Induction of labour with gestational diabetes

In this post, I share what induction of labour means, look into the evidence-based research around the need for induced birth with gestational diabetes and look into the different methods used for inducing labour.

For a baby to be born, the cervix (neck of the uterus) has to shorten, soften and open, and there needs to be contractions. This process happens naturally between 38 – 42 weeks in most pregnancies and is known as ‘spontaneous labour’. Induction of labour is the process of starting labour artificially.

Reasons for induction
  1. Prolonged pregnancy – where pregnancy continues after 41 weeks
  2. Pre-labour rupture of membranes – where the waters surrounding the baby break and labour does not start within 24 hours causing a risk of infection
  3. Medical reasons – where it is felt there is increased risk to the health of your baby or you should the pregnancy continue
Induction of labour

Does a diagnosis of gestational diabetes mean you have to be induced?

NO. Induction of labour before 40+6 is not advised unless there are maternal or fetal complications​1​. If you are advised to have an early induction of labour, this is advice and ultimately the choice is yours to make and consent to.

Evidence-based research on induction of labour with gestational diabetes

The most common gestational diabetes birth question is around the necessity of early induction of labour. This is due to the fact that many people diagnosed with gestational diabetes are told they will be induced, but why? And what does the evidence-based research say about early induction of labour versus awaiting spontaneous birth with gestational diabetes?

Why is induction of labour advised with gestational diabetes?

Conventionally induction of labour has been used in diabetic pregnancy to prevent stillbirth or prevent excessive fetal growth and associated birth-related complications it may cause, such as shoulder dystocia [where the baby’s shoulder gets stuck behind the pelvic bone when being delivered] and birth fractures.

It’s important to understand that historically the severity of diabetes and level of blood glucose control during pregnancy has not always been considered. The known complications seen in pre-existing diabetes and poorly controlled diabetic pregnancies is often lumped together with gestational diabetes and well-controlled blood glucose. Yet, the associated risks for these different groups will not be the same during birth and, therefore, should not be advised in the same way.

First, let’s address the issue of gestational diabetes and the risk of stillbirth.

It is also critical to distinguish GDM [gestational diabetes mellitus] from PGDM [pre-gestational diabetes mellitus or pre-exsisting diabetes] pregnancies when deciding on the timing of delivery. Though often treated similarly, the risk of stillbirth is dramatically different.​2​

Berger H, Melamed N. (2014)

A 2019 Action Medical Research, Cure Kids, Sands and Tommy’s funded study led by the University of Leeds and the University of Manchester by Dr Tomasina Stacey, of 41 maternity units in England found that as long as the NICE National Guidelines are followed for screening, diagnosis and management of gestational diabetes, then there is no increased risk in stillbirth.

women with gestational diabetes have no increase in stillbirth risk if national guidelines are followed for screening, diagnosis and management.

Dr Tomasina Stacey, The University of Manchester

Optimal screening and diagnosis of GDM [Gestational Diabetes Mellitus] mitigate the higher risks of late stillbirth in women ‘at risk’ of GDM and/or with raised FPG [Fasting Plasma Glucose levels].​3​

Stacey T et al. (2019)

From 9981 citations, 419 were identified for full-text review and 73 met inclusion criteria (n = 70,292,090). There was no significant association between gestational diabetes and stillbirth in cohort studies (pooled OR 1.04 [95% CI 0.90, 1.21]; I2 86.1%) or in case–control studies (pooled OR 1.57 [95% CI 0.83, 2.98]; I2 94.8%). Gestational diabetes was associated with lower odds of stillbirth among cohort studies presenting with an adjusted OR (pooled OR 0.78 [95% CI 0.68, 0.88]; I2 42.7%).​4​

Lemieux P et al. (2021)
Gestational diabetes and excessive growth (fetal macrosomia)

With gestational diabetes, when there is too much sugar remaining in the mother’s bloodstream, this is passed through (fed) to the baby. The baby then has to increase its own insulin production to help process the excess sugars. Insulin is a growth hormone and the result is that the baby’s growth increases, in particular, the abdominal circumference [AC] (tummy) increases. It is adipose tissue (subcutaneous fat) caused by the overproduction of insulin that causes excessive growth.

