title: Obstetric interventions for women with type 1 or type 2 diabetes.
abstract: OBJECTIVE
  To determine whether differences exist in the rates of obstetric intervention between women with type 1 diabetes and those with type 2 diabetes, and whether there has been any change in cesarean rates over time, paralleling that seen in the general obstetric population.
  
  
  METHODS
  Data were examined from a prospectively collected series on the outcomes of 1030 deliveries (382 by women with type 1 diabetes, 648 by women with type 2 diabetes) from 1988 to 2008.
  
  
  RESULTS
  There was a secular trend to increasing maternal age (type 1, P < 0.003; type 2, P < 0.03). Intervention rates (induction of labor or elective cesarean) did not differ between type 1 (88%) and type 2 (85%) diabetes. The overall cesarean rate was 52%-55% with no secular trend. Poorer glycemic control in early pregnancy and primiparity were associated with primary cesarean in both groups. In women with type 1 diabetes, greater maternal obesity and retinopathy were also associated with primary cesarean.
  
  
  CONCLUSIONS
  Intervention rates are high in pregnancies among women with type 1 diabetes and those with type 2 diabetes but they have not changed significantly. Secular trends toward increasing maternal age and obesity suggest that intervention rates are unlikely to decrease in the near future.
authors.affiliation: Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Diabetes Pregnancy Clinic, Auckland City Hospital, Auckland, New Zealand. Electronic address: t.cundy@auckland.ac.nz.
authors.forename: Tim
authors.initials: T
authors.lastname: Cundy
authors.forename: Joanna
authors.initials: J
authors.lastname: Morgan
authors.forename: Claire
authors.initials: C
authors.lastname: O'Beirne
authors.forename: Greg
authors.initials: G
authors.lastname: Gamble
authors.forename: Astrid
authors.initials: A
authors.lastname: Budden
authors.forename: Valeria
authors.initials: V
authors.lastname: Ivanova
authors.forename: Mairi
authors.initials: M
authors.lastname: Wallace
mesh_terms: D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D036861:Delivery, Obstetric / Q000706:statistics & numerical data / Q000639:trends; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D006801:Humans; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D011446:Prospective Studies; D055815:Young Adult
keywords: Cesarean delivery; Induction of labor; Secular trends; Type 1 diabetes; Type 2 diabetes