GSB 7.1 Standardlösung

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Diabetes in Germany - adults

Sectio caesarea

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Both diabetes occurring for the first time during pregnancy (prevalence of gestational diabetes) and diabetes existing before pregnancy (pregestational diabetes) present a risk for complications during pregnancy and birth (DDG et al. 2021; DDG, DGGG 2018). Diabetes can lead to accelerated fetal growth with subsequent increased birth weight of the newborn. This increases the risk of complications such as birth injuries and leads to more frequent deliveries by cesarean section

Key messages

  • In 2021, over 30% of newborn singletons were delivered by cesarean section.
  • In the presence of gestational diabetes (38.2%) or pregestational diabetes (50.0%), newborns were significantly more likely to be delivered by cesarean section.
  • Over time, the frequency of cesarean section among women with pregestational diabetes increased from 47.7% in 2013 to 50.0% in 2021, while remaining relatively constant for women without diabetes or with gestational diabetes.

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trend

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cross-section

By state

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  • By gender

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  • By age

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  • By education group

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Results

In 2021, 31.0% of all singletons were delivered by cesarean section. Women with gestational diabetes (38.2%) and pregestational diabetes (50.0%) were more likely to deliver their newborns by cesarean section than women without diabetes (30.1%). Over time, there was a slight decrease initially from 2013 to 2018 and then an increase again by 2021 in the frequency of cesarean delivery among women without diabetes (2013: 30.6%; 2018: 29.2%; 2021: 30.1%) and women with gestational diabetes (2013: 38.1%; 2018: 37.0%; 2021: 38.2%). For women with pregestational diabetes, stronger fluctuations can be observed, but with a tendency of increasing frequency of cesarean section (2013: 47.7%; 2021: 50.0%). Differentiated by age group, the frequency of cesarean section increases with higher maternal age for all women.

Conclusion

Overall, almost one-third of all singletons were born by cesarean section, with the proportion being higher among women with gestational diabetes and especially among women with pregestational diabetes than among women without diabetes. While there was little change over time for women without diabetes or with gestational diabetes, the proportion of cesarean deliveries among women with pregestational diabetes increased over time. Increasing maternal age could explain only a modestportion of the increase. These temporal developments are not in line with the achievement of the goal to promote a physiological birth of the national health goal “Gesundheit rund um die Geburt” (Health around Childbirth) (BMG, 2017).

Show more information on methodology and data sources

Definition

The indicator sectio caesarea is defined as the proportion of women with hospital births in a given year in which the child was delivered by caesarean section (OPS-Code: 5-74).

Reference population

All women with inpatient singleton births in Germany.

Data sources

Quality assurance perinatal medicine (obstetrics) at the Institute for Quality and Transparency in Health Care (IQTIG) since 2015 based on the perinatal statistics provided by the federal states. This source provides data on all of the approximately 700,000 births that occur in German hospitals annually

Calculation

  • Observed relative values: Quotient of the number of women with documented cesarean section (OPS code: 5-74) as mode of delivery and the number of all women with hospital birth.
  • Age standardisation: Direct age standardization is performed using age groups <25, 25-29, 30-34, 35-39, and ≥40 years with the 2021 hospital birth population.
  • Stratification: The analysis distinguishes between women with pregestational diabetes (documented in Catalog A: "Medical History and General Findings/First Screening Examination" in the maternity log), gestational diabetes (prevalence of gestational diabetes), and no diabetes.

Data quality

The data only contains information on in-hospital birth, as the data is provided by the hospitals. Therefore, data from out-of-hospital births, which represent a very small proportion of less than 2%, are not included. As documentation of gestational diabetes in maternity logs might be incomplete, it is possible that prevalence is being underestimated. Furthermore, no distinction between type 1 and type 2 diabetes is possible in pregestational diabetes.

Referencen and external links

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