Women with Diabetes Have More C-sections and Fetal Complications

Author: St. Michael's Hospital
Published: 2010/09/17 - Updated: 2022/09/10
Peer Reviewed Publication: Yes
Category Topic: Pregnancy - Related Publications

Page Content: Synopsis - Introduction - Main

Synopsis: Nearly half of women with diabetes before pregnancy have a potentially-avoidable C-section, and their babies are twice as likely to die as those born to women without diabetes. Infants born to women with diabetes are at much higher risk of severe complications - which can be prevented by controlling glucose and blood pressure levels at conception and during pregnancy.

Definition: Cesarean Delivery: Cesarean delivery, also known as C-section or caesarean delivery, is used to deliver a baby through surgical incisions in the abdomen and uterus. Cesarean delivery is often performed because vaginal delivery puts the baby or mother at risk. The World Health Organization recommends that a cesarean section be performed only when medically necessary. Some C-sections are performed without a medical reason, upon request by someone, usually the mother. Cesarean delivery on maternal request (CDMR) is a cesarean section birth requested by a pregnant woman without a medical reason. A C-section typically takes 45 minutes to an hour. It may be done with a spinal block, where the woman is awake, or under general anesthesia.

Introduction

Researchers from St. Michael's Hospital, the Institute for Clinical Evaluative Sciences (ICES), and Women's College Hospital say rates of diabetes in Ontario have doubled in the last 12 years. Nearly one in 10 Ontario adults has been diagnosed with diabetes, including more women than ever before.

Main Content

As women develop type 2 diabetes (adult onset) during childbearing age, complications during pregnancy are becoming increasingly common.

"We are seeing more younger women living with diabetes. While older men still have higher rates than older women, women under 45 are getting diagnosed at the same rate as men in that age group," says Dr. Lorraine Lipscombe, a scientist at the Women's College Research Institute at Women's College Hospital and ICES.

"This trend is having increasing implications for younger women. With more women having babies later in life, we see more women getting pregnant with diabetes. The POWER Study found that having diabetes before pregnancy significantly increases the risk of pregnancy and fetal complications."

The POWER (Project for an Ontario Women's Health Evidence-Based Report) Study, a joint study from St. Michael's Hospital and ICES, is the first in the province to provide a comprehensive overview of women's health regarding income, education, ethnicity, and geography. The findings are detailed in the report titled Diabetes-the Ninth Chapter to be released as part of the study. Policymakers and healthcare providers can use findings to improve Ontario women's access, quality, and care outcomes. The POWER Study was funded by Echo: Improving Women's Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care.

"By identifying the provincial variations in diabetes care, the Local Health Integration Networks can now use this data for priority setting, planning, and quality improvement activities," says Pat Campbell, CEO of Echo. "By implementing interventions at the policy, population health, and practice levels, we can reduce these regional inequities and improve the health of both men and women with diabetes."

The POWER study examined the impact of diabetes on Ontarians. Key findings include:

45 percent of women with pre-gestational diabetes have C-sections compared with 37 percent of women with gestational diabetes and 27 percent without diabetes.
Babies born to women with pre-pregnancy diabetes have twice as many fetal complications as those born to women without diabetes.
The rate of stillbirth/in-hospital mortality in women with pre-pregnancy diabetes is twice that of women with diabetes (5.2 per 1,000 vs. 2.5. per 1,000) than those without diabetes.
Rates of major and minor congenital anomalies were 60 percent higher among women with pre-pregnancy diabetes than women without diabetes.
More than 50 percent of people who don't yet have diabetes have risk factors for the disease.
One in four adults aged 65 and older has been diagnosed with diabetes.

"Infants born to women with diabetes are at much higher risk for serious complications - which can be prevented by controlling glucose and blood pressure levels at the time of conception and during pregnancy," says Dr. Gillian Booth, a scientist at St. Michael's Hospital and scientist at ICES. "This reflects a need for more targeted pre-pregnancy counseling and better pregnancy care for this group of women."

"Diabetes is quickly becoming a worldwide epidemic, owing to a dramatic rise in type 2 diabetes - but most diabetes can be prevented," says Arlene Bierman, a physician at St. Michael's Hospital and principal investigator of the study. "We need to focus on preventing or reducing rates of diabetes among young women, one of the most vulnerable groups, and ensure that women who have diabetes get effective treatment," adds Dr. Bierman, also an ICES investigator.

Related Information

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by St. Michael's Hospital and published on 2010/09/17, this content may have been edited for style, clarity, or brevity.