{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T23:35:13Z","timestamp":1777073713076,"version":"3.51.4"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Perineal lacerations are a common obstetric complication influenced by maternal and intrapartum factors. While gestational diabetes mellitus (GDM) is linked to adverse pregnancy outcomes, the impact of diet-controlled GDM (GDMA1) on perineal injury remains unclear. This study explores the relationship between GDMA1 and perineal lacerations in vaginal deliveries.<\/jats:p>\n                  <jats:p>A population-based retrospective cohort study was conducted at a tertiary medical center (1988\u20132016), including all vaginal deliveries beyond 24 weeks gestation. Women with GDMA1 were compared with those without diabetes. The primary outcomes were the rates and severity of perineal lacerations. Univariate analysis was followed by multivariable analysis, adjusting for relevant confounders.<\/jats:p>\n                  <jats:p>Among 250,171 deliveries, 9,640 (3.8%) were in women with GDMA1. Women with GDMA1 were significantly older and delivered earlier than non-diabetic women, although both groups delivered at term. Rates of instrumental deliveries and episiotomy were significantly higher in the GDMA1 group, and newborns were significantly larger. Perineal lacerations occurred more frequently in women with GDMA1 compared with non-diabetic women (21.2 vs. 18.8%; p\u2009&lt;\u20090.001), with first-degree tears accounting for most of the difference. In multivariate analysis, GDMA1 was independently associated with an increased risk of perineal tears (OR = 1.12, 95% CI: 1.06\u20131.17), while mediolateral episiotomy was associated with a reduced risk of obstetric anal sphincter injury (OASIS; OR = 0.68, 95% CI: 0.53\u20130.87).<\/jats:p>\n                  <jats:p>GDMA1 is associated with a modestly increased risk of perineal lacerations, predominantly first-degree tears, but does not significantly impact severe perineal trauma. These findings suggest that women with GDMA1 can be reassured regarding the risk of severe perineal trauma. Nonetheless, individualized risk assessment remains important in guiding delivery management, particularly in the presence of other contributing risk factors.<\/jats:p>","DOI":"10.1055\/a-2716-2056","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T23:04:48Z","timestamp":1760655888000},"page":"989-994","source":"Crossref","is-referenced-by-count":0,"title":["Perineal Lacerations and Obstetric Anal Sphincter Injuries in Diet-Controlled Gestational Diabetes: A Large Cohort Study"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2660-9311","authenticated-orcid":false,"given":"Tamar","family":"Eshkoli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Amit","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adva","family":"Bugaiski-Shaked","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liane","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8133-0356","authenticated-orcid":false,"given":"Yael","family":"Baumfeld","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adi Y.","family":"Weintraub","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4063-5911","authenticated-orcid":false,"given":"Reut","family":"Rotem","sequence":"additional","affiliation":[{"name":"Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland"},{"name":"Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/birt.12258","article-title":"The effect of perineal lacerations on pelvic floor function and anatomy at 6 months postpartum in a prospective cohort of nulliparous women","volume":"43","author":"L Leeman","year":"2016","journal-title":"Birth"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s00192-016-2956-1","article-title":"Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis","volume":"27","author":"T S Verghese","year":"2016","journal-title":"Int Urogynecol J"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.ejogrb.2020.02.025","article-title":"Risk factors for severe perineal trauma during childbirth: an updated meta-analysis","volume":"247","author":"V Pergialiotis","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.ejogrb.2016.12.029","article-title":"Can we predict obstetric anal sphincter injury?","volume":"210","author":"K Drusany Stari\u010d","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"29","key":"ref5","first-page":"1","article-title":"The Management of Third- and Fourth-Degree Perineal Tears: Green-top Guideline No. 29","volume":"29","author":"Royal College of Obstetricians & Gynaecologists","year":"2015","journal-title":"Royal College of Obstetricians and Gynaecologists"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s00192-019-03983-0","article-title":"Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study","volume":"31","author":"J C D'Souza","year":"2020","journal-title":"Int Urogynecol J"},{"issue":"07","key":"ref7","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1111\/aogs.12894","article-title":"Variations in rates of severe perineal tears and episiotomies in 20 European countries: a study based on routine national data in Euro-Peristat Project","volume":"95","author":"B