Women with diabetes are at increased risk for cesarean delivery, but there is a paucity of data examining practice patterns associated with indication for cesarean delivery among women with and without diabetes. We conducted a secondary analysis of the Consortium on Safe Labor data to evaluate cesarean delivery practices among women with gestational diabetes (GDM) and pregestational diabetes in a large U.S. cohort.
Of the 191,174 women, 9,791 (5.1%) had GDM and 2,792 (1.4%) had pregestational diabetes. The overall cohort cesarean delivery rate was 30%. After adjusting for covariates, cesarean delivery rates were higher for women with GDM (28 vs. 45%, aOR 1.44, 95% CI 1.36-1.54) and pregestational diabetes (28 vs. 59%, aOR 2.21, 95% CI 1.99-2.46). Women with GDM and pregestational diabetes were more likely to undergo pre-labor cesarean delivery. Because indications for cesarean delivery may differ by maternal parity, stratified analyses were performed in nulliparous and multiparous women by diabetes type. Elective cesarean delivery and cesarean delivery for macrosomia were more common among women with diabetes, while cesarean delivery for failure to progress was less likely (Table). These data suggest that encouraging an attempt of vaginal delivery in women with diabetes and no contraindications may be one strategy to reduce the risk for cesarean delivery in this high-risk population.
J. Grasch: None. K. Miller: None. D. Haas: None. M. Tuuli: None. C.M. Scifres: None.