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In Diabetes Patients, Modifiable Factors Up Risk of Cesarean

In nulliparous women, pre-pregnancy BMI, gestational weight gain among risk factors

FRIDAY, April 23 (HealthDay News) -- Nulliparous women with type 1 diabetes mellitus have a high rate of cesarean delivery, and their potentially modifiable risk factors for cesarean delivery include pre-pregnancy body weight, gestational weight gain, and accuracy of the prediction of fetal macrosomia, according to a study published in the May issue of Obstetrics & Gynecology.

Jacques Lepercq, M.D., of Groupe Hospitalier Cochin -- Saint Vincent de Paul in Paris, and colleagues evaluated 209 nulliparous women with type 1 diabetes mellitus and a single pregnancy who were consecutively delivered after 22 weeks of gestation between 1997 and 2008.

The researchers found that a cesarean delivery was performed without labor in 45 percent of the women. Gestational weight gain higher than 15 kg and suspected macrosomia were independently associated with cesarean delivery without labor. Of the 115 women who underwent a trial of labor, 47 percent had a cesarean delivery. Pre-pregnancy body mass index more than 25 kg/m2 was independently associated with cesarean delivery, as was a Bishop score of three or lower. Factors not found to be associated with cesarean delivery: preconception care, presence of nephropathy, hemoglobin A1C levels during pregnancy, preeclampsia, and preterm delivery.

"In the absence of macrosomia and when glycemic control is good, a conservative management with fetal surveillance waiting for a favorable cervical status should be investigated in a randomized controlled study to potentially decrease the rate of failed inductions in this high-risk population," the authors write.

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