the effectiveness of planned birth at or near term gestation for pregnant women with pre-existing (Type 1 or Type 2) diabetes compared with an expectant approach.
Female , Humans , Pregnancy , Cesarean Section , Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Labor, Induced , Pregnancy in Diabetics , Term Birth
Biesty, L. M., Egan, A. M., Dunne, F., Smith, V., Meskell, P., Dempsey, E., Ni Bhuinneain, G. M. and Devane, D. (2018) 'Planned birth at or near term for improving health outcomes for pregnant women with pre-existing diabetes and their infants', Cochrane Database of Systematic Reviews, 2, Art. No.: CD012948 (19pp). doi:10.1002/14651858.CD012948
© 2018, The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. All rights reserved. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2018, Issue 2. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.