Risk factors for primary cesarean delivery in women with gestational diabetes mellitus: a predictive model for...

Gestational diabetes mellitus (GDM) is associated with complications such as fetal macrosomia, shoulder dystocia, and prolonged labor, making cesarean section an important delivery option to reduce maternal and neonatal risks. This study aims to identify factors associated with cesarean delivery in women with GDM and to develop a predictive model for clinical risk assessment.

This retrospective cross-sectional study included 2,276 GDM patients who were delivered at a tertiary hospital from January 2020 to December 2023. Data on age, BMI, gravidity, abortion history, and family history of diabetes were collected. Patients were grouped by delivery mode. ANOVA/Kruskal-Wallis, chi-square test, Pearson correlation, and stepwise logistic regression were used to identify independent predictors. Two prediction models were developed and evaluated using ROC curves.

Among all included GDM patients, 200 (8.79 %) underwent cesarean section. The average age and BMI were 30.8 ± 3.9 years and 23.658 ± 4.221, respectively. Cesarean section rates increased with rising BMI (p<0.05). Significant differences among BMI groups were observed in age, number of pregnancies, miscarriage history, family history of diabetes, HbA_1c, hemoglobin (HGB), and platelet count (PLT) (all p<0.05). BMI was correlated with adjusted BMI, HbA_1c, HGB, and PLT. Logistic regression identified six independent predictors of cesarean section: BMI, adjusted BMI, HGB, PLT, prothrombin time (PT), and D-dimer. Model one showed good predictive ability (AUC=0.792). After optimization, Model two (including BMI grouping, number of miscarriages, and HbA_1c) performed better (AUC=0.842).

A multi-parameter model demonstrates strong potential for predicting cesarean risk in GDM patients and may assist clinical decision-making.