What do systematic reviews say?

Insulin Aspart (+ NPH) vs human insulin (+ NPH insulin)

The review found no eligible studies for this question.

• Different insulin types and regimens for pregnant women with pre‐existing diabetes 2017 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Insulin Detemir + prandial insulin Aspart vs NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens)

• Different insulin types and regimens for pregnant women with pre‐existing diabetes 2017 · Cochrane Headline outcomes only
  no estimate extracted
  0 studies · 0 participants
  GRADE not reported

Lispro vs regular insulin (Different insulin types within similar insulin regimens)

It is very uncertain whether lispro changes caesarean section compared with regular insulin (Different insulin types within similar insulin… (very low certainty).

• Different insulin types and regimens for pregnant women with pre‐existing diabetes 2017 · Cochrane Headline outcomes only
  RR 0.59 [0.25, 1.39]
  1 study · 33 participants
  Very low

Metformin vs glibenclamide ‐ maternal outcomes

Metformin showed no clear difference in caesarean section compared with glibenclamide ‐ maternal outcomes (low certainty).

• Oral anti‐diabetic pharmacological therapies for the treatment of women with gestational diabetes 2017 · Cochrane Headline outcomes only
  RR 1.2 [0.83, 1.72]
  4 studies · 554 participants
  Low

Glibenclamide vs acarbose ‐ maternal outcomes

Glibenclamide showed no clear difference in caesarean section compared with acarbose ‐ maternal outcomes (low certainty).

• Oral anti‐diabetic pharmacological therapies for the treatment of women with gestational diabetes 2017 · Cochrane Headline outcomes only
  RR 0.95 [0.53, 1.7]
  1 study · 43 participants
  Low

Lifestyle interventions vs control ‐ Maternal outcomes

Lifestyle interventions showed no clear difference in caesarean section compared with control ‐ Maternal outcomes (low certainty).

• Lifestyle interventions for the treatment of women with gestational diabetes 2017 · Cochrane Headline outcomes only
  RR 0.9 [0.78, 1.05]
  10 studies · 3545 participants
  Low

Insulin vs anti‐diabetic agent

Insulin showed no clear difference in caesarean section compared with anti‐diabetic agent (moderate certainty).

• Insulin for the treatment of women with gestational diabetes 2017 · Cochrane Headline outcomes only
  RR 1.03 [0.93, 1.14]
  17 studies · 1988 participants
  Moderate

Exercise vs control

Exercise showed no clear difference in caesarean section compared with control (moderate certainty).

• Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes 2017 · Cochrane Headline outcomes only
  RR 0.86 [0.63, 1.16]
  5 studies · 316 participants
  Moderate

CSII vs MDI: maternal outcomes

It is very uncertain whether CSII changes caesarean section compared with MDI: maternal outcomes (very low certainty).

• Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes 2016 · Cochrane Headline outcomes only
  RR 1.09 [0.66, 1.77]
  3 studies · 71 participants
  Very low

Nitric oxide donors vs placebo

Nitric oxide donors showed no clear difference in caesarean section compared with placebo (moderate certainty).

• Nitric oxide donors for cervical ripening and induction of labour 2016 · Cochrane Headline outcomes only
  RR 0.99 [0.88, 1.11]
  9 studies · 2624 participants
  Moderate

Tight vs moderate glycaemic control (maternal outcomes)

It is very uncertain whether tight changes caesarean section compared with moderate glycaemic control (maternal outcomes) (very low certainty).

• Different intensities of glycaemic control for pregnant women with pre‐existing diabetes 2016 · Cochrane Headline outcomes only
  RR 1.21 [0.22, 6.5]
  1 study · 45 participants
  Very low

Very tight vs tight‐moderate glycaemic control (infant outcomes)

It is very uncertain whether very tight changes caesarean section compared with tight‐moderate glycaemic control (maternal outcomes) (very low certainty).

• Different intensities of glycaemic control for pregnant women with pre‐existing diabetes 2016 · Cochrane Headline outcomes only
  RR 0.92 [0.49, 1.73]
  1 study · 22 participants
  Very low

Tight‐moderate vs less‐tight glycaemic targets (maternal outcomes)

Tight‐moderate may leads to lower caesarean section compared with loose glycaemic control (maternal outcomes) (low certainty).

• Different intensities of glycaemic control for pregnant women with pre‐existing diabetes 2016 · Cochrane Headline outcomes only
  RR 0.28 [0.1, 0.78]
  1 study · 60 participants
  Low

Immediate vs deferred delivery of the preterm baby with suspected fetal compromise

Immediate leads to higher caesarean section compared with deferred delivery of the preterm baby with suspected fetal compromise (high certainty).

• Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes 2016 · Cochrane Headline outcomes only
  RR 1.15 [1.07, 1.24]
  1 study · 547 participants
  High

Amnioinfusion vs no amnioinfusion

Amnioinfusion showed no clear difference in caesarean section compared with no amnioinfusion (low certainty).

• Amnioinfusion for chorioamnionitis 2016 · Cochrane Headline outcomes only
  RR 1 [0.35, 2.83]
  1 study · 34 participants
  Low

Myo‐inositol vs placebo

• Dietary supplementation with myo‐inositol in women during pregnancy for treating gestational diabetes 2016 · Cochrane Headline outcomes only
  no estimate extracted
  0 studies · 0 participants
  GRADE not reported

Intervention not reported

It is very uncertain whether the intervention changes caesarean section (very low certainty).

• External cephalic version for breech presentation at term 2015 · Cochrane Headline outcomes only
  RR 0.57 [0.4, 0.82]
  8 studies · 1305 participants
  Very low

External cephalic version (ECV) commenced before term vs ECV at term

External cephalic version (ECV) commenced before term showed no clear difference in caesarean section compared with ECV at term (high certainty).

• External cephalic version for breech presentation before term 2015 · Cochrane Headline outcomes only
  RR 0.92 [0.85, 1]
  3 studies · 1888 participants
  High

Intervention not reported

The intervention may leads to higher caesarean section (low certainty).

• Planned caesarean section for term breech delivery 2015 · Cochrane Headline outcomes only
  RR 2.04 [1.91, 2.17]
  3 studies · 2396 participants
  Low

Intervention not reported

The intervention showed no clear difference in caesarean section (high certainty).

• Routine ultrasound in late pregnancy (after 24 weeks' gestation) 2015 · Cochrane Headline outcomes only
  RR 1.02 [0.97, 1.09]
  6 studies · 27461 participants
  High