Dataset Information

Predictors of a successful vaginal delivery in women with type 1 diabetes: a retrospective analysis of 20 years.

ABSTRACT:

Purpose

To evaluate the independent factors associated with the success of a trial of vaginal birth (TVB) in women with type 1 diabetes. Despite all therapeutic efforts and technological innovations, rates of caesarean sections (CS) in pregnant women with type 1 diabetes remain unchanged above 60%. Our aim was to point out influencing factors to improve the quality of antepartum counseling.

Methods

We performed a retrospective cohort study of 195 pregnancies with type 1 diabetes treated between 2000 and 2019. After exclusions, 118 women with near-term singleton pregnancies intended vaginal birth (TVB). Group differences between CS and successful vaginal delivery were analyzed. Multivariate logistic regression was performed by including clinical and metabolic variables to determine the independent effects on a successful vaginal delivery. Subgroup analysis for nulliparous women.

Results

Of 118 women with TVB, 67 (56.8%) were delivered vaginally. History of previous vaginal delivery (OR 10.29; CI 2.39; 44.30), HbA1c changes during pregnancy (per % increase; OR 0.59; CI 0.36; 0.96) and gestational weight gain (per kg; OR 0.87; CI 0.80; 0.96) were independent predictors for a successful vaginal delivery. In nulliparous women, the duration of diabetes was independently and negatively associated with vaginal delivery.

Conclusion

Provided data can help to improve antepartum counseling in type 1 diabetic patients. It seems that women with type 1 diabetes should avoid postponing pregnancy and childbirth.

SUBMITTER: Weschenfelder F

PROVIDER: S-EPMC9166876 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Predictors of a successful vaginal delivery in women with type 1 diabetes: a retrospective analysis of 20 years.

Weschenfelder Friederike F Herrmann Eva E Lehmann Thomas T Schleußner Ekkehard E Kloos Christof C Battfeld Wilgard W Groten Tanja T

Archives of gynecology and obstetrics 20210924 6

<h4>Purpose</h4>To evaluate the independent factors associated with the success of a trial of vaginal birth (TVB) in women with type 1 diabetes. Despite all therapeutic efforts and technological innovations, rates of caesarean sections (CS) in pregnant women with type 1 diabetes remain unchanged above 60%. Our aim was to point out influencing factors to improve the quality of antepartum counseling.<h4>Methods</h4>We performed a retrospective cohort study of 195 pregnancies with type 1 diabetes t ...[more]

PMID: 34559296

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Project description:BackgroundAlthough monitoring systems for high-risk postpartum haemorrhage (PPH) are well-established, predicting immediate PPH-defined as blood loss ≥ 500 mL within 2 h postpartum, distinct from general PPH (≥ 500 mL within 24 h)-remains challenging in low-risk vaginal deliveries. This case-control study aimed to explore the association between predelivery coagulation profiles and the occurrence of immediate PPH in low-risk parturients, specifically those without severe pregnancy complications and with singleton vertex presentations.MethodsA retrospective analysis was conducted on 409 vaginal deliveries at a tertiary hospital from 2014 to 2019. Of these, 179 cases met the WHO criteria for immediate PPH, while 230 served as controls (blood loss < 500 mL). Thirty clinical and laboratory variables were extracted, including predelivery coagulation parameters-platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT)-as well as delivery characteristics such as forceps-assisted delivery and placental retention. Logistic regression was used to identify independent risk factors, and a multivariable prediction model was subsequently developed.ResultsMultivariate analysis identified several independent predictors of immediate PPH: Rural residence, Forceps deliveries, Retained placenta and membrane, Newborn birth weight ≥ 3500 g, PLT ≤ 212 × 10⁹/L, PT > 11 s, APTT > 28.8 s, and TT > 13.8 s. (all P < 0.05). The combined prediction model demonstrated excellent predictive performance, with an area under the receiver operating characteristic curve (AUC) of 0.854, achieving 82.58% sensitivity and 74.78% specificity.ConclusionsThis multidimensional predictive model effectively identifies parturients at elevated risk for immediate PPH in low-risk deliveries, enabling more targeted preventive interventions. Prospective studies are warranted to validate and refine this model in broader clinical settings.

Project description:BackgroundLess than one-half of women with gestational diabetes mellitus are screened for type 2 diabetes postpartum. Other approaches to postpartum screening need to be evaluated, including the role of screening during the delivery hospitalization.ObjectiveTo assess the performance of an oral glucose tolerance test administered during the delivery hospitalization compared with the oral glucose tolerance test administered at a 4- to 12-week postpartum visit.Study designWe conducted a combined analysis of patient-level data from 4 centers (6 clinical sites) assessing the utility of an immediate postpartum 75-g oral glucose tolerance test during the delivery hospitalization (PP1) for the diagnosis of type 2 diabetes compared with a routine 4- to 12-week postpartum oral glucose tolerance test (PP2). Eligible women underwent a 75-g oral glucose tolerance test at both PP1 and PP2. Sensitivity, specificity, and negative and positive predictive values of the PP1 test were estimated for diagnosis of type 2 diabetes, impaired fasting glucose, or impaired glucose tolerance.ResultsIn total, 319 women completed a PP1 screening, with 152 (47.6%) lost to follow-up for the PP2 oral glucose tolerance test. None of the women with a normal PP1 oral glucose tolerance test (n=73) later tested as having type 2 diabetes at PP2. Overall, 12.6% of subjects (n=21) had a change from normal to impaired fasting glucose/impaired glucose tolerance or a change from impaired fasting glucose/impaired glucose tolerance to type 2 diabetes. The PP1 oral glucose tolerance test had 50% sensitivity (11.8-88.2), 95.7% specificity (91.3-98.2%) with a 98.1% (94.5-99.6%) negative predictive value and a 30% (95% confidence interval, 6.7-65.3) positive predictive value for type 2 diabetes vs normal/impaired fasting glucose/impaired glucose tolerance result. The negative predictive value of having type 2 diabetes at PP2 compared with a normal oral glucose tolerance test (excluding impaired fasting glucose/impaired glucose tolerance) at PP1 was 100% (95% confidence interval, 93.5-100) with a specificity of 96.5% (95% confidence interval, 87.9-99.6).ConclusionA normal oral glucose tolerance test during the delivery hospitalization appears to exclude postpartum type 2 diabetes mellitus. However, the results of the immediate postpartum oral glucose tolerance test were mixed when including impaired fasting glucose or impaired glucose tolerance. As a majority of women do not return for postpartum diabetic screening, an oral glucose tolerance test during the delivery hospitalization may be of use in certain circumstances in which postpartum follow-up is challenging and resources could be focused on women with an abnormal screening immediately after the delivery hospitalization.

Dataset Information

Predictors of a successful vaginal delivery in women with type 1 diabetes: a retrospective analysis of 20 years.

Purpose

Methods

Results

Conclusion

Publications

Predictors of a successful vaginal delivery in women with type 1 diabetes: a retrospective analysis of 20 years.

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