Magnitude Of Cesarean Section And Associated Factors Among Diabetic Mothers In A Tertiary Hospital, BSMMU: A Cross-Sectional Study

Abstract

Background: Cesarean section (CS) rates are rising globally, particularly among high-risk pregnancies complicated by diabetes mellitus (DM), which significantly increases maternal and neonatal morbidity. In Bangladesh, gestational diabetes affects 10–14% of pregnancies, often leading to complications such as macrosomia and preeclampsia that heighten CS risk. Diabetic mothers are two to three times more likely to undergo CS due to factors like poor glycemic control, obesity, and fetal distress.

Aim of the study: This study aims to assess the magnitude of cesarean section and identify the associated maternal, obstetric, and fetal factors among diabetic mothers.

Methods: This cross-sectional study was conducted at Department of Fetomaternal Medicine, BSMMU, Dhaka, including 100 diabetic pregnant women (GDM, type 1, or type 2) admitted for delivery. The study duration was (duration), from June 2023 to May 2024. Women with multiple pregnancies, incomplete records, or without diabetes were excluded. Data were collected using structured questionnaires and hospital records, covering socio-demographics, obstetric history, diabetes type, glycemic control, delivery mode, and neonatal outcomes. The primary outcome was the mode of delivery. Bivariate and multivariable logistic regression analyses were performed using SPSS version 26 to identify factors associated with cesarean section. Statistical significance was set at p < 0.05, with results presented as adjusted odds ratios and 95% confidence intervals.

Results: Among 100 diabetic pregnant women, 65% underwent cesarean section (CS), while 35% had vaginal deliveries. Most participants were aged 25–34 (58.33%) and from urban areas (70%). Multigravida and multiparous women comprised 60% and 63.33%, respectively, with 74.17% attending at least four ANC visits. Gestational diabetes mellitus was the most common (56.67%), and insulin was the primary glycemic control method (33.33%). Prior CS (25%) and fetal distress (11.67%) were leading CS indications. Favorable neonatal outcomes were observed, though 15% required NICU admission. Significant CS predictors included previous CS, poor glycemic control, and macrosomia (p < 0.05).

Conclusion: This study highlights a high cesarean section rate among diabetic mothers, primarily linked to prior CS, poor glycemic control, and macrosomia. Despite generally favorable neonatal outcomes, improved prenatal diabetes management and individualized care are essential to reduce unnecessary CS and enhance maternal and neonatal health in high-risk pregnancies.