The Feasibility Of Expectant Management Versus Induction At 38 Weeks Among Individuals With Gestational Diabetes Mellitus: A Randomized Controlled Pilot Trial (EAGER Pilot Trial)

Inclusion Criteria: * Diagnosis of GDM after 24 weeks of gestation, based on documented 1-step or 2-step screening and diagnostic tests for GDM. * Singleton fetus at randomization. * Confirmed live fetus within 24 hours prior to randomization. * Gestational age between 36 weeks + 0 days and 38 weeks + 0 days inclusive based on an ultrasound in the first or second trimester \[≤ 23 weeks + 0 days\]. For pregnancies conceived by in vitro fertilization, dating will be based on the embryo age at transfer. * Cephalic presentation. * Planning to deliver at a participating site. * Aged 16 years or older. Exclusion Criteria: * Pre-pregnancy diabetes mellitus. * Any obstetrical/maternal indication for immediate delivery including placenta abruption, abnormal fetal well-being either by non-stress test or biophysical profile, history of venous thromboembolism (VTE) on low molecular weight heparin, pre-existing hypertension, gestational hypertension, preeclampsia, eclampsia, or Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome at the time of randomization. * Contraindication to labour and/or vaginal delivery. * Signs of labour (regular uterine contractions accompanied by cervical dilation and/or effacement) at the time of randomization. * Significant vaginal bleeding or ruptured membranes at the time of randomization. * Prior Cesarean delivery. * Placenta previa, placenta accreta, or vasa previa. * Cerclage in current pregnancy. * Known major fetal anomaly (e.g., gastroschisis, congenital heart defects). * Known oligohydramnios (AFI \< 5 or MVP \< 2 or no 2 by 2 pocket). * Known fetal growth restriction (EFW \< 3rd percentile). * Refusal of blood products. * Use of unregulated substances.