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

Abstract

Background Women with gestational diabetes mellitus (GDM) have a higher risk of cesarean delivery (CD) than glucose-tolerant women. The aim of this study was to develop and validate a risk score for predicting primary CD in women with GDM. Methods A risk score for predicting primary CD was developed using significant clinical features of 385 women who had a diagnosis of GDM and delivered at our institution between January 2011 and December 2014. The score was then tested for validity in another cohort of 448 individuals with GDM who delivered between January 2015 and December 2018. Results The risk score was developed using the features nulliparity, excess gestational weight gain, and insulin use. The scores that classified the pregnant women as low risk (0 points), intermediate risk (1–3 points), and high risk (≥ 4 points) were directly associated with the primary CD rates of the women in the development cohort: 14.7, 38.2 and 62.3%, respectively (P < 0.001). The model showed good calibration and acceptable discriminative power with a C statistic of 0.724 (95% confidence interval, 0.670–0.777). Similar results were observed in the validation cohort. Conclusion A risk score using the features nulliparity, excess gestational weight gain, and insulin use can estimate the risk for primary CD in women with GDM.

Standardising the assessment of caesarean birth using an oxford caesarean prediction score for mothers with gestational diabetes

“…The distribution of caesarean prediction scores is shown in Figure 3. To evaluate the difference in caesarean prediction scores between different populations, we also tested a risk score for primary caesarean birth developed based on a Thai population [7]. The AUROC of the Thai model on the UK cohort is 0.617 ± 0.005.…”

“…A caesarean prediction score table could be helpful to allocate healthcare resources and reduce the rate of ECB. The only model currently proposed to do this is from Thailand and has not been validated outside that setting [7]. The HAPO study [8] confirmed a linear association between blood glucose values at 28 weeks (through the oral glucose tolerance test) and subsequent risk of primary caesarean birth.…”

The combined effect of pre-pregnancy body mass index and gestational weight gain on the risk of pre-labour and intrapartum caesarean section—The ICE-MCH study

“…Moreover, in a previous study, we reported that among normal weight Icelandic women, the risk of pregnancy complications, including gestational hypertension, gestational diabetes, and pre-eclampsia, started to increase after gestational weight gain above 18 kg [ 27 ]. Some of these complications, in turn, have been found to increase the risk of caesarean section [ 28 , 29 ]. However, in that study, we found no association between gestational weight gain with complications in delivery, including caesarean section [ 27 ].…”

Single site pilot clinical investigation of a novel app-assisted self-management programme for gestational diabetes

“…Emergency caesarean delivery is more likely in pregnancies complicated by GDM compared to non-diabetic pregnancies even in average for gestational age weights [39,40]. A validated prediction model was successful in identifying an increased risk of CS in patients with GDM based on insulin use, gestational weight gain and nulliparity [41]. Though gestational diabetes by definition resolves within 6 weeks of delivery, these mothers remain at increased risk of the subsequent development of type two diabetes.…”