One of the biggest challenge in management of patients with diabetes in pregnancy is management of macrosomia and accurate estimation of birth weight. Thus, nondirective counselling and shared decision making process regarding mode and timing of delivery to reduce fetal and neonatal complications is extremely important.
There is good quality evidence supporting the need to reduce iatrogenic early term birth to reduce the risk of learning and behavioural problems at school age. But, there are multiple challenges in achieving this in patients with pre-existing diabetes. IOL for all around 38wks or wait for expectant management in patients with well controlled diabetes? What does the data suggest and what evidence do we have to adequately counsel our patients?