Diabetes Mellitus in pregnancy-a risk factor for perineal injuries, independent of neonatal macrosomia

Abstract

Perineal lacerations, mainly 3rd and 4th degree tears (also known as- OASIS), are obstetrical complications that may cause significant morbidity. DM can adversely affect the condition of body tissues and their blood supply, changes that may contribute to the risk of childbirth perineal trauma. Gestational diabetes can also affects other obstetrical characteristics such as macrosomia and induction of labor that are additional risk factors for perianal trauma. We investigated the association between DM in pregnancy (gestational and pre-gestational) and perineal tears during vaginal childbirth. A population-based cohort study was conducted and included all women who delivered vaginally beyond 24-week gestation. Deliveries occurred during the years 1988 and 2016 at a single large teaching medical center. Rates of perineal lacerations were compared between women with DM in pregnancy (GDMA1 and GDMA2) and pre-gestational DM to those without DM. In addition, obstetrical and neonatal characteristics were compared between women with different types of DM. Multiple gestations, women lacking prenatal care and complication of stillbirth were excluded. Multivariable models of negative binomial regression analysis were used to evaluate prediction of perineal lacerations and associated risk factors. The study population included 250,853 pregnant women who met the inclusion criteria. Of these, 239,535 were without DM, while 11,318 women were diagnosed with DM in pregnancy. Women with DM had a higher rate of lacerations (21.% vs. 18.8%) with higher rates of OASIS (table 1). In the multivariate analysis, DM was found to be a significant risk factor for perineal lacerations, after controlling for birth weight, maternal age and nulliparity. When comparing pre-gestational and gestational DM while no difference was found in overall rates of lacerations, more extensive tears (second degree and higher) were more common in the pre-gestational group, as were certain pregnancy complications (table 2). Women with DM in pregnancy have a higher risk for perineal lacerations during childbirth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)