Abstract
PurposeTo evaluate the independent factors associated with the success of a trial of vaginal birth (TVB) in women with type 1 diabetes. Despite all therapeutic efforts and technological innovations, rates of caesarean sections (CS) in pregnant women with type 1 diabetes remain unchanged above 60%. Our aim was to point out influencing factors to improve the quality of antepartum counseling.MethodsWe performed a retrospective cohort study of 195 pregnancies with type 1 diabetes treated between 2000 and 2019. After exclusions, 118 women with near-term singleton pregnancies intended vaginal birth (TVB). Group differences between CS and successful vaginal delivery were analyzed. Multivariate logistic regression was performed by including clinical and metabolic variables to determine the independent effects on a successful vaginal delivery. Subgroup analysis for nulliparous women.ResultsOf 118 women with TVB, 67 (56.8%) were delivered vaginally. History of previous vaginal delivery (OR 10.29; CI 2.39; 44.30), HbA1c changes during pregnancy (per % increase; OR 0.59; CI 0.36; 0.96) and gestational weight gain (per kg; OR 0.87; CI 0.80; 0.96) were independent predictors for a successful vaginal delivery. In nulliparous women, the duration of diabetes was independently and negatively associated with vaginal delivery.ConclusionProvided data can help to improve antepartum counseling in type 1 diabetic patients. It seems that women with type 1 diabetes should avoid postponing pregnancy and childbirth.
Highlights
Decades ago, in women with type 1 diabetes pregnancies were rare and highly jeopardized by intrauterine death, preterm delivery, hypertensive disorders or fetal macrosomia.Nowadays, due to new treatment options and substantially improved diabetic control there is a continuous increase of women with type 1 diabetes getting pregnant, reaching term and delivering healthy newborns
We focused on predictors of successful vaginal delivery in women with trial of vaginal birth (TVB)
Insulin treatment methods during pregnancy were stratified in multiple daily injections (MDI) or continuous subcutaneous insulin injections (CSII, pump therapy) regardless of the method used before the pregnancy
Summary
In women with type 1 diabetes pregnancies were rare and highly jeopardized by intrauterine death, preterm delivery, hypertensive disorders or fetal macrosomia.Nowadays, due to new treatment options and substantially improved diabetic control there is a continuous increase of women with type 1 diabetes getting pregnant, reaching term and delivering healthy newborns. In women with type 1 diabetes pregnancies were rare and highly jeopardized by intrauterine death, preterm delivery, hypertensive disorders or fetal macrosomia. As a vaginal delivery is the most desired birth experience in the vast majority of women, this obvious disproportion compared to healthy non-diabetic women is extremely relevant. Women with type 1 diabetes frequently suffer from preexisting diabetes-related complications such as nephropathy and severe hypertension, which obliging elective CS [1, 6]. Higher rates of CS can be explained by higher rates of elective CS. In those undergoing the trial of vaginal birth (TVB) emergency CS rates are still inexplicably high
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