title: Factors associated with cesarean delivery in nulliparous women with type 1 diabetes.
abstract: OBJECTIVE
  To identify factors associated with cesarean delivery in nulliparous women with type 1 diabetes mellitus.
  
  
  METHODS
  We performed a nested case-control study within a cohort of nulliparous women with type 1 diabetes mellitus. Independent factors and odds ratios were identified by logistic regression.
  
  
  RESULTS
  Among 209 women, a cesarean delivery was performed without labor in 94 women (45%). Gestational weight gain higher than 15 kg (39% compared with 23%; odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1-4.5) and suspected macrosomia (79% compared with 21%; OR, 13.1; 95% CI, 5.3-32.2) were independently associated with cesarean delivery without labor. Among 115 women who underwent a trial of labor, 54 (47%) had a cesarean delivery. Prepregnancy body mass index more than 25 kg/m2 (84% compared with 39%; OR, 7.5; 95% CI, 1.9-29.4) and Bishop score 3 or lower (66% compared with 25%; OR, 5.9; 95% CI, 2.2-16.1) were independently associated with cesarean delivery in labor. Preconception care, presence of a nephropathy, hemoglobin A1C levels during pregnancy, preeclampsia, and preterm delivery were not associated with cesarean delivery. The rates of wound infection and endometritis were 0.7% and 3%, respectively.
  
  
  CONCLUSIONS
  The rate of cesarean delivery in nulliparous women with type 1 diabetes mellitus is very high. Prepregnancy body weight, gestational weight gain, and accuracy of the prediction of fetal macrosomia are potentially modifiable risk factors for cesarean delivery.
authors.affiliation: From the Service de Gynécologie Obstétrique, Service de Diabétologie, Groupe Hospitalier Cochin - Saint-Vincent de Paul, AP-HP, Université Paris Descartes, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Lepercq
authors.forename: Jean Patrick
authors.initials: JP
authors.lastname: Le Meaux
authors.forename: Antoine
authors.initials: A
authors.lastname: Agman
authors.forename: José
authors.initials: J
authors.lastname: Timsit
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D002585:Cesarean Section / Q000401:mortality / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D006442:Glycated Hemoglobin; D006801:Humans; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000097:blood / Q000601:surgery*; D012307:Risk Factors; D014219:Trial of Labor; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin
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