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World J Diabetes. Mar 15, 2023; 14(3): 179-187
Published online Mar 15, 2023. doi: 10.4239/wjd.v14.i3.179
Gestational diabetes mellitus: The optimal time of delivery
Xuan Li, Teng-Teng Li, Rui-Xian Tian, Jia-Jia Fei, Xing-Xing Wang, Hui-Hui Yu, Zong-Zhi Yin
Xuan Li, Teng-Teng Li, Rui-Xian Tian, Jia-Jia Fei, Xing-Xing Wang, Hui-Hui Yu, Zong-Zhi Yin, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Zong-Zhi Yin, NHC Key Laboratory of the Study of Abnormal Gametes and the Reproductive Tract, Anhui Medical University, Hefei 230022, Anhui Province, China
Zong-Zhi Yin, Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei 230022, Anhui Province, China
Author contributions: Li X, Li TT, and Tian RX wrote the manuscript; Li X, Li TT, Tian RX, Fei JJ, Wang XX, and Yu HH prepared the researched data and contributed to the discussion; Li X, Li TT, and Tian RX contributed equally to this paper; and all authors have approved the final version.
Supported by National Natural Science Foundation of China, No. 82071679 and 82271721; and Basic and Clinical Cooperative Research Promotion Program of Anhui Medical University, No. 2019xkjT020.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zong-Zhi Yin, MD, PhD, Doctor, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230022, Anhui Province, China. dr_yinzongzhi@qq.com
Received: December 25, 2022
Peer-review started: December 25, 2022
First decision: January 9, 2023
Revised: January 17, 2023
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 15, 2023
Abstract

Gestational diabetes mellitus (GDM) is a common pregnancy complication strongly associated with poor maternal-fetal outcomes. Its incidence and prevalence have been increasing in recent years. Women with GDM typically give birth through either vaginal delivery or cesarean section, and the maternal-fetal outcomes are related to several factors such as cervical level, fetal lung maturity, the level of glycemic control still present, and the mode of treatment for the condition. We categorized women with GDM based on the latter two factors. GDM that is managed without medication when it is responsive to nutrition- and exercise-based therapy is considered diet- and exercise-controlled GDM, or class A1 GDM, and GDM managed with medication to achieve adequate glycemic control is considered class A2 GDM. The remaining cases in which neither medical nor nutritional treatment can control glucose levels or patients who do not control their blood sugar are categorized as class A3 GDM. We investigated the optimal time of delivery for women with GDM according to the classification of the condition. This review aimed to address the benefits and harms of giving birth at different weeks of gestation for women with different classes of GDM and attempted to provide an analytical framework and clearer advice on the optimal time for labor.

Keywords: Diabetes, Glucose, Pregnancy, Delivery, Optimal time, Maternal-fetal outcomes

Core Tip: The global incidence of gestational diabetes mellitus (GDM) is increasing, and GDM is closely related to adverse maternal-fetal outcomes. Therefore, the time of delivery for women with GDM has gained increasing attention in recent years. The maternal and fetal outcomes of pregnancy in women with GDM are closely related to the level of glycemic control and modality of treatment. This review aims to summarize current research on the classification of GDM, discuss the benefits and harms of delivery at different gestational weeks in women with GDM, and determine the optimal time of delivery for women with different classes of GDM.