Why are cesarean delivery rates so high in diabetic pregnancies?

Aims: The purpose of this study was to examine factors relevant to mode of delivery in term pregnancies complicated by gestational and pre-gestational diabetes. Methods: A retrospective chart review of term (greater than or equal to 37 weeks) singleton pregnancies complicated by Class A(2) through Class R pregnancies which delivered from 1991-1997 was performed. Exclusion criteria were prior cesarean delivery, non-vertex presentation, fetal structural defects, or any contraindications to vaginal delivery. Maternal and fetal factors relevant to mode of delivery were examined and compared. Stepwise logistic regression analysis was performed to examine factors predictive of delivery mode. Results: A total of 148 patients met study criteria. Induction rates were 60.9% for gestational and 79.8% for pre-gestational diabetics. The overall cesarean delivery rate by Diabetes Class for A(2), B, C, DF pregnancies was 20.3%, 40%, 37%, and 57.1% respectively. In Class A(2) pregnancies no factor was associated with cesarean delivery and only nulliparity (p = 0.03) was associated in Class B-F pregnancies. Conclusions: These results suggest that physician factors may play an important role in the risk for cesarean delivery in our diabetic population.