How is fetal macrosomia determined?

Fetal macrosomia is defined as a fetal birth weight of ≥ 4000g or 8lb13oz. During pregnancy, macrosomia can be predicted from growth scan measurements (head circumference, abdominal circumference and femur length which determines an estimated fetal weight) taken of the baby during an ultrasound. An example is shown in the image above.

These measurements are estimates with accuracy dependent on multiple factors such as the baby’s position during the scan and the skill of the sonographer. Less than 1 in every ten are wrong​5​and there is general acceptance of up to a 15% margin of error.

How accurate are sonographic estimated fetal weights in suspected macrosomia?

A retrospective cohort study in New York City of 502 patients between 2011 – 2017 looking into the accuracy of sonographic estimated fetal weight [sonoEFW] in suspected macrosomia, found an increasingly more significant overestimation in birth weight [BW] the greater the estimated weight.

A total of 502 patients were included, of whom 301 (60.1%) had a sonoEFW 4000–4249g, 135 (26.9%) had a sonoEFW 4250–4499g, 45 (9.0%) had a sonoEFW 4500–4749g, and 21 (4.2%) had a sonoEFW 475 g. In each sonoEFW group, the risk of overestimating BW was greater than 50%, and the likelihood of overestimation of BW increased significantly across sonoEFW groups (69.4, 76.3, 80.0, 95.2%, p < .001)

CONCLUSION In patients undergoing sonoEFW within 2 weeks of delivery, sonoEFWs 4000g are significantly more likely to overestimate than underestimate the true BW. Obstetricians should be cautious about intervening based on sonoEFW alone, given the high risk that this value is an overestimation of the true weight.​6​

Zafman K et al.(2018)
Does induction of labour and delivering a smaller baby reduce the risk of birth-related complications such as shoulder dystocia and birth fractures with gestational diabetes?

The GINEXMAL research trial of 425 women affected by GDM in Italy, Slovenia, and Israel between 2010 – 2014 looked into the maternal and perinatal outcomes after induction of labour versus expectant management in pregnant women with gestational diabetes at term.

The participants were split into 2 groups, 214 were randomised to induction of labour and 211 were randomised to expectant management (twice-weekly electronic fetal heart rate monitoring and biophysical profiling until 41+0 weeks of gestation).

As expected, the babies born in the induction group were born earlier and weighed less. 12.6% of those induced ended in caesarean section, versus 11.8% in the expectant management group. No maternal or perinatal deaths occurred. No significant difference was found in postpartum haemorrhage, severe perineal tears, maternal blood transfusion, management of the third stage of labour, and ICU admission.

There was a two-fold increase of 10% versus 4.1% in hyperbilirubinaemia (neonatal jaundice) in babies born in the induction group versus expectant management.

In the induction group 13 cases, 6.1% were reported macrosomic, versus 24 cases,11.4% in the expectant management group.

Shoulder dystocia occurred in a total of 4 cases (0.9%): 1.4% of the induction group and 0.5% in the expectant management group, all of which were resolved without any significant birth trauma, showing that in this study induction of labour did not reduce shoulder dystocia.

In women with gestational diabetes, without other maternal or fetal conditions, no difference was detected in birth outcomes regardless of the approach used (i.e. active versus expectant management).​7​

Alberico S et al.(2016)

There is insufficient evidence to clearly identify if there are differences in health outcomes for women with gestational diabetes and their babies when elective birth is undertaken compared to waiting for labour to start spontaneously or until 41 weeks’ gestation if all is well.​8​

Biesty L et al.(2018)
shoulder dystocia
But does gestational diabetes always mean a macrosomic (excessively large) baby?

Left undiagnosed or untreated, gestational diabetes can cause macrosomia in the baby.

But if blood glucose levels are monitored and controlled with diet and/or glucose-lowering medication or insulin, macrosomia can be prevented, therefore meaning the birth is no higher risk than that of a non-diabetic person.

Induction of labour in insulin-controlled gestational diabetes

The need for glucose-lowering medication such as insulin during gestational diabetes pregnancy may often be given as a reason for advising early induction of labour. However, if blood glucose levels remain controlled with insulin, is early induction of labour warranted?

