185 Cesarean section rates by induction of labor indication in diabetic pregnancies

Abstract

Pregestational (PGDM) and gestational diabetes (GDM) are increasing in the US. These conditions are associated with increased rates of induction of labor (IOL) and cesarean section (CS). The increased rate of CS in diabetic women is most notable in those undergoing IOL. Data are limited regarding the indications for IOL in diabetic women and how the indication influences the CS rate (CSR). This retrospective cohort study included chart abstracted data on term births (370- 426 weeks) at 17 hospitals (1/2016 to 3/2019). The rate of IOL was calculated for each of the three groups of interest: normoglycemic (NG), GDM, and PGDM pregnancies. Indications for IOL were assigned to 6 groups (Table 1) and compared between NG, GDM and PGDM pregnancies. CS rates for PGDM and GDM pregnancies were compared to NG pregnancies, stratifying by indication for IOL. Univariate and multivariate logistic regression analyses were used to calculate odds ratios and 95% CI’s for CS for each indication for IOL using NG pregnancies as reference. Odds ratios were adjusted for maternal age, BMI and birth weight. A total of 78,330 term pregnancies were included in the cohort. Rate of IOL was 41.5% in GDM and 40.6% in PGDM compared to 26.5% in NG women (p<0.001). Obstetric indications were the predominant indication for IOL among NG pregnancies, while maternal indications were most common for GDM and PGDM pregnancies (Table 1). The CSR in women with GDM was similar to NG women regardless of IOL indication (Table 2). Compared to NG pregnancies, the CSR after IOL was highest in women with PGDM (38.6%; aOR 2.07, CI 1.65-2.61) and this remained true for all indications, except fetal, with aORs ranging from 2.03-5.23 (Table 2). Across indications, the CSR in GDM pregnancies is similar to NG pregnancies while PGDM pregnancies have twice the odds of CS after IOL compared to NG pregnancies. This increased CS risk persists across all indications for IOL, except for fetal indications, suggesting an inherent resistance to IOL in women with PGDM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)