Summary of findings for the main comparison. Planned elective birth (induction or caesarean) compared to expectant management for pregnant women with gestational diabetes.
| Planned birth (induction or caesarean) compared to expectant management for pregnant women with gestational diabetes | ||||||
| Patient or population: pregnant women with gestational diabetes, between 38 ‐ 39 gestational weeks, without other maternal or fetal conditions. Setting: Italy, Slovenia and Israel. Intervention: planned birth (induction of labour at 38/39 gestational weeks). Comparison: expectant management of labour. | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with expectant management | Risk with planned elective birth (induction) | |||||
| Maternal mortality or serious maternal morbidity | 9 per 1000 | 14 per 1000 (2 to 83) | RR 1.48 (0.25 to 8.76) | 425 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1 2 3 | No events reported in either group for maternal mortality and serious maternal morbidity related to the intensive care unit admissions |
| Caesarean section | 118 per 1000 | 126 per 1000 (76 to 210) | RR 1.06 (0.64 to 1.77) | 425 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1 2 4 | |
| Instrumental vaginal birth | 104 per 1000 | 84 per 1000 (47 to 152) | RR 0.81 (0.45 to 1.46) | 425 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1 2 5 | |
| Perinatal mortality rate | 0 per 1000 | 0 per 1000 (0 to 0) | not estimable | 425 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1 2 6 | No events reported in either group |
| Shoulder dystocia | 5 per 1000 | 14 per 1000 (1 to 134) | RR 2.96 (0.31 to 28.21) | 425 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1 2 7 | |
| Large‐for‐gestational age | 114 per 1000 | 60 per 1000 (32 to 116) | RR 0.53 (0.28 to 1.02) | 425 (1 RCT) | ⊕⊕⊝⊝ LOW 1 2 8 | |
| Acidaemia ‐ not measured | ‐ | ‐ | ‐ | ‐ | ‐ | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 One study included in this review, therefore inconsistency cannot be assessed
2 High risk of bias for blinding of participants and personnel and blinding of outcome assessment (downgraded x 1)
3 Confidence interval crosses the line of no effect and confidence intervals include appreciable benefit and harm. Criteria for optimal information size (23,171 women per group), in relation to intensive care unit admission, have not been met (downgraded x 2).
4 Confidence interval crosses the line of no effect and confidence intervals include appreciable benefit and harm. Criteria for optimal information size (1,616 women per group) have not been met (downgraded x 2).
5 Confidence interval crosses the line of no effect and confidence intervals include appreciable benefit and harm. Criteria for optimal information size (1,920 women per group) have not been met (downgraded x 2).
6 No events for this outcome. Drawing on the neonatal deaths recorded in Rosenstein 2012 at 37, 38 and 39 weeks' gestation for women with gestational diabetes, criteria for optimal information size (477,500 women per group) have not been met (downgraded x 2).
7 Confidence interval crosses the line of no effect and confidence intervals include appreciable benefit and harm. Criteria for optimal information size (46,145 women per group) have not been met (downgraded x 2).
8 Confidence interval crosses the line of no effect and confidence intervals include appreciable benefit. Criteria for optimal information size (1,743 women per group) have not been met (downgraded x 1).