Table 2.
Summary of pooled analyses of the effect of induction on adverse maternal and neonatal outcomes in women with GDM
| Outcomes | Study design | N of studies | N of Women | Effect estimate (95% CI) i |
I2 (%) | |
|---|---|---|---|---|---|---|
| Maternal outcomes | ||||||
| CS | All | 11 | 13,617 | 1.02 (0.82, 1.27) | 59 | |
| RCT | 3 | 674 | 0.95 (0.64, 1.43) | 0 | ||
| Observational | 8 | 12,943 | 1.03 (0.79, 1.34) | 70 | ||
| Instrumental vaginal delivery | All | 5 | 9290 | 0.99 (0.84, 1.17) | 0 | |
| RCT | 2 | 474 | 0.84 (0.47, 1.50) | 0 | ||
| Observational | 3 | 8816 | 1.00 (0.85, 1.19) | 0 | ||
| Severe perineal lacerations a | All b | 3 | 8829 | 0.57 (0.38, 0.85) | 0 | |
| RCT | 1 | 273 | 0.13 (0.01, 2.52) | NA | ||
| Observational | 2 | 8556 | 0.59 (0.39, 0.88) | 0 | ||
| ICU | All | 1 | 425 | 1.49 (0.25, 8.98) | NA | |
| RCT | 1 | 425 | 1.49 (0.25, 8.98) | NA | ||
| Neonatal outcomes | ||||||
| Macrosomia a | All | 8 | 12,384 | 0.64 (0.55, 0.74) | 0 | |
| RCT | 2 | 625 | 0.49 (0.30, 0.81) | 0 | ||
| Observational | 6 | 11,759 | 0.64 (0.54, 0.77) | 12 | ||
| LGA | All | 4 | 11,320 | 0.81 (0.63, 1.05) | 61 | |
| RCT | 1 | 200 | 0.37(0.17, 0.83) | NA | ||
| Observational | 3 | 11,120 | 0.88 (0.72, 1.06) | 42 | ||
| Shoulder dystocia c | All d | 7 | 12,232 | 0.80 (0.49, 1.31) | 32 | |
| RCT | 2 | 625 | 0.75 (0.04, 15.49) | 62 | ||
| Observational | 5 | 11,607 | 0.79 (0.49, 1.30) | 36 | ||
| NICU a | All | 4 | 9080 | 1.40 (0.90, 2.19) | 59 | |
| RCT | 1 | 425 | 0.99 (0.14, 7.06) | NA | ||
| Observational | 3 | 8655 | 1.41 (0.85, 2.32) | 72 | ||
| 5-min Apgar score < 7 a | All e | 4 | 2943 | 0.61 (0.17, 2.22) | 7 | |
| RCT | 1 | 425 | 4.98 (0.24, 104.28) | NA | ||
| Observational | 3 | 2518 | 0.40 (0.10, 1.55) | 0 | ||
| Neonatal acidemia a | All f | 2 | 2564 | 1.84 (0.38, 8.92) | 14 | |
| RCT | 1 | 425 | 7.00 (0.36, 136.35) | NA | ||
| Observational | 1 | 2139 | 1.16 (0.24, 5.48) | NA | ||
| Perinatal mortality g | All h | 5 | 9195 | 0.64 (0.16, 2.58) | 0 | |
| Observational | 5 | 9195 | 0.64 (0.16, 2.58) | 0 | ||
CS: caesarean section; ICU: intensive care unit; LGA: Large-for-gestational-age; NICU: neonatal intensive care unit;
a One RCT (Singh et al. 2013) had no events recorded in both induction group and expectant management and were excluded from the final pooled analyses for severe perineal lacerations, macrosomia, NICU, 5-min Apgar score < 7 and neonatal academia; b One RCT (Alberico et al. 2017) and one observational study (Vitner et al. 2019) had no events recorded in one group and applied a fix correction approach; c One observational study (Alberico et al. 2010) had no events recorded in both groups and were excluded from the final pooled analyses for shoulder dystocia; d One RCT (Kjos et al. 1993) had no events recorded in one group and applied a fix correction approach; e One RCT (Alberico et al. 2017) and two observational studies (Alberico et l 2010; Vitner et al. 2019) had no events recorded in one group and applied a fix correction approach; f One RCT (Alberico et al. 2017) had no events recorded in one group and applied a fix correction approach; g Three RCTs (Kjos et al. 1993; Singh et al. 2013; Alberico et al. 2017) and one observational study (Sutton et al. 2014) had no recorded events in both groups and were excluded from the final pooled analyses for perinatal mortality; h Five observational studies (Alberico et al. 2010; Lurie et al. 1996; Melamed et al. 2016; Rayburn et al. 2005; Vitner et al. 2019) had no events recorded in one group and applied a fix correction approach; i Pooled odds Ratio (OR) was generated by random-effects models with the Mantel-Haenszel method