title: Factors associated with urgent cesarean delivery in women with type 1 diabetes mellitus.
abstract: OBJECTIVE
  Type 1 diabetes mellitus (DM) is associated with a threefold to fivefold increased risk for stillbirth during pregnancy. The objective of the present study was to identify factors associated with prelabor urgent cesarean delivery for fetal compromise in women with type 1 DM.
  
  
  METHODS
  We performed a nested case-control study within a prospective cohort of single pregnancies in women with type 1 DM managed with standardized protocols regarding treatment of diabetes and prenatal care. Twice-weekly home antenatal surveillance including nonstress test was initiated at 32 weeks of gestation and continued until planned delivery at 38-39 weeks of gestation. We identified factors associated with urgent cesarean delivery for an abnormal nonstress test. The calculated total sample size was 416 pregnancies. Independent factors and adjusted odds ratio (OR) were identified by logistic regression.
  
  
  RESULTS
  Among 479 pregnancies, the rate of urgent cesarean delivery for an abnormal nonstress test was 4%. A hemoglobin A1C (Hb A1C) level at delivery of 6.4% or higher occurred in 34% of the pregnancies and was independently associated with urgent cesarean delivery (2% compared with 8%, P=.003, OR 4.16, 95% confidence interval 1.40-12.32). In the multivariable analysis, lack of preconception care and occurrence of gestational hypertension or preeclampsia were not associated with urgent cesarean delivery. The rate of stillbirth was 2 per 1,000.
  
  
  CONCLUSIONS
  In women with type 1 DM, an Hb A1C level at delivery of 6.4% or higher was associated with prelabor urgent cesarean delivery. This suggests that tight glycemic control throughout pregnancy might reduce the risk of late fetal compromise.
  
  
  METHODS
  III.
authors: Department of Obstetrics and Gynecology of Port Royal, Department of Diabetology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; Paris Descartes University, Sorbonne Paris Cité, and INSERM Unit 953, Epidemiological Research Unit on Perinatal Health and Women's Health, Paris, France.
authors: Grégoire
authors: G
authors: Miailhe
authors: Camille
authors: C
authors: Le Ray
authors: José
authors: J
authors: Timsit
authors: Jacques
authors: J
authors: Lepercq
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D011446:Prospective Studies; D012307:Risk Factors
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