Risk Factors for a Primary Cesarean Delivery in Pregnancies Complicated by Pregestational Diabetes

Objective: The Cesarean delivery risk is increased in pregnancies complicated by pregestational diabetes. Our study aim is to identify risk factors and predictors for a primary Cesarean delivery in women whose pregnancy is complicated by pregestational diabetes. Methods: This is a retrospective study of women with pregestational diabetes and singleton pregnancies managed with uniform treatment plans and strict control of their blood glucose levels at an academic medical center. Maternal demographics and clinical characteristics were collected and evaluated. Logistic regression was used to analyze the association of risk factors on primary Cesarean rates. Results: There were 252 women evaluated. Group 1 consisted of 117 women delivered by primary Cesarean (45.4%). Group 2 consisted of women delivered vaginally (53.6%). The best predictors for a cesarean delivery were the maternal BMI in the 1 st trimester (BMI > 40, Relative Risk (RR) 60.3% (95% 47.7– 71.97) and hypertensive disorders of pregnancy (RR, 55.39% (95%, Confidence Interval (CI) 47.87– 63.71)). Maternal weight gain, elevated hemoglobin A1c levels in the 3 rd trimester, and ratio of head circumference to abdominal circumference (HC/AC) on a 3 rd trimester ultrasound were other significant contributors for an elevated primary cesarean rate. Conclusion: In pregestational diabetes overseen by a dedicated diabetic pregnancy management team with uniform treatment plans, and strict blood glucose control, chronic hypertension and maternal weight gain were the primary contributors for a primary cesarean. Other contributors included maternal hemoglobin A1c levels, HC/AC ratios on ultrasound, and maternal weight gain during pregnancy. These results highlight the importance of actively managing maternal weight and hypertension prior to pregnancy and focusing on maternal glucose control and weight gain during pregnancy. Keywords: cesarean section, diabetes mellitus, gestational weight gain, glycosylated hemoglobin, hypertension, obesity