EXAMINATION OF FACTORS CONTRIBUTING TO THE RISK OF CESAREAN DELIVERY IN WOMEN WITH GESTATIONAL DIABETES

To determine whether increased neonatal fat is associated with an elev ated risk of cesarean delivery in infants born to mothers with gestati onal diabetes mellitus. Methods: Of 166 infants born to mothers with g estational diabetes, 110 were born vaginally (91 spontaneous, 19 instr umental) and 56 by cesarean. Data were collected on maternal demograph ics, maternal anthropometrics, delivery variables, and neonatal anthro pometrics. We compared all characteristics between women who delivered vaginally and the 29 delivered by cesarean in labor. Results: The dif ference in birth weight between infants delivered by cesarean and vagi nally was not statistically significant (3520 +/- 456 and 3374 +/- 559 g, respectively [mean +/- standard deviation]). There were significan t differences between the cesarean and vaginal delivery groups in the rate of nulliparity (80 versus 48%, respectively), maternal pregravid body mass index (28.6 +/- 7.7 versus 25.2 +/- 5.8 kg/m(2)), fetal posi tion at delivery (23.8 versus 96.2% occiput anterior), and all estimat es of neonatal body fat (ponderal index: 2.77 +/- 0.20 versus 2.67 +/- 0.26 kg/m(3), sum of two-site skinfold measurements: 11.7 +/- 2.8 ver sus 10.5 +/- 1.8 mm; and percent body fat: 15.1 +/- 4.9 versus 13.0 +/ - 3.3). Stepwise logistic regression analysis demonstrated that fetal position, maternal nulliparity, and fetal fat contributed independentl y to the cesarean risk. Conclusion: Increased newborn fat is associate d independently with an increased risk for cesarean in labor.