Vaginal birth after cesarean among women with gestational diabetes.
OBJECTIVE
We sought to determine the pregnancy and infant outcomes of women with gestational diabetes who attempted vaginal birth after previous cesarean delivery.


METHODS
We conducted a retrospective cohort study to compare women with gestational diabetes with matched control subjects without diabetes who attempted vaginal birth after cesarean at Grady Memorial Hospital, Atlanta, from January 1, 1989, through December 31, 1999. One hundred fifty-six women with gestational diabetes were matched with 272 control subjects. Data were analyzed with the Student t test, chi2 analysis, and the Fisher exact test.


RESULTS
The parities of the women with gestational diabetes and the control subjects were similar, with most having had only one previous pregnancy. Women with gestational diabetes were significantly older than control subjects and more likely to be white or Hispanic. Women with gestational diabetes who attempted a trial of labor were significantly more likely than control subjects to be delivered abdominally. Women with gestational diabetes who had a successful vaginal birth after cesarean were significantly more likely than control subjects to have an operative delivery with forceps or vacuum.


CONCLUSIONS
Women with gestational diabetes are less likely than those without diabetes to have a successful trial of labor. Women with gestational diabetes considering vaginal birth after cesarean should be appropriately counseled about the risk of attempting a trial of labor after previous cesarean delivery.
Coleman
T L
TL
Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Randall
H
H
Graves
W
W
Lindsay
M
M
D000328:Adult; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012016:Reference Values; D012189:Retrospective Studies; D013525:Surgical Instruments; D014219:Trial of Labor; D014620:Vacuum Extraction, Obstetrical; D016064:Vaginal Birth after Cesarean