Birth planning in cases of diabetes during pregnancy

Pregnant women with gestational diabetes (GDM) or type 1 and type 2 diabetes mellitus (DM) are high-risk pregnant women. Care should be well planned both prepartum, intrapartum and postpartum in order to ensure optimal care for mother and child. If the GDM is insulin-dependent, the pregnant woman should be advised to give birth in a hospital with neonatal care, as the risk of fetal hypoglycemia is increased. If the patient has type 1 or 2 DM, it should be recommended to give birth in a hospital with neonatal care and referral to the perinatal center is indicated in the case of poorly controlled DM or signs of diabetic fetopathy. In the case of insulin-dependent diabetes, regular cardiotocography (CTG) monitoring of the fetus from 32 + 0 weeks gestation is recommended due to the increased risk of intrauterine fetal death (IUFD) otherwise, CTG controls can be carried out after 36 + 0 weeks gestation. The frequency of the CTG controls should be selected considering any additional risk factors. In the case of a well-controlled, diet-controlled GDM, there are no indications to induce the pregnancy before 40 + 0 weeks gestation. Expectative management up to 40 + 6 weeks gestation under regular monitoring can be selected. If GDM is insulin-dependent and well controlled, induction of labor can be postponed until 39 + 0 to 40 + 0 weeks gestation. If there are maternal complications in type 1 or type 2 DM, if the diabetes is poorly controlled or if the patient has already had IUFD in her medical history, induction after 37 + 0 weeks gestation should be considered. Otherwise, induction of labor is recommended between weeks 39 + 0 and 40 + 0 weeks gestation. A longer extension past term pregnancy should be avoided. A GDM or DM is not a contraindication for vaginal birth with a normal fetal estimated weight, not even after a previous cesarean section.