Prevalence and risk factors of cesarean section in a population of Tunisian diabetic pregnant women.

AIM

To determine the rate of and indication of cesarean section among women with preexisting and gestational diabetes mellitus compared with glucose-tolerant women.

METHODS

from case-control study of 400 Tunisian pregnant women (200 in group diabetes and 200 in group control) seen over a 5-year period for medical management, women who had a cesarean section were identified and the reason for the section determined from a review of the medical record. A control group of women who had a section were obtained from an existing data-base of glucose-tolerant women.

RESULTS

Women in the diabetic group were significantly older, with higher BMI and birth weight than in the control group (p<0.05). Total cesarean rate was significantly higher in the diabetic group (50,2%) than in the control group (28,2%)( OR= 2.72 IC[1.76-4.20]). The rate of elective cesarean delivery was significantly higher in the diabetic group (40.5%) than in the control group (8.5%) (OR= 4,87 [2,69-8,90]). However, vaginal delivery success rate when trial of labour was tried was similar in both study groups (76% and 78%). Most frequent indications for cesarean delivery in the diabetic group were foetal macrosomia and scarred uterus. Multivariate analysis showed that maternal obesity, unbalanced diabetes, unplanned pregnancy, and foetal macrosomia were significantly correlated with risk of cesarean delivery in diabetic women.

CONCLUSION

Cesarean rate in our population of diabetic pregnant women is higher than in the control group. Maternal obesity, uncontrolled diabetes, unplanned pregnancy, and foetal macrosomia were significantly correlated with risk of cesarean delivery in diabetic women.