The poorly controlled GDM with a PGDM phenotype (elevated BMI, marked insulin resistance as manifested by insulin requirements, polyhydramnios and increased fetal abdominal circumference) should likely be managed more conservatively with consideration towards earlier induction. Conversely, the “low risk” well-controlled primiparous GDM patient with an unfavourable cervix is likely to benefit from expectant management. Although commonly used by practitioners, the distinction between insulin-treated and diet-treated GDM pregnancies should not necessarily be the sole criterion used when deciding on timing of delivery​2​

Berger H, Melamed N. (2014)

A study between 2010 – 2012 in Vienna comparing maternal and fetal outcomes in 100 insulin-controlled gestational diabetes patients found that induction of labour at 38 weeks did not significantly reduce the rate of large for gestational age babies compared to induction at 40 weeks. Still, they found a higher rate of neonatal hypoglycemia. It, therefore, questions the benefit of earlier induction of labour in insulin-controlled women with gestational diabetes who have good glycaemic control.

we would favor routine induction of labor at 40 weeks of gestation until studies are published which document a clear advantage of earlier delivery. In women with a LGA [large gestational age] fetus, inadequate metabolic control, or overt diabetes , we would emphasize a more individual approach.​9​

Worda K et al. (2017)

Where induction of labour IS necessary

In some cases, induction of labour may be necessary for medical reasons. With gestational diabetes, some possible causes may include poor control of blood glucose levels, concerns over placenta function and concerns over fetal wellbeing.

Achieving the birth you want with an induction

If you are advised to have an induction of labour and feel it is the best option for you and your baby, there are still many steps you can take and implement to maximise your chances of having the birth you want. Ideas include:

  • staying mobile
  • having an optimal birth environment, make use of lights & music
  • using a birthing pool or bath to help with pain relief 
  • preparing a clear birth plan
  • choosing the best birthing partners

Look into hypnobirthing breathing and relaxation techniques as these things can still be used to help you enjoy a better and more positive birthing experience.

Discuss how you can make your birth personal for you and your partner, whichever birth plan is needed. It isn’t only about the type of birth. It is about the delivery of your baby, the safest way possible with you feeling comfortable, happy, in control, and able to make informed choices.

Membrane Sweep (Stretch & Sweep)

Membrane sweeps have been shown to increase the chances of labour starting naturally within 48 hours of the procedure and can reduce the need for other methods of induction.

A sweep is a vaginal examination that involves the doctor or midwife inserting a gloved finger into the vagina through the cervix and making circular sweeping movements to separate the membranes from the cervix. This process may help soften and ripen the cervix and increase the production of hormones called prostaglandins, which hopefully encourage labour to start.

There may be some discomfort during the procedure, so you can ask for pain relief (Entonox, gas & air) whilst having a sweep performed. You may experience some light bleeding following the sweep.

Much like a vaginal examination, a care provider must gain informed consent to perform a sweep. You are within your rights to decline a stretch and sweep if you do not want one.

A sweep can be performed as an outpatient in a clinic or surgery, and even at home by a midwife.

If a sweep has not been mentioned in your appointments, but it is something you feel would be beneficial prior to induction, then you should discuss this with your consultant or midwife.

Membrane sweeping may be effective in achieving a spontaneous onset of labour, but the evidence for this was of low certainty. When compared to expectant management, it potentially reduces the incidence of formal induction of labour. Questions remain as to whether there is an optimal number of membrane sweeps and timings and gestation of these to facilitate induction of labour.​10​

Finucane E et al. (2020)

Natural methods of induction with gestational diabetes

Many people desperately want to induce their labours naturally to avoid an artificial induction. You may come across many different ways to encourage labour naturally, but remember, many lack evidence, and some could be more detrimental to you as a person with diabetes.

Eating ten whole pineapples or a hot tomato-based curry when you can’t tolerate tomatoes will do nothing but push your blood sugar levels sky-high!

