Objective: To identify risk factors of cesarean delivery in pregnant women with diabetes mellitus and complications caused by gestational diabetes.

Materials and Methods: A retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Phatthalung Hospital. The participants consisted of pregnant women who labored at Phatthalung Hospital between 2017 and 2021. The inclusion criteria comprised women who labored from 28 to 42 weeks and had complete medical records. Patients having previous cesarean sections, cesarean section on maternal demand, and twin pregnancy were excluded. The study group was diabetic mellitus pregnant women, while non-diabetic pregnant women was generated by random numbers at ratio of 1:1 as control group. The data collected were demographic data, age, body mass index (BMI), number of gestations, parity, abortion, type of diabetic mellitus, underlying disease, route of delivery, indications for cesarean delivery, and maternal and neonatal outcomes.

Results: Two thousand twelve pregnant women consisted of 1,006 pregnancies with diabetes and 1,006 non-diabetic pregnancies. Pregnant women with diabetes significantly increased the risk of cesarean section 1.42 time (95% CI 1.19 to 1.70, p<0.001). The greatest indication for cesarean section of both groups was cephalopelvic disproportion, but failure for induction of labor and macrosomia were found in the study group more than in the control group. Logistic regression analysis, adjusted for age group, number of gestations, and BMI, showed that pregnancy-induced hypertension and newborn weight of 4,000 g or more were risk factors for cesarean section among diabetic pregnancies. The maternal complications of the study group were preeclampsia, indicated preterm labor, and premature rupture of membranes. The common fetal complications were macrosomia and birth asphyxia.

Conclusion: Risk factors of cesarean section among pregnant women with diabetes included preeclampsia and newborn weight of 4,000 g or more. Gestational diabetes increased significantly the maternal and fetal complications.

Keywords: Gestational diabetic mellitus; Cesarean section; Complications

DOI: 10.35755/jmedassocthai.2023.09.13757

Received 31 January 2023 | Revised 10 July 2023 | Accepted 13 July 2023