15 Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with onset or first recognition during p regnancy (1). Women with undiagnosed or poorly managed GDM are at incre a s e d risk of having a large for gestational age (LGA) infant. A LGA infant may be re s p o nsible for cephalo-pelvic dispro p o rtion and hence an increased risk of obstetric intervention including cesarean section.While it is not invariable that women with GDM will have a higher section rate (2,3), it has been suggested recently that knowledge by the obstetric care pro v i d e r s that a woman has GDM is likely to lead to a higher rate (4-6). If this is the case, then some of the potential advantages of diagnosing GDM may be offset by the cost, inconvenience, and complications of this higher section rate. However, if higher section rates are found only in some hospitals, then knowledge about this local practice should not be endorsed as a general disincentive to test women for GDM.The aim of this study was to determ i n e the cesarean section rate in a consecutive series of women with GDM and to compare the reasons for section with a control gro u p of consecutive glucose-tolerant women. RESEARCH DESIGN AND M E T H O D S -The diagnosis of GDM was based on the recommendations of the Australasian Diabetes in Pregnancy Society (ADIPS) criteria (7). Unless indicated earlier in pre g n a n c y, all women were tested at the beginning of the 3rd trimester with a 75-g oral glucose tolerance test (GTT) administ e red in the morning after an overnight fast. Although the ADIPS criteria allow the option of a pre l i m i n a ry screening test, all women in our Health Area of New South Wales, Australia have the definitive GTT as a one-stage test. Women were diagnosed with GDM if the 2-h plasma glucose level was 8.0 mmol/l (144 mg/dl). Although the ADIPS criteria specify that GDM is also diagnosed if the fasting level is 5.5 mmol/l (99 mg/dl), 92% or more of cases of GDM a re diagnosed on the result of the 2-h level (8). For local logistical reasons some women only have the 2-h test on the GTT (9).The women with GDM who had had a section were from a consecutive series of women re f e rred for the medical management of their GDM to a diabetologist (R.G.M.) over the period 1990-1998. All details were obtained from a compre h e n s i v e clinical database established and maintained for all women treated. All women were seen initially and reviewed as re q u i red by a dietitian and diabetes educator. All women received a carbohydrate-controlled diet and p e rf o rmed home glucose monitoring. The use of insulin was recommended if the fasting glucose was 5.5 mmol/l or the postprandial glucose levels were 8.0 mmol/l 1 h after a meal or 7.0 mmol/l 2 h after a meal. Obstetric care was conducted independently of the medical management and t h e re were no combined appointments. The number of obstetric care providers primarily responsible for the deliveries varied over the period when the data was being collected but was approximately six.For compa...
The higher rate of Caesarean section appeared to be related to the combination of a twin pregnancy and GDM rather than the twin pregnancy or the GDM independently.
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