More Caesarean deliveries for diabetic mothers

Significantly weaker uterine contractions in diabetic pregnant women lead to higher rates of emergency Caesarean deliveries, according to researchers from the University of Liverpool.

Researchers found a difference in the calcium levels within the uterine muscles of more than 100 pregnant women with and without diabetes. Normally, calcium levels should rise to produce effective contractions.

The data showed that women with diabetes have significantly lower levels of calcium. Those women also have reduced channels through which the calcium enters the muscle cell membrane.

In addition, the medication oxytocin failed to stimulate the uterine contractions of women with diabetes to the same strength as women without diabetes.

“Our work shows that calcium is inhibited from entering the muscle cells. This, together with evidence of reduced overall muscle mass, contributes to a poorly contracting uterus in women with diabetes,” said Sue Wray, professor at the Institute of Translational Medicine at the University of Liverpool.

Wray said that more than 60 percent of pregnant women with diabetes will need a Caesarean section to delivery a child successfully.

“Future studies to help diabetic women should now focus on why the condition causes these changes in the first instance and if there is any way to stop it from happening,” she said.

Low-risk women with diabetes have a 42 percent rate of Caesarean section compared to 24 percent without diabetes, according to 2005 data gathered by the Washington State Department of Health. “Low risk” was defined as first-time mothers having a single child positioned head down.

Besides diabetes, other factors found in that study to contribute to significantly higher rates of Caesarean births include advanced maternal age, obesity, hypertension and/or induced labor.
With poor blood sugar control, the risks of diabetes during pregnancy include large babies, toxins in the blood, swelling, and hypertension, according to the Juvenile Diabetes Research Foundation.

To avoid complications to the unborn child, physicians may elect to induce labor or perform a Caesarean section before the due date.

Pregnant women with diabetes can have a normal vaginal delivery if there are no complications and the baby is not too large. Only a quarter of births complicated by diabetes have a normal vaginal birth, according to the University of Liverpool.

Sources: University of Liverpool, Washington State Department of Health, Juvenile Diabetes Research Foundation

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