Risk Factors for a Primary Cesarean Delivery in Pregnancies Complicated by Pregestational Diabetes
Year: 2026
Type: article
Study design: Observational Study
Abstract: Dana S Abulez,1 Lauren Hutka,1 Ruofei Du,2 Mary K Clarkson,1 Ryan Hui,1 Everett F Magann,1 Nafisa K Dajani1 1Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USACorrespondence: Everett F Magann, Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St., #518, Little Rock, AR, 72205, USA, Tel +1 501 686 8345, Fax +1 501 526 7820, Email [email protected]: The Cesarean delivery risk is increased in pregnancies complicated by pregestational diabetes. Our study aim is to identify risk factors and predictors for a primary Cesarean delivery in women whose pregnancy is complicated by pregestational diabetes.Methods: This is a retrospective study of women with pregestational diabetes and singleton pregnancies managed with uniform treatment plans and strict control of their blood glucose levels at an academic medical center. Maternal demographics and clinical characteristics were collected and evaluated. Logistic regression was used to analyze the association of risk factors on primary Cesarean rates.Results: There were 252 women evaluated. Group 1 consisted of 117 women delivered by primary Cesarean (45.4%). Group 2 consisted of women delivered vaginally (53.6%). The best predictors for a cesarean delivery were the maternal BMI in the 1st trimester (BMI > 40, Relative Risk (RR) 60.3% (95% 47.7– 71.97) and hypertensive disorders of pregnancy (RR, 55.39% (95%, Confidence Interval (CI) 47.87– 63.71)). Maternal weight gain, elevated hemoglobin A1c levels in the 3rd trimester, and ratio of head circumference to abdominal circumference (HC/AC) on a 3rd trimester ultrasound were other significant contributors for an elevated primary cesarean rate.Conclusion: In pregestational diabetes overseen by a dedicated diabetic pregnancy management team with uniform treatment plans, and strict blood glucose control, chronic hypertension and maternal weight gain were the primary contributors for a primary cesarean. Other contributors included maternal hemoglobin A1c levels, HC/AC ratios on ultrasound, and maternal weight gain during pregnancy. These results highlight the importance of actively managing maternal weight and hypertension prior to pregnancy and focusing on maternal glucose control and weight gain during pregnancy.Keywords: cesarean section, diabetes mellitus, gestational weight gain, glycosylated hemoglobin, hypertension, obesity
Authors: Abulez DS, Hutka L, Du R, Clarkson MK, Hui R, Magann EF, Dajani NK
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7120739751
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