Examination of factors contributing to the risk of cesarean delivery in women with gestational diabetes.
OBJECTIVE
To determine whether increased neonatal fat is associated with an elevated risk of cesarean delivery in infants born to mothers with gestational diabetes mellitus.


METHODS
Of 166 infants born to mothers with gestational diabetes, 110 were born vaginally (91 spontaneous, 19 instrumental) and 56 by cesarean. Data were collected on maternal demographics, maternal anthropometrics, delivery variables, and neonatal anthropometrics. We compared all characteristics between women who delivered vaginally and the 29 delivered by cesarean in labor.


RESULTS
The difference in birth weight between infants delivered by cesarean and vaginally was not statistically significant (3520 +/- 456 and 3374 +/- 559 g, respectively [mean +/- standard deviation]). There were significant differences between the cesarean and vaginal delivery groups in the rate of nulliparity (80 versus 48%, respectively), maternal pregravid body mass index (28.6 +/- 7.7 versus 25.2 +/- 5.8 kg/m2), fetal position at delivery (23.8 versus 96.2% occiput anterior), and all estimates of neonatal body fat (ponderal index: 2.77 +/- 0.20 versus 2.67 +/- 0.26 kg/m3; sum of two-site skinfold measurements: 11.7 +/- 2.8 versus 10.5 +/- 1.8 mm; and percent body fat: 15.1 +/- 4.9 versus 13.0 +/- 3.3). Stepwise logistic regression analysis demonstrated that fetal position, maternal nulliparity, and fetal fat contributed independently to the cesarean risk.


CONCLUSIONS
Increased newborn fat is associated independently with an increased risk for cesarean in labor.
Bernstein
I M
IM
Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington.
Catalano
P M
PM
D001724:Birth Weight; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007746:Labor Presentation; D016015:Logistic Models; D011247:Pregnancy; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors