Risk score for predicting primary cesarean delivery in women with gestational diabetes mellitus
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(2020) 20:607
RESEARCH ARTICLE
Open Access
Risk score for predicting primary cesarean delivery in women with gestational diabetes mellitus Chadakarn Phaloprakarn*
and Siriwan Tangjitgamol
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. Keywords: Gestational diabetes mellitus, Primary cesarean delivery, Risk score
Background The prevalence of gestational diabetes mellitus (GDM), one of the most common medical disorders of pregnancy, ranged from 1.8 to 25.1% in a previous report [1]. Its prevalence is increasing worldwide in parallel with the increased global prevalence of type 2 diabetes [2]. GDM poses multiple risks to pregnant women and their offspring, such as preeclampsia, macrosomia, and a consequent increase in obstetric interventions involving cesarean delivery (CD) [3, 4]. Several studies have reported that * Correspondence: [email protected] Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok 10300, Thailand
women with GDM have a higher risk of CD, specifically primary CD, than glucose-tolerant women [5–8]. One of the main reasons is to avoid complications associated with macrosomia, including shoulder dystocia and birth trauma. Although there are no current absolute indications for elective CD in women with GDM, standard practice guidelines recommend a scheduled CD when the estimated fetal weight (EFW) is 4500 g or more [9, 10]. Although a cesarean section is a common surgical procedure that can effectively prevent maternal and fetal mortality and morbidity when indicated, the complications of the procedure are well recognized, especially in an emergency setting, and include obstetric hemorrhage, postpartum infection, and the long-
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