Evaluation of Clinical Practice Guidelines on Timing and Onset of Labour in Gestational Diabetes Mellitus: A Scoping Review.

backgroundGestational diabetes mellitus (GDM) is the most common pregnancy complication globally, yet recommendations for the timing and onset of labour vary. Clinical practice guidelines (CPGs) aim to improve safety and quality by guiding decision making through evidence-based recommendations.

objectivesScoping review with embedded guideline appraisal to assess the consistency of recommendations regarding the timing and onset of labour for women with GDM and whether variation was associated with guideline quality. SEARCH STRATEGY: Databases (MEDLINE, CINAHL, EBSCO, Scopus, Embase, JBI Guidelines) and websites of relevant professional organisations were searched. SELECTION CRITERIA: Guidelines and consensus statements published from 2015 to January 2025, available in English from high-income countries, were included. DATA COLLECTION AND ANALYSIS: Guideline quality was assessed using the AGREE-II tool, and recommendations were analysed descriptively. MAIN

resultsOf 1422 records screened, 24 CPGs met the inclusion criteria. The quality of the included CPGs varied, with inconsistent applicability and stakeholder involvement (mean AGREE-II domain scores 55%), developmental rigour (43%), and editorial independence (37%). On the basis of the AGREE-II scores, only 3 CPGs were recommended for use without modifications. Even among higher quality guidelines, recommendations for the onset and timing of labour varied, from 37 to 40+ 6 weeks.

conclusionsConsiderable variation exists with regard to the quality of CPGs and recommendations about the timing of birth for women with GDM. These findings highlight the importance of shared decision making and the need for further research to assist women and their maternity care providers in discussing optimal birth timing.