Likewise, although studies suggest a benefit of consuming dates (the dried fruit) to encourage cervical softening and ripening, possibly decreasing the need for induction and may shortening latent and second stages of labour​11​, dates are very high in natural sugars (even when paired they are difficult to tolerate).

even when ‘paired‘ dates are hard to tolerate

Safer methods you may want to try with gestational diabetes:

  • Sexual intercourse, as semen contains natural prostaglandins, which may help to ripen or soften the cervix, and having an orgasm can trigger the release of oxytocin​12​
  • Nipple stimulation is also said to help and so why not try colostrum harvesting if you plan on breastfeeding? 

Methods of induction

Artificial rupture of the membranes (ARM)

When the cervix is open to around 2 or 3 cm, and the baby’s head has engaged, it should be possible to break the waters around the baby. This procedure is carried out by using a small plastic hook that releases the water and allows the pressure of the baby’s head to press on the cervix and stimulate contractions. The procedure may be uncomfortable, but it should not be painful. It will not harm you or your baby.

Artificial Rupture of the Membranes, Sara P, O’Brien P (2022)​[NO_PRINTED_FORM]​

Prostaglandin pessary

Prostaglandin (Propess or Prostin) is a vaginal pessary containing hormones used when the cervix is not ready or ‘favourable’ to go into labour. It helps by either encouraging the start of labour or aiding softening and opening of the cervix enough to perform an artificial rupture of the membranes.

A midwife inserts the pessary into the vagina during a vaginal examination. The pessary has a tape/string attached to aid removal, similar to a tampon. It stays in for 12 – 24 hours unless labour starts or there are any concerns about you or your baby’s health. A midwife will re-examine you so many hours after the first pessary, and if the cervix is still not ready for labour, then a second pessary is usually given. Your care team will monitor the baby with EFM (Electric Fetal Monitoring or CTG) every few hours. Between monitoring, you will be encouraged to walk about or use a ‘birthing ball’, as being active can help encourage labour to start.


Prostaglandin gel

Much the same as the pessary mentioned above, it works by causing softening and dilation of the cervix. Still, instead of a pessary, it comes in a gel which is administered using a syringe inserted high into the vagina by a midwife. Once again, a midwife will re-examine you so many hours after the gel, and a second dose of the gel may be administered if the first dose does not produce the desired response. Your care team will monitor the baby with EFM (Electric Fetal Monitoring or CTG) every few hours. Between monitoring, you will be encouraged to walk about or use a ‘birthing ball’, as being active can help encourage labour to start.


Cervical ripening balloon; foley catheter, or ‘Cooks balloon’

This procedure involves a catheter similar to what is used in the urinary bladder in patients. The difference here is that the catheter is inserted into your cervix. It has a balloon at the tip, and when it is in place, the balloon is filled with saline (a sterile fluid). The catheter stays in for 24 hours with the balloon putting gentle pressure on the cervix. The pressure should soften and open your cervix enough to start labour or to be able to perform an artificial rupture of the membranes. The balloon may fall out by itself or need to be removed by a midwife. In some hospitals they allow the patient to return home for 24 hours following insertion of the cervical ripening balloon.

Dilapan Rods

Dilapan rods are rigid gel rods that are inserted into the vagina. They increase in size by absorbing fluids from the cervical canal which allows the cervix to dilate and soften. Usually, a set of 3 – 5 rods are inserted and used over a 12- 24 hour period.


Oxytocin (Syntocinon) Hormone Drip

This is a synthetic form of the hormone that causes your uterus to commence contractions. This is given intravenously through a drip in the hand. It can only be given once your waters have been broken. The IV drip is increased slowly until your uterus is contracting regularly and strongly. Women respond differently to how well the drip works on contractions as it depends on how ready your body is for the labour process. Your baby’s heart rate will be monitored continuously by a CTG (cardiotocograph or EFM) during labour. You can still move, bounce on a birthing ball and walk around, but you are slightly more limited due to the IV drip.

Mutiple methods of induction

Your healthcare professional may use multiple attempts and different methods to induce labour.

Typically a vaginal examination is performed along with CTG monitoring of the baby to start. The next step will depend on how softened and ripened the cervix is. In some patients, an ARM may be performed straight away, leading to labour. In others, the healthcare professional may use mechanical or chemical induction methods one after another depending on what is required, e.g. the pessary, followed by the drip after 24 hours.

