Timing of delivery in women with pre-pregnancy diabetes mellitus: a population-based study
Bibliographic record
Abstract
Objectives Controversy exists about the timing of delivery of women with pre-pregnancy type 1 and 2 diabetes mellitus (PDM). This study aims to compare maternal and neonatal outcomes after induction of labor (IOL) at 38 weeks’ gestation versus expectant management from 39 weeks onward. Research design and methods This was a retrospective population-based cohort study using data from the Better Outcomes Registry and Network in Ontario Canada. Included were all women with PDM, who had a singleton hospital birth at ≥38 0/7 weeks’ gestation from 2012 to 2017. Maternal and perinatal outcomes were compared between 937 pregnancies that underwent IOL at 38 0/7 –38 6/7 weeks (‘38-IOL group’) versus 1276 pregnancies expectantly managed resulting in a birth at ≥39 0/7 weeks (‘39-Exp group’). The primary outcome was all-cause cesarean delivery. Multivariable modified Poisson regression was performed to generate adjusted relative risks (aRR) and 95% CIs, adjusted for parity, maternal age, pre-pregnancy body mass index and PDM type. Other outcomes included instrumental delivery, neonatal intensive care unit (NICU) admission, and newborn metabolic disturbances. Results Cesarean delivery occurred in 269 women (28.7%) in the 38-IOL group versus 333 women (26.1%) in the 39-Exp group—aRR 1.07 (95% CI 0.94 to 1.22). The respective rates of instrumental delivery were 11.2% and 10.2% (aRR 1.25, 95% CI 0.98 to 1.61). NICU admission was more common in the 38-IOL group (27.6%) than in the 39-Exp group (16.8%) (aRR 1.61, 95% CI 1.36 to 1.90), as were jaundice requiring phototherapy (12.4% vs 6.2%) (aRR 1.93, 95% CI 1.46 to 2.57) and newborn hypoglycemia (27.3% vs 14.7%) (aRR 1.74, 95% CI 1.46 to 2.07). Conclusion In pregnant women with PDM, IOL at 38 0/7 –38 6/7 weeks was not associated with a higher risk of cesarean delivery, compared with expectant management, but was associated with a higher risk of certain adverse neonatal outcomes.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".