| 20040420-17 Diet-controlled gestational
diabetes mellitus does not influence the success rates for vaginal birth
after cesarean delivery - American
Journal of Obstetrics and Gynecology , vol 190, no 3, March
2004, pp 790-796 Marchiano D; Elkousy M; Stevens E; et
al - (2004) |
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OBJECTIVE: We sought to determine whether women with
diet-controlled gestational diabetes mellitus who attempt vaginal birth
after cesarean delivery are at increased risk of failure, when compared
with their non-diabetic counterparts. STUDY DESIGN: We identified 13,396
women who attempted vaginal birth after cesarean delivery among 25,079
pregnant women with a previous cesarean delivery who were delivered
between 1995 and 1999 at 16 community and university hospitals. Analysis
was limited to 9437 women without diabetes mellitus and 423 women with
diet-controlled diabetes mellitus who attempted vaginal birth after
cesarean delivery with a singleton gestation and 1 previous low-flap
cesarean delivery. Data that were collected by trained abstractors,
included demographics, medical history, and both pregnancy and neonatal
outcomes. Multivariable logistic regression analysis was performed to
determine an adjusted odds ratio for vaginal birth after cesarean delivery
success among women with diet-controlled gestational diabetes compared
with women with no diabetes mellitus. We controlled for birth weight,
maternal age, race, tobacco, chronic hypertension, hospital settings,
labor management, and obstetric history. RESULTS: Forty-nine percent of
the women with gestational diabetes mellitus and 67% of the women with no
diabetes mellitus attempted vaginal birth after cesarean delivery. The
success rate for attempted vaginal birth after cesarean delivery among
gestational diabetic women was 70%, compared with 74% for non-diabetic
women. We found that gestational diabetes mellitus is not an independent
risk factor for vaginal birth after cesarean delivery failure. The
relative risk for vaginal birth after cesarean delivery success in women
with gestational diabetes mellitus compared with women without gestational
diabetes mellitus was 0.94 (95% CI, 0.87-1.00). After an adjustment was
made for confounding, the odds ratio for success with gestational diabetes
mellitus was 0.87 (95% CI, 0.68-1.10). CONCLUSION: Women with
diet-controlled gestational diabetes mellitus who were carrying singleton
fetuses who had no more than 1 previous low flap cesarean delivery should
be counseled that their disease does not decrease their chances for a
successful vaginal birth after cesarean delivery. Among diet-controlled
diabetic women, the overall success rate for vaginal birth after cesarean
delivery remains acceptable, and attempted vaginal birth after cesarean
delivery should not be discouraged solely on the basis of gestational
diabetes mellitus. (9 references)
(Author) |
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