It is advisable to discuss which induction methods are available for you in your hospital and what the induction process would look like, e.g. how many attempts would be acceptable and over what period of time. Each induction attempt must be made with informed consent and this can be included in your birth plan.

Induction can be a lengthy (and sometimes lonely) process

Be prepared and realistic. How well the induction process works depends on how ready your body is for induction, and so for some people, it can be swift and straightforward, but for others, it could take several days! It would help if you took comfortable clothes to wear; you do not need to be in night clothes or a hospital gown unless you’d prefer to be.

Take plenty of things to occupy yourself: things to read, games to play, music to listen to etc., as well as plenty of GD-friendly snacks as hospital food is notorious for being tricky for many to tolerate with gestational diabetes! Take a look at my Hospital Bag List for more help.

If you go into the hospital and just lay on your bed waiting for something to happen after the induction process has started, then you could be in for a long wait. To assist the induction process, it is best to remain as active as possible. Walking, climbing stairs and bouncing on a birthing ball all help to encourage labour to start. Our mantra to anyone going in for induction in our Facebook support group is “bounce, bounce, bounce!”

In many hospitals, birthing partners can visit during daytime visiting hours but have to go home until you are in active labour. It is worthwhile asking your hospital what their guidelines are for birthing partners and visitors for those being induced so that you are prepared.

Continous fetal monitoring during gestational diabetes birth

Continuous fetal monitoring (having fetal heartbeat continuously recorded and monitored) during labour with gestational diabetes. What does the evidence-based research say about the need for continuous fetal monitoring with gestational diabetes?

Electronic fetal monitoring (EFM) or CTG (cardiotocography)

Looking at the literature, this is an example of where gestational diabetes has been lumped together with pre-existing diabetes.

In the majority of intrapartum care guidelines, there is no differentiation between GDM [gestational diabetes mellitus] and PGDM [pre gestational diabetes mellitus or pre-exsiting diabetes] regarding the recommendation of continuous fetal monitoring.​13​

Jabak S, Hameed A. (2020)

A 2020 study reviewed the literature available on continuous fetal monitoring for gestational diabetes, specifically in diet-controlled GDM women with normal fetal growth. They compared three studies involving 482 women with diabetes in pregnancy but found a lack of evidence to support the recommendation for continuous fetal monitoring.

There have been no randomized control trials behind these recommendations. The aforementioned women have comparable outcomes to pregnant women who are not affected by diabetes and can be considered as low risk till any evidence is found.

With the lack of current evidence, we find it difficult to recommend mothers with well-controlled gestational diabetes to give birth in obstetrics led unit with continuous fetal monitoring and deny them a chance to have home birth or birth in midwifery-led birth units. There is an urgent need to conduct large scale randomized controlled trials to establish evidence for or against this recommendation.​13​

Jabak S, Hameed A. (2020)
wireless, waterproof electronic fetal monitor for intermittent fetal monitoring

Induction more painful than spontaneous labour?

Some people may find that labour and contractions are brought on much faster with induction and, therefore, it may be more intense than if the body was to spontaneously labour at its own pace. 

Pain relief should be discussed with your health care professionals and detailed in your birth plan. 

Many mothers have used birthing pools and baths for pain relief, even during inductions. The diagnosis of gestational diabetes does not necessarily mean that waterbirth is off the cards. For more information on waterbirths with gestational diabetes, read more here.

Blood glucose levels in labour

Current guidelines recommend that blood glucose levels remain between 4.0 – 7.0 mmol/L during labour for those with diabetes​1​. A variable-rate insulin infusion (sliding scale) may be used if levels go beyond these parameters.

It is important to note that just because a patient is using insulin therapy to control blood glucose levels, no guidelines recommend the immediate or preventative use of a variable-rate insulin infusion (sliding scale) during labour. It is only if blood glucose levels fall outside the guideline parameters (4.0 – 7.0 mmol/L).

variable-rate insulin infusion (sliding scale)

This is another area where research is lacking, especially in differentiating gestational diabetes from pre-existing diabetes. Current research is underway on this matter: the GILD study [Glucose control In Labour with Diabetes].

Can I opt for a caesarean birth instead of an induction?

