C-Sections More Prevalent in Diabetic Women Independent of Fetal Weight
Sept. 27, 1999 (Los Angeles) -- Pregnant diabetic women are more likely to undergo cesarean delivery even when their fetus is of average weight, researchers at the University of South Carolina have found. This goes against the conventional wisdom that diabetic women require cesarean delivery solely because their babies have a larger birth weight, one of the investigators tells WebMD.
According to co-author Robert E. McKeown, PhD, professor of epidemiology and research at the University of South Carolina, these findings "suggest to us there may be factors other than birth weight at work."
John L. Kitzmiller, MD, director of maternal-fetal medicine at the Good Samaritan Hospital in San Jose, Calif., says that some doctors may view all pregnant diabetic women as high-risk patients, even when their condition is well controlled. Sometimes the women themselves insist on a C-section if they believe having diabetes places them at higher risk of complications, according to Kitzmiller, who was not involved in the study. But, he tells WebMD, "I teach my residents that if the baby is of normal size, they should treat the pregnancy normally and deliver vaginally."
To conduct their study, McKeown and his colleagues evaluated more than 42,000 births occurring in South Carolina in 1993. Almost 4% of the pregnancies were complicated by diabetes, and close to a quarter of all the births were through cesarean delivery. After ruling out other possible causes, the authors found that cesarean delivery was strongly associated with diabetes in the mother, and that these estimates were essentially unchanged even when they accounted for birth weight. The study appears in the September issue of Diabetes Care.
Diabetic women who want to deliver vaginally should "really work faithfully with their obstetrician" to manage their diabetes carefully throughout the pregnancy, McKeown says. Communication with health care providers is "paramount," he adds. "The woman should have a frank and open discussion with her doctor regarding her desire to deliver vaginally if possible, and to have a C-section only if there is an indicated medical need, not just because she's diabetic."
Having a supportive person present during labor may also help, says Kitzmiller, citing evidence that cesarean delivery rates go down for all women when a "sympathetic person" is on hand. Adds McKeown, "I think that's a good idea for anybody."