Blondel","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1016\/j.ajog.2003.09.030","article-title":"Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States","volume":"189","author":"D E Fenner","year":"2003","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00192-015-2795-5","article-title":"Risk factors for severe obstetric perineal lacerations","volume":"27","author":"M Vale de Castro Monteiro","year":"2016","journal-title":"Int Urogynecol J"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.ijgo.2004.08.010","article-title":"Risk factors and obstetric complications associated with macrosomia","volume":"87","author":"N E Stotland","year":"2004","journal-title":"Int J Gynaecol Obstet"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1186\/s12884-015-0689-7","article-title":"Birth position and obstetric anal sphincter injury: a population-based study of 113 000 spontaneous births","volume":"15","author":"C Elvander","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/AOG.0000000000001523","article-title":"Practice Bulletin No. 165: prevention and management of obstetric lacerations at vaginal delivery","volume":"128","author":"American College of Obstetricians and Gynecologists' Committee on Practice Bulletins\u2014Obstetrics","year":"2016","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1080\/14767058.2018.1514376","article-title":"Risk factors for obstetric anal sphincter injuries (OASIS) during vacuum extraction delivery in a university affiliated maternity hospital","volume":"33","author":"D Segal","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1186\/s12884-023-05779-z","article-title":"Comparison of adverse maternal and perinatal outcomes between induction and expectant management among women with gestational diabetes mellitus at term pregnancy: a systematic review and meta-analysis","volume":"23","author":"R Luo","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1097\/AOG.0000000000002501","article-title":"ACOG Practice Bulletin No. 190: gestational diabetes mellitus","volume":"131","author":"Committee on Practice Bulletins - Obstetrics","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"S 02","key":"ref16","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1159\/000371628","article-title":"Gestational diabetes mellitus and macrosomia: a literature review","volume":"66","author":"K Kc","year":"2015","journal-title":"Ann Nutr Metab"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.midw.2018.11.010","article-title":"Diabetes mellitus and lower genital tract tears after vaginal birth: a cohort study","volume":"69","author":"K M Strand-Holm","year":"2019","journal-title":"Midwifery"},{"issue":"05","key":"ref18","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/ajo.12950","article-title":"Obstetric anal sphincter injuries among women with gestational diabetes and women without gestational diabetes: a NSW population-based cohort study","volume":"59","author":"R Zeki","year":"2019","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"108615","DOI":"10.1016\/j.biopha.2019.108615","article-title":"Mechanistic insight into diabetic wounds: pathogenesis, molecular targets and treatment strategies to pace wound healing","volume":"112","author":"S Patel","year":"2019","journal-title":"Biomed Pharmacother"},{"issue":"06","key":"ref20","first-page":"797","article-title":"Association between median episiotomy and severe perineal lacerations in primiparous women","volume":"156","author":"M Labrecque","year":"1997","journal-title":"CMAJ"},{"issue":"02","key":"ref21","first-page":"260","article-title":"Selected use of midline episiotomy: effect on perineal trauma","volume":"70","author":"J M Thorp Jr.","year":"1987","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref22","first-page":"765","article-title":"Midline episiotomies: more harm than good?","volume":"75","author":"P Shiono","year":"1990","journal-title":"Obstet Gynecol"},{"issue":"20","key":"ref23","doi-asserted-by":"crossref","first-page":"2516","DOI":"10.1001\/jama.286.20.2516","article-title":"Gestational diabetes mellitus","volume":"286","author":"L Jovanovic","year":"2001","journal-title":"JAMA"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"100247","DOI":"10.1016\/j.ajogmf.2020.100247","article-title":"Temporal trends in the incidence of and associations between the risk factors for obstetrical anal sphincter injuries","volume":"3","author":"N Ekstein-Badichi","year":"2021","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"412","DOI":"10.3109\/14767058.2012.733761","article-title":"Screening for gestational diabetes in the 21st century: a population-based cohort study in Israel","volume":"26","author":"T Sella","year":"2013","journal-title":"J Matern Fetal Neonatal Med"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2716-2056.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T22:48:18Z","timestamp":1777070898000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2716-2056"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":25,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2026,4,24]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2716-2056","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]}}}