 If early elective birth is necessary, you may be advised to have an induction of labour but have reasons for preferring to have a caesarean section instead. You are within your rights to request a caesarean birth if you wish.

You can ask for a caesarean birth even if your doctor or midwife doesn’t think that you have a medical need for one. This is called a maternal request caesarean birth. Your hospital must listen to your reasons for wanting a caesarean birth and have good reasons for saying no.

You should be given the opportunity to discuss the benefits and potential risks of caesarean birth compared to giving birth vaginally. However, once you have made your decision it should be respected. An individual obstetrician can say no to your request on the basis that they do not want to carry out an intervention that they believe to be harmful. However, they must refer you to a doctor who is happy to carry out a caesarean section. If all obstetricians in a unit take the same view, you should be referred to an obstetrician in a different hospital who is willing to carry out the surgery.

Birthrights UK
gestational diabetes c-section birth stories

Failed induction

In some cases, induction of labour is not successful following repeated attempts.  Your management will be discussed with your consultant and a plan will be put into place which may include a decision for an elective caesarean section. You may want to detail in your birth plan, how many attempts of induction you would be happy with before you would want a caesarean section. Remember, each attempt to induce should be with informed consent.

Induced VBAC (vaginal birth after caesarean)

Many people with gestational diabetes have had successful VBAC inductions and spontaneous VBAC labours. VBAC and induced VBAC is something you should discuss with your consultant if you have had a previous caesarean section and would like to try for a vaginal birth.

1.4.6 Diabetes should not in itself be considered a contraindication to attempting vaginal birth after a previous caesarean section. [2008]​1​

NICE Guidelines

Women with gestational diabetes are less likely than those without diabetes to have a successful trial of labor. Women with gestational diabetes considering vaginal birth after cesarean should be appropriately counseled about the risk of attempting a trial of labor after previous cesarean delivery.​14​

Coleman T et al. (2001)

Informed Consent

Throughout your pregnancy and birth, and even more so when you have any complications such as gestational diabetes, you will need to make decisions about your care. There are many decisions to be made, from additional appointments, scans, medication to timing & mode of birth. Your doctors and midwives should give you all the information you need to help you make decisions that are right for YOU. This is INFORMED CONSENT.

the clinician should consider the maternal, fetal and neonatal implications of induction of labour versus expectant management, involve the patient in the decision process and as usual follow the maxim of “first do no harm”.​2​

Berger H, Melamed N. (2014)
gestational diabetes birth informed consent
You should be given clear & factual information that makes sense to you

Don’t be afraid to ask why certain things are being recommended to you personally.

informed consent clear and factual information
You should be told both the benefits and the risks for anything that is being advised or recommended

For anything being advised, you should be told both the benefits and risks involved.

benefits and risks informed consent
 You should not feel pressured into making any decisions

Health care professionals should not use coercive language to push you into making decisions. If you feel this is happening ask for a second opinion and/or the support of the PMA (Professional Midwife Advocate). You can also discuss this with PALS (Patient Advice and Liaison Services).

not feel pressured - informed consent
Use B.R.A.I.N to help you ask more questions and to help make decisions
BRAIN informed consent
You always have a CHOICE

You can say NO to anything that is being advised or recommended. Your healthcare professionals will respect your decision and will work with you to create a plan to support you as best as they can.

You are the best person to make the right decision for YOU

Once you have the facts, you are the only person who knows how you feel and whatever you decide your healthcare team have a duty of care to support you.

Research publications

Elective delivery in diabetic pregnant women

Induction of labour at or near term for suspected fetal macrosomia

Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis

Delivery Timing and Cesarean Delivery Risk in Women with Mild Gestational Diabetes

Insulin-requiring diabetes in pregnancy: A randomized trial of active induction of labor and expectant management

Induction of labour versus expectant management in gestational diabetes pregnancies

Gestational diabetes and fetal growth acceleration: induction of labour versus expectant management

Managing Labor and Delivery of the Diabetic Mother

Expectant Management Versus Labor Induction for Suspected Fetal Macrosomia: A Systematic Review

Methods of induction of labour: a systematic review

Indications for induction of labour: a best-evidence review

Diabetes in pregnancy and cesarean delivery

Gestational diabetes: is a higher cesarean section rate inevitable?

