title: Trial of labor after cesarean delivery for pregnancies complicated by gestational diabetes mellitus.
abstract: OBJECTIVE
  To assess rates of, and factors associated with, trial of labor and vaginal delivery among pregnancies complicated by both gestational diabetes (GDM) and a previous cesarean delivery.
  
  
  METHODS
  In a retrospective study of singleton deliveries at a university hospital in Israel between 2009 and 2015, women with one previous cesarean delivery and GDM were matched to those without GDM by past cesarean delivery indication: non-favorable (non-progressive labor or failed induction) or favorable (all other indications). Computerized files were reviewed, and maternal, obstetric, and neonatal outcomes were compared.
  
  
  RESULTS
  In total, 109 women with GDM were matched to 109 control women. Trial of labor was attempted by 55 (50.5%) women in the control group and 11 (10.1%) in the GDM group (P<0.001). Overall, 42 (38.5%) control women and 5 (4.6%) women with GDM delivered vaginally (P<0.001). Multivariable logistic regression identified lack of GDM as the most significant factor associated with trial of vaginal delivery, followed by a prior vaginal delivery. Among women attempting a trial of labor, past vaginal delivery, but not GDM status, was associated with successful vaginal delivery.
  
  
  CONCLUSIONS
  GDM significantly diminished the likelihood of a trial of vaginal delivery after cesarean delivery and its subsequent success.
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hadas
authors.initials: H
authors.lastname: Ganer Herman
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Zviya
authors.initials: Z
authors.lastname: Kogan
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Kovo
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data
keywords: Cesarean delivery; Gestational diabetes mellitus; Trial of labor; Vaginal delivery