Pregnancy outcomes in relation to different types of diabetes mellitus and modes of delivery in macrosomic foetuses in Bahrain

Abstract

Objectives The mode of delivery in diabetic patients is debatable. This study was designed to assess the pattern of delivery of macrosomic babies with a high prevalence of diabetes mellitus in Bahrain. Methods This retrospective analysis was conducted on mothers who delivered babies weighing ≥4.0 Kgs from 2001 to 2011 at Bahrain Defence Force Hospital. Data regarding patients' age, weight, mode of delivery, diabetic status, gestational age and parity were recorded. The main outcome was the effect of diabetes mellitus on the decision to allow vaginal delivery for macrocosmic babies. Other outcomes were failed trial of labour, parity, maternal age and foetal weight on the trial of labour and neonatal morbidity associated with vaginal births. Results The incidence of macrosomic babies was 2.2% of total births. Pre-existing diabetes mellitus was 3.9% of the study cohort. The rate of elective Caesarean section increased from 12.5% in non-diabetic mothers to 50% in patients with pre-existing diabetes. In cases of allowing a trial of labour, approximately 70% of patients with pre-existing diabetes had successful vaginal delivery. Patients with a previous delivery were less likely to undergo emergency procedures, but had the same probability for elective Caesarean compared with primigravida. Patient's age and foetal weight had no influence on successful trial of vaginal birth. Conclusions There was a trend to offer more elective Caesarean sections in patients with macrosomic babies in the presence of pre-existing diabetes. The majority of patients who were offered a trial of labour achieved vaginal delivery with minimal morbidity.

Assessment of Adverse Birth Outcomes and Associated Factors among Diabetic Pregnant Mothers Who Delivered at Mettu Karl Hospital, Illubabor Zone, South West Ethiopia-2018

“…Clients with complications (preterm delivery) in recent pregnancies were found to have higher odds of experiencing adverse birth outcomes than those without the complications with (p<0.0001) [OR=95%CI 9.763 (4.560, 20.902)]. This finding was consistent with the study done in Sudan [22], Saudi Arabia [17], Cameron [25], and Bahrain [20]. The link may be explained in terms of the fact that the complications that have occurred during pregnancy have affected the well-being of the fetus in the uterus.…”

“…The most major complication of diabetes mother was preterm delivery, 17.6% which was greater in pre-gestational diabetes, which accounts 5.4% GDM and 12.4% PGDM. Which was smaller than study done in Bahrain which was 9.5% and 25.9% respectively, and also greater than study done Qatar 6.12% were preterm baby [18,20]. The variations between the findings may be due to variations in quality of maternal health services.…”

“…Other study done in Bahrain-Oman was greater than this result which was 9.2% prevalence [20]. This prevalence LBW related to termination of pregnancy as a result of diabetic complication/ diabetic co-morbidity and the difference related to quality care they provide.…”

“…The most common neonatal adverse outcome observed were macrosomia and which occurred in 22%, with the majority being neonates born to mothers with gestational diabetes. The study done in Cameron [21] and Sudan [22] was the prevalence was higher than this which was 38.7% and 28%, but in contrast to the finding of Bahrain [20] and Saudi Arabia [17] which was 15.1% and 11% prevalence respectively. The variations may be due to variations in quality of care they provide.…”

“…In this study neonate of mothers with diabetes with poor Apgar score at 5 th minutes were 10.1%, this is higher than study done in Bahrain were 2.7% [20]. The study done India was greater than this which was 65% [24].…”