Predictors of cesarean delivery in pregnant women with gestational diabetes mellitus

Abstract

Purpose The aim of this study was to evaluate which risk factors may lead patients with gestational diabetes mellitus to cesarean delivery. Methods This was a retrospective, descriptive study. The subjects of the study were pregnant women with gestational diabetes mellitus attending a public maternity hospital in the south of Brazil. The primary outcomes assessed were based on maternal and fetal characteristics. The data were correlated using an odds ratio (OR) with a 95% confidence interval (95%CI), calculated using multinomial logistic regression. Results A total of 392 patients with gestational diabetes mellitus were analyzed, and 57.4% of them had cesarean deliveries. Among the maternal characteristics, the mean age of the patients and the pregestational body mass index were greater when a cesarean delivery was performed (p ¼ 0.029 and p < 0.01 respectively). Gestational age at birth, newborn weight, weight class according to gestational age, and Apgar score were not significant. The analysis of the OR showed that the chance of cesarean delivery was 2.25 times (95%CI ¼ 1.49-2.39) greater if the pregnant woman was obese, 4.6 times (95%CI ¼ 3.017-7.150) greater if she was a primigravida, and 5.2 times (95% CI ¼ 2.702-10.003) greater if she had a previous cesarean delivery. The other parameters analyzed showed no differences. Conclusion The factors that led to an increase in the occurrence of cesarean deliveries included history of a prior cesarean section, first pregnancy, and obesity. Palavras-chave► cesárea ► diabetes gestacional ► fatores de risco ResumoObjetivo O objetivo deste trabalho é avaliar quais os fatores de risco que podem levar pacientes com diabetes mellitus gestacional ao parto cesáreo. Métodos Trata-se de um estudo retrospectivo descritivo. Foram sujeitos do estudo gestantes portadoras de diabetes mellitus gestacional atendidas em uma maternidade pública do Sul do Brasil. Os desfechos primários avaliados foram baseados em características maternas e fetais. Os dados foram relacionados por meio da razão de chance

Risk score for predicting primary cesarean delivery in women with gestational diabetes mellitus

“…The three risk factors for primary CD in our risk scoring system, in descending order of importance, were nulliparity, insulin use, and GWG above the IOM recommendations. These three variables were also identified as factors that were significantly associated with primary CD in previous studies [8,13,14]. The adjusted odds ratio of 4.62 for nulliparity as a risk factor for primary CD that was demonstrated in our study was comparable to the finding of Gascho et al [13], who also reported a 4.6-fold-greater odds of primary CD for nulliparous pregnant women with GDM.…”

“…Various characteristic features have been identified as risk factors for CD in women with GDM. These include advanced maternal age, nulliparity, obesity, gestational weight gain (GWG) above the Institute of Medicine (IOM) recommendations, and insulin use [6,8,13,14]. In real clinical practice, an obstetrician may be reluctant to proceed with primary CD based on a patient's individual risk.…”

Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia

“…For instance, GDM increased the incidence of cesarean sections (CS) from 30% [13] to 35% [62]. Though GDM alone is not an indication for CS before 38 weeks of gestation, it becomes evident that CS is a priority choice for many Table 2 Maternal, socio-demographic and life style characteristics of the study participants by GDM status among women completed the follow up from pregnancy through to delivery in Gondar town public health facilities, Northwest Ethiopia March 2018-March, 2019 (n = 694) (Continued) GDM Gestational diabetes mellitus a =Divorced or widowed b = participants with hemoglobin data (n=681) c = participants with prior history of pregnancy (n=400) MUAC=mid upper arm circumference cm=centimeter obstetricians due to different maternal and fetal complications arising from GDM [15]. Despite evidences showing the benefits of vaginal delivery, CS has been preferred for most diabetic pregnant women with previous operations for fear of the rupture of the uterus that may be associated with the risk of fetal macrosomia [63,64].…”

“…Gestational diabetes mellitus has been associated with an increased risk for pregnancy induced hypertension (PIH) with relative risk ranges from 1.4 to 4.15 [4][5][6][7][8][9] although some studies suggest that the relation between PIH and GDM is not well understood [10,11]. It also increases the rate of cesarean delivery by up to 57.4% and has a greater impact in cases of obesity and/or previous history of cesarean section [12][13][14][15][16][17][18]. The risk of induction of labor ranges from 33-38% [13,[18][19][20], premature rupture of membranes (PROM) [9,[21][22][23], antepartum hemorrhage (APH) [24], and postpartum hemorrhage (PPH) were associated with GDM [2,23].…”

The Pathophysiology of Gestational Diabetes Mellitus

“…Macrosomia is also a risk factor for shoulder dystocia—a form of obstructed labor. Thus, babies of GDM pregnancies are usually delivered by caesarean section [ 63 , 64 ]. Once delivered, these babies are at increased risk of hypoglycemia, which is likely due to formed dependence on maternal hyperglycemia (fetal hyperinsulinemia), which can contribute to brain injury if not properly managed [ 65 ].…”