{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T10:34:51Z","timestamp":1777631691337,"version":"3.51.4"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100010805","name":"Forskningsr\u00e5det i Syd\u00f6stra Sverige","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010805","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To evaluate the impact of pregestational diabetes on duration of active labour (DAL) in induced and spontaneous labour and to compare caesarean section (CS) rates and indications between women with and without diabetes.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A population\u2010based cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Sweden.<\/jats:p>\n <\/jats:sec>\n \n Population<\/jats:title>\n \n 243\u2009537 nulliparous women, registered in the Swedish Pregnancy Register, who delivered a singleton fetus at \u2265\u200934\n +0<\/jats:sup>\n gestational weeks\u2009+\u2009days between 2014 and 2020. Women with gestational diabetes mellitus were excluded.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n DAL was compared between women with pregestational diabetes and those without diabetes using Kaplan\u2010Meier survival analysis and Cox regression analysis.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n DAL. Rates and indications for CS.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Women with pregestational diabetes had longer active labour and a reduced chance of vaginal delivery at a given time\u2010point compared to women without diabetes, adjusted hazard ratio 0.65 (95% CI: 0.60\u20130.70,\n p<\/jats:italic>\n \u2009<\u20090.001). Among those with spontaneous labour, median DAL in diabetic vs. non\u2010diabetic women was 9.60\u2009h versus 8.75\u2009h, difference 0.85\u2009h (95% CI 0.20\u20131.50),\n p<\/jats:italic>\n \u2009<\u20090.001. Corresponding numbers for induced labours were 8.92\u2009h versus 7.20\u2009h, difference 1.72\u2009h (95% CI 0.94\u20132.49),\n p<\/jats:italic>\n \u2009<\u20090.001.\n <\/jats:p>\n Elective and emergency CS rates were higher in women with pregestational diabetes than non\u2010diabetic women (7.4% and 29.4% vs. 2.6% and 7.1% respectively), with suspected macrosomia (50.4%) and fetal distress (31.9%) being the most common indications for CS among women with pregestational diabetes.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The prolonged labour duration in women with pregestational diabetes highlights the importance of the labour ward staff's support and patience in managing diabetic parturients, potentially allowing more time before diagnosing labour dystocia. Extended labour duration may also influence women's birth experience.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.18276","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T03:35:25Z","timestamp":1751859325000},"page":"1635-1643","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pregestational Diabetes and Duration of Active Labour Compared With Non\u2010Diabetic Women: A Population\u2010Based Cohort Study"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6249-4259","authenticated-orcid":false,"given":"Sofia","family":"Nevander","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4160-9472","authenticated-orcid":false,"given":"Sara","family":"Carlh\u00e4ll","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5765-2630","authenticated-orcid":false,"given":"Karin","family":"K\u00e4ll\u00e9n","sequence":"additional","affiliation":[{"name":"Institution of Clinical Sciences, Lund. Department of Obstetrics and Gynecology Lund University Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9491-9728","authenticated-orcid":false,"given":"Caroline","family":"Lilliecreutz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4679-550X","authenticated-orcid":false,"given":"Marie","family":"Blomberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-0656"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-2717"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191710846"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-022-04510-8"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38043.583160.EE"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-5-496"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-021-06255-9"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2022.2128653"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181d992ab"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-011-2371-6"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2613.2010.00718.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2016.270"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2012.626923"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14592"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13266"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000425668.87506.4c"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1996.tb14164.x"},{"key":"e_1_2_10_19_1","unstructured":"\u201cGynecology SAoMaSSoOa. 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