White's classification of maternal diabetes and vaginal birth after cesarean delivery success in women undergoing a trial of labor

Abstract

Objective: To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabetic women based on White's Classification.

Methods: This is a secondary analysis of an observational study conducted at 19 medical centers of women attempting VBAC. Diabetic women with singleton gestations, one prior cesarean delivery, and cephalic presentation who underwent a trial of labor were included. Vaginal birth after cesarean delivery success rates and maternal and neonatal complications were compared based on White's Classification.

Results: Of 11,856 women who underwent trial of labor, 624 met all study criteria (class A1, 356; A2, 169; B, 70; C, 21; D/R/F, 8). Vaginal birth after cesarean delivery success in each group was: A1, 68.5% (95% confidence interval [CI] 63.4-73.3%); A2, 55% (95% CI 47.2-62.7%); B, 70% (95% CI 57.9-80.4%); C, 47.6% (95% CI 25.7-70.2%); and D/F/R, 12.5% (95% CI 0.3-52.7%). Maternal and neonatal complications were rare and not found to be different among groups.

Conclusion: Our study provides estimates for VBAC success based on White's classification and indicates a relatively low rate of perinatal complications after VBAC attempt for diabetic women.

Level of evidence: III.

Figure 1

Vaginal birth after cesarean (VBAC) success by White’s classification. Error bars= 95% confidence interval. White’s class A1, diet-controlled gestational diabetes; A2, insulin-controlled gestational diabetes; B, diabetes less than 10 years in duration or age of onset after 20 years; C, diabetes of 10 to 20 years in duration or age of onset between 10 and 20 years; D/F/R, more than 20 years in duration or age of onset less than 10 years or presence of nephropathy or retinopathy.