You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

ACOG MEMBER SUBSCRIPTION ACCESS

If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription.

Factors Associated With Cesarean Delivery in Nulliparous Women With Type 1 Diabetes

Lepercq, Jacques MD; Le Meaux, Jean Patrick MD; Agman, Antoine MD; Timsit, José MD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181d992ab
Original Research
Abstract

OBJECTIVE: To identify factors associated with cesarean delivery in nulliparous women with type 1 diabetes mellitus.

METHODS: We performed a nested case-control study within a cohort of nulliparous women with type 1 diabetes mellitus. Independent factors and odds ratios were identified by logistic regression.

RESULTS: Among 209 women, a cesarean delivery was performed without labor in 94 women (45%). Gestational weight gain higher than 15 kg (39% compared with 23%; odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1–4.5) and suspected macrosomia (79% compared with 21%; OR, 13.1; 95% CI, 5.3–32.2) were independently associated with cesarean delivery without labor. Among 115 women who underwent a trial of labor, 54 (47%) had a cesarean delivery. Prepregnancy body mass index more than 25 kg/m2 (84% compared with 39%; OR, 7.5; 95% CI, 1.9–29.4) and Bishop score 3 or lower (66% compared with 25%; OR, 5.9; 95% CI, 2.2–16.1) were independently associated with cesarean delivery in labor. Preconception care, presence of a nephropathy, hemoglobin A1C levels during pregnancy, preeclampsia, and preterm delivery were not associated with cesarean delivery. The rates of wound infection and endometritis were 0.7% and 3%, respectively.

CONCLUSION: The rate of cesarean delivery in nulliparous women with type 1 diabetes mellitus is very high. Prepregnancy body weight, gestational weight gain, and accuracy of the prediction of fetal macrosomia are potentially modifiable risk factors for cesarean delivery.

LEVEL OF EVIDENCE: II

In Brief

Prepregnancy body weight, gestational weight gain, and prediction of fetal macrosomia are potentially modifiable risk factors for cesarean delivery in women with type 1 diabetes.

Author Information

From the Service de Gynécologie Obstétrique, Service de Diabétologie, Groupe Hospitalier Cochin - Saint-Vincent de Paul, AP-HP, Université Paris Descartes, Paris, France.

The authors thank Babak Khoshnood, MD, PhD, for statistical assistance.

Presented as a poster at the 40th annual meeting of the Diabetes and Pregnancy Study Group, October 2–4, 2008, Cavtat, Croatia.

Corresponding author: Jacques Lepercq, MD, Service de Gynecologie Obstétrique, Groupe hospitalier Cochin Saint Vincent de Paul, 82, avenue Denfert-Rochereau, 75014 Paris, France; e-mail j.lepercq@svp.aphp.fr.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.