Risk Score for Predicting Primary Cesarean Delivery in Women with Gestational Diabetes Mellitus

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2020 Oct 9

PMID 33032545

Citations 13

Authors

Chadakarn Phaloprakarn

Siriwan Tangjitgamol

Affiliations

Soon will be listed here.

Abstract

Background: Women with gestational diabetes mellitus (GDM) have a higher risk of cesarean delivery (CD) than glucose-tolerant women. The aim of this study was to develop and validate a risk score for predicting primary CD in women with GDM.

Methods: A risk score for predicting primary CD was developed using significant clinical features of 385 women who had a diagnosis of GDM and delivered at our institution between January 2011 and December 2014. The score was then tested for validity in another cohort of 448 individuals with GDM who delivered between January 2015 and December 2018.

Results: The risk score was developed using the features nulliparity, excess gestational weight gain, and insulin use. The scores that classified the pregnant women as low risk (0 points), intermediate risk (1-3 points), and high risk (≥ 4 points) were directly associated with the primary CD rates of the women in the development cohort: 14.7, 38.2 and 62.3%, respectively (P < 0.001). The model showed good calibration and acceptable discriminative power with a C statistic of 0.724 (95% confidence interval, 0.670-0.777). Similar results were observed in the validation cohort.

Conclusion: A risk score using the features nulliparity, excess gestational weight gain, and insulin use can estimate the risk for primary CD in women with GDM.

Citing Articles

Association between gestational diabetes mellitus diagnostic criteria and adverse pregnancy outcomes-a systematic review and meta-analysis of adjusted effect sizes from studies using current diagnostic criteria.

Mahmoud E, Elsayed A, Elsayed B, Elsalakawi Y, Gopinath A, Chivese T BMJ Open. 2024; 14(11):e091258.

PMID: 39578035 PMC: 11590801. DOI: 10.1136/bmjopen-2024-091258.

Perinatal outcomes in pregnancies achieved after fertility treatments with and without diet-controlled GDM.

Karen B, Steiner N, Rotem R, Baumfeld Y, Weintraub A, Eshkoli T Arch Gynecol Obstet. 2024; 310(6):2899-2906.

PMID: 39499310 DOI: 10.1007/s00404-024-07780-z.

Understanding the Genetic Landscape of Gestational Diabetes: Insights into the Causes and Consequences of Elevated Glucose Levels in Pregnancy.

Brito Nunes C, Borges M, Freathy R, Lawlor D, Qvigstad E, Evans D Metabolites. 2024; 14(9).

PMID: 39330515 PMC: 11434570. DOI: 10.3390/metabo14090508.

Gestational diabetes-related gut microbiome dysbiosis is not influenced by different Asian ethnicities and dietary interventions: a pilot study.

Gupta A, Chan S, Toh R, Low J, Liu I, Lim S Sci Rep. 2024; 14(1):9855.

PMID: 38684759 PMC: 11058859. DOI: 10.1038/s41598-024-60386-y.

Impact of Race/Ethnicity and Insurance Status on Obstetric Outcomes: Secondary Analysis of the NuMoM2b Study.

Rayas M, Munoz J, Boyd A, Kim J, Mangold C, Moreira A Am J Perinatol. 2023; 41(S 01):e2907-e2918.

PMID: 37935375 PMC: 11074238. DOI: 10.1055/s-0043-1776345.

References

Collins G, Reitsma J, Altman D, Moons K . Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BJOG. 2015; 122(3):434-43. DOI: 10.1111/1471-0528.13244. View

Xu C, Fu Q, Tao H, Lin X, Wang M, Xia S . Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women: The Shanxi Study. Curr Med Sci. 2018; 38(4):618-625. DOI: 10.1007/s11596-018-1922-1. View

Boriboonhirunsarn D, Waiyanikorn R . Emergency cesarean section rate between women with gestational diabetes and normal pregnant women. Taiwan J Obstet Gynecol. 2016; 55(1):64-7. DOI: 10.1016/j.tjog.2015.08.024. View

Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A . Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017; 60(4):636-644. PMC: 6518373. DOI: 10.1007/s00125-017-4206-6. View

Moon J, Kwak S, Jang H . Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus. Korean J Intern Med. 2017; 32(1):26-41. PMC: 5214732. DOI: 10.3904/kjim.2016.203. View

Zhu Y, Zhang C . Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: a Global Perspective. Curr Diab Rep. 2016; 16(1):7. PMC: 6675405. DOI: 10.1007/s11892-015-0699-x. View

Cheng Y, Chung J, Kurbisch-Block I, Inturrisi M, Shafer S, Caughey A . Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Obstet Gynecol. 2008; 112(5):1015-22. DOI: 10.1097/AOG.0b013e31818b5dd9. View

. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2001; 894:i-xii, 1-253. View

Harrison A, Shields N, Taylor N, Frawley H . Exercise improves glycaemic control in women diagnosed with gestational diabetes mellitus: a systematic review. J Physiother. 2016; 62(4):188-96. DOI: 10.1016/j.jphys.2016.08.003. View

10.

Carpenter M, Coustan D . Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982; 144(7):768-73. DOI: 10.1016/0002-9378(82)90349-0. View

11.

Wang C, Zhu W, Wei Y, Feng H, Su R, Yang H . Exercise intervention during pregnancy can be used to manage weight gain and improve pregnancy outcomes in women with gestational diabetes mellitus. BMC Pregnancy Childbirth. 2015; 15:255. PMC: 4603976. DOI: 10.1186/s12884-015-0682-1. View

12.

Harrell Jr F, Lee K, Mark D . Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996; 15(4):361-87. DOI: 10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4. View

13.

Hedderson M, Xu F, Sridhar S, Han E, Quesenberry C, Crites Y . A cohort study of maternal cardiometabolic risk factors and primary cesarean delivery in an integrated health system. PLoS One. 2018; 13(7):e0199932. PMC: 6029787. DOI: 10.1371/journal.pone.0199932. View

14.

Ehrenberg H, Durnwald C, Catalano P, Mercer B . The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol. 2004; 191(3):969-74. DOI: 10.1016/j.ajog.2004.06.057. View

15.

Garabedian C, Deruelle P . Delivery (timing, route, peripartum glycemic control) in women with gestational diabetes mellitus. Diabetes Metab. 2010; 36(6 Pt 2):515-21. DOI: 10.1016/j.diabet.2010.11.005. View

16.

Caughey A, Cahill A, Guise J, Rouse D . Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014; 210(3):179-93. DOI: 10.1016/j.ajog.2014.01.026. View

17.

Collins G, Ogundimu E, Altman D . Sample size considerations for the external validation of a multivariable prognostic model: a resampling study. Stat Med. 2015; 35(2):214-26. PMC: 4738418. DOI: 10.1002/sim.6787. View

18.

Hernandez T, Brand-Miller J . Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward. Diabetes Care. 2018; 41(7):1343-1345. PMC: 6014541. DOI: 10.2337/dci18-0014. View

19.

Buscicchio G, Gentilucci L, Giannubilo S, Tranquilli A . Computerized analysis of fetal heart rate in pregnancies complicated by gestational diabetes mellitus. Gynecol Endocrinol. 2009; 26(4):270-4. DOI: 10.1080/09513590903247840. View

20.

Gascho C, Leandro D, Silva T, Silva J . Predictors of cesarean delivery in pregnant women with gestational diabetes mellitus. Rev Bras Ginecol Obstet. 2017; 39(2):60-65. PMC: 10309367. DOI: 10.1055/s-0037-1598644. View