Vaginal birth after cesarean among women with gestational diabetes

OBJECTIVE: We sought to determine the pregnancy and infant outcomes of wome n with gestational diabetes who attempted vaginal birth after previous cesa rean delivery. STUDY DESIGN: We conducted a retrospective cohort study to compare women wi th gestational diabetes with matched control subjects without diabetes who attempted vaginal birth after cesarean at Grady Memorial Hospital, Atlanta, from January 1, 1989, through December 31, 1999. One hundred fifty-six wom en with gestational diabetes were matched with 272 control subjects. Data w ere analyzed with the Student t test, chi (2) analysis, and the Fisher exac t test. RESULTS: The parities of the women with gestational diabetes and the contro l subjects were similar, with most having had only one previous pregnancy. Women with gestational diabetes were significantly older than control subje cts and more likely to be white or Hispanic. Women with gestational diabete s who attempted a trial of labor were significantly more likely than contro l subjects to be delivered abdominally Women with gestational diabetes who had a successful vaginal birth after cesarean were significantly more likel y than control subjects to have an operative delivery with forceps or vacuu m. CONCLUSION: Women with gestational diabetes are less likely than those with out diabetes to have a successful trial of labor. Women with gestational di abetes considering vaginal birth after cesarean should be appropriately cou nseled about the risk of attempting a trial of labor after previous cesarea n delivery.