Diet-controlled gestational diabetes mellitus does not influence the success rates for vaginal birth after cesarean delivery

Vaginal birth after cesarean among women with gestational diabetes

Twin pregnancy outcomes for women with gestational diabetes mellitus compared with glucose tolerant women

Sexual intercourse for cervical ripening and induction of labour

The association of sexual intercourse during pregnancy with labor onset

Index of National Maternity Statistics 

Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more)

Outcomes of elective induction of labour compared with expectant management: population-based study

Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis


  1. 1.
    Diabetes in pregnancy: management from preconception to the postnatal period. NICE National Institute for Health and Care Excellence. Published December 2020. Accessed March 2022.
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    Berger H, Melamed N. Timing of delivery in women with diabetes in pregnancy. Obstet Med. Published online January 15, 2014:8-16. doi:10.1177/1753495×13513577
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    Stacey T, Tennant P, McCowan L, et al. Gestational diabetes and the risk of late stillbirth: a case–control study from England, UK. BJOG: Int J Obstet Gy. Published online March 19, 2019. doi:10.1111/1471-0528.15659
  4. 4.
    Lemieux P, Benham JL, Donovan LE, Moledina N, Pylypjuk C, Yamamoto JM. The association between gestational diabetes and stillbirth: a systematic review and meta-analysis. Diabetologia. Published online October 21, 2021:37-54. doi:10.1007/s00125-021-05579-0
  5. 5.
    Milner J, Arezina J. The accuracy of ultrasound estimation of fetal weight in comparison to birth weight: A systematic review. Ultrasound. Published online February 2018:32-41. doi:10.1177/1742271×17732807
  6. 6.
    Zafman KB, Bergh E, Fox NS. Accuracy of sonographic estimated fetal weight in suspected macrosomia: the likelihood of overestimating and underestimating the true birthweight. The Journal of Maternal-Fetal & Neonatal Medicine. Published online September 3, 2018:967-972. doi:10.1080/14767058.2018.1511697
  7. 7.
    Alberico S, Erenbourg A, Hod M, et al. Immediate delivery or expectant management in gestational diabetes at term: the GINEXMAL randomised controlled trial. BJOG: Int J Obstet Gy. Published online November 4, 2016:669-677. doi:10.1111/1471-0528.14389
  8. 8.
    Biesty LM, Egan AM, Dunne F, et al. Planned birth at or near term for improving health outcomes for pregnant women with gestational diabetes and their infants. Cochrane Database of Systematic Reviews. Published online January 5, 2018. doi:10.1002/14651858.cd012910
  9. 9.
    Worda K, Bancher-Todesca D, Husslein P, Worda C, Leipold H. Randomized controlled trial of induction at 38 weeks versus 40 weeks gestation on maternal and infant outcomes in women with insulin-controlled gestational diabetes. Wien Klin Wochenschr. Published online February 6, 2017:618-624. doi:10.1007/s00508-017-1172-4
  10. 10.
    Finucane EM, Murphy DJ, Biesty LM, et al. Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews. Published online February 27, 2020. doi:10.1002/14651858.cd000451.pub3
  11. 11.
    Sagi-Dain L, Sagi S. The effect of late pregnancy date fruit consumption on delivery progress – A meta-analysis. EXPLORE. Published online November 2021:569-573. doi:10.1016/j.explore.2020.05.014
  12. 12.
    Carbone L, De Vivo V, Saccone G, et al. Sexual Intercourse for Induction of Spontaneous Onset of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of Sexual Medicine. Published online November 2019:1787-1795. doi:10.1016/j.jsxm.2019.08.002
  13. 13.
    Jabak S, Hameed A. Continuous intrapartum fetal monitoring in gestational diabetes, where is the evidence? The Journal of Maternal-Fetal & Neonatal Medicine. Published online December 13, 2020:1-4. doi:10.1080/14767058.2020.1849117
  14. 14.
    Coleman TL, Randall H, Graves W, Lindsay M. Vaginal birth after cesarean among women with gestational diabetes. American Journal of Obstetrics and Gynecology. Published online May 2001:1104-1107. doi:10.1067/mob.2001.115176