… The purpose of the study was to examine the neonatal outcomes of primary cesarean delivery in women who had no other known complications or medical risk factors. The logical result of this examination would seem to be comparable neonatal mortality rates among cesarean and vaginally born infants. In fact, what the results show is that cesarean independently raises the risk of neonatal death by almost three-fold – .62 per 1000 deaths among vaginal births versus 1.77 per 1000 infant deaths among cesarean babies.

Even more astounding than the simple fact that cesarean section raises the risk of infant death – regardless of the reason the cesarean was performed – is that even when the researchers adjusted for sociodemographic, medical and congenital factors, and removed infants with APGARs under 4, the risk of death was only reduced “moderately”. A stark difference in the death rates between cesarean born infants and vaginally born infants remained even with no medical explanation.

We aren’t talking about babies dying from the few, rare complications that can arise in childbirth. We’re talking about healthy, low-risk mothers electing for a primary cesarean section with no medical indication resulting in a nearly three times higher rate of death than those who have a vaginal birth.

According to Marian MacDorman, the CDC’s study leader, “These findings should be of concern for clinicians and policymakers who are observing the rapid growth in the number of primary Caesareans to mothers without a medical indication.”

Even today, most pregnant women in Germany are unsystematically offered a blood sugar test to identify those women whose blood sugar levels rise too much during pregnancy …

… “We cannot be certain that the tests as currently carried out in the doctor’s surgery yield more benefit than harm.”

Gestational diabetes is a question of definition

During pregnancy it is normal that a woman’s metabolic rate changes and sugar takes longer to be absorbed by the body. In May 2008 an international study confirmed that rising blood sugar levels increase the risk, for example, of a Caesarean section or birth injuries. However, there is disagreement over when increased blood sugar levels should be treated, as there is no threshold where these risks increase dramatically.

Nevertheless, it should be noted that a diagnosis of gestational diabetes has far-reaching consequences for a pregnant woman. Not only does she have to accept the unpleasant news that something is not right, she also has to adapt her diet and take more physical exercise. In addition, blood sugar levels have to be measured several times a day and, if they do not drop to the prescribed targets within a short time, daily insulin injections have to be administered.

Treatment can have positive effects

… treatment reduces the risk of certain rare birth complications in pregnant women with a marked metabolic disorder. One such complication is shoulder dystocia …

Potential disadvantages of routine screening have not been researched

Even if there is an indication of benefit from treatment, this does not automatically mean that routine screening is also useful for identifying pregnant women with gestational diabetes. Although some professional associations have been recommending this type of screening for many years, potential harms have not yet been sufficiently investigated. IQWiG could not find any studies which directly showed that routine screening was of more benefit than harm.

In view of this uncertainty, the Institute considered a long list of potential disadvantages. However, the potential risks were not assessed as being so serious that they might cancel out the potential benefit. Thus, the Institute has indirectly deduced an indication that routine screening for gestational diabetes leads to a reduction in perinatal complications.

… Experts around the world are not agreed on how women with a metabolic disorder should be routinely identified.

… Consequently, many tests for gestational diabetes that are already being offered to pregnant women should be viewed critically. “These tests label many pregnant women as being at risk, without it being clear whether they would actually profit from having treatment”, explains Sawicki. A harm is particularly likely if a woman with a mild metabolic disorder during pregnancy is recommended to have treatment which is too strong.