Higher Risk of Cesarean with Diabetes During Pregnancy

Dec 19, 2011
Brenda Lane

Cesarean More Common in DIabetic Mothers - Flickr Photos by isafmedia

While it is known that women who are diabetic have a higher chance of cesarean, until now experts have not known why. A lack of calcium may be the culprit.

Expectant mothers who develop diabetes, either before or during pregnancy, are much more likely to have problems during labor. In fact, many studies have shown that women with diabetes have a much greater chance of a cesarean. One recent 30 year study showed that diabetic moms had an 85.9% chance of cesarean, as compared to 37.8% in the non-diabetic group. However identifying what causes labor complications and eventually cesareans with women who have diabetes has been a mystery until recently.

Why Does Diabetes Increase Cesareans?

Experts have seen that women with gestational diabetes tend to have bigger babies, known as LGA or large for gestational age newborns. Because of this risk, care providers may be more likely to induce women with diabetes even before their due date. Regardless of whether or not having a big baby may or may not complicate the mother's labor, research has shown that inductions alone carry with them a higher risk of cesarean.

However is there more at play here than just a mother's body not being ready for labor or having a big baby that increases the risk for cesarean in women with gestational diabetes? Is there something inherent to the disease of diabetes that interferes with labor and the ability of the uterus to contract well? Experts have now discovered that there is.

Research Shows Lack of Calcium in Uterus of Diabetic Women

In order to investigate what might be causing dysfunctional labor in diabetic women, scientists from Liverpool University were able to extract muscle cells (by taking biopsies) of 100 pregnant women, both with and without diabetes. Normally in labor, the calcium levels in the uterus increase in order to meet the additional demands of the uterine muscle in labor. However in diabetic mothers, this was not the case.

In fact, the UK researchers discovered that not only were the calcium levels in diabetic women dramatically reduced, but the channels in the cell membrane that allow the calcium to pass to the cells were also reduced. Even when the diabetic women were given pitocin (as in the case of an induction), they had more difficulty reaching the same level of contraction intensity as the non-diabetic women.

Research Needed on Diabetes and Cesarean Rate

While experts have learned that calcium levels in diabetic women does seem to interfere with labor and may play a significant role in increasing the woman's chance of having a cesarean, they agree that more research is still needed to figure out ways to prevent this from happening.

Until more evidence shows exactly what care providers and expectant mothers with diabetes can do, they suggest that childbirth with diabetic moms may need to be treated differently. "Pursuant to our extensive laboratory data, we suggest that all diabetic labours should be considered a unique entity and require a different approach compared with nondiabetic patients, " advise the UK study authors. This may include using a higher dosage of pitocin or being induced over a longer duration that in non-diabetic women.

References:

Badakhsh, MH, et al. "A thirty year analysis of cesarean section rate in gestational diabetes and normal pregnant population in Tehran, Iran: A concerning trend." Gynecology and Endrocrinology, November 2011.
S. Al-Qahtani, "Diabetes is associated with impairment of uterine contractibility and high Cesarean section rate," Diabetologia, Online First, June 2011.