FREQUENCY OF CESAREAN SECTION IN PREGNANT WOMEN PRESENTING WITH GESTATIONAL DIABETES MELLITUS USING RISK SCORE AT TERTIARY CARE HOSPITAL, KARACHI

Abstract

Background: Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication associated with adverse maternal and neonatal outcomes, including an increased likelihood of cesarean section. Identifying predictive factors for surgical delivery is essential for optimizing obstetric care. Risk stratification models incorporating maternal characteristics such as nulliparity, excessive gestational weight gain, and insulin use may enhance clinical decision-making. However, limited data exist on the predictive accuracy of such models in the local population, necessitating further investigation.

Objective: To determine the frequency of cesarean section among pregnant women with GDM using a risk score and evaluate its predictive value.

Methods: A cross-sectional study was conducted at the Department of Gynaecology and Obstetrics, JPMC, Karachi, over six months. A total of 134 pregnant women diagnosed with GDM were enrolled using non-probability consecutive sampling. Patients were categorized into low, intermediate, and high-risk groups based on nulliparity, excessive gestational weight gain, and insulin use. Additional variables, including estimated fetal weight and gestational age, were also analyzed. Data were analyzed using SPSS version 20. Chi-square test assessed associations, and binary logistic regression determined predictors of cesarean section. One-way ANOVA compared continuous variables across risk categories, with statistical significance set at p ≤ 0.05.

Results: Cesarean section was performed in 64.9% of cases, with significantly higher rates in high-risk (89.3%), intermediate-risk (71.2%), and low-risk (46.3%) groups (χ² = 22.557, p < 0.001). Logistic regression confirmed the risk score as a strong predictor (OR = 4.135, 95% CI: 2.183 – 7.833, p < 0.001). Insulin use, gestational weight gain, nulliparity (OR = 0.962, p = 0.928), estimated fetal weight (OR = 1.324, p = 0.482), and gestational age (OR = 0.959, p = 0.780) were not significant predictors. One-way ANOVA showed no significant differences in gestational weight gain (p = 0.682), estimated fetal weight (p = 0.276), or gestational age (p = 0.386) across risk categories.

Conclusion: Risk stratification effectively predicts cesarean delivery in GDM pregnancies, emphasizing its clinical utility. Refining predictive models with additional obstetric variables may further enhance decision-making and optimize maternal outcomes.