{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:17:11Z","timestamp":1789643831458,"version":"4.0.0"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,2,17]],"date-time":"2019-02-17T00:00:00Z","timestamp":1550361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2019,10]]},"abstract":"Background<\/jats:title>Obstetric anal sphincter injuries (OASI<\/jats:styled-content>s) are associated with maternal morbidity; however, it is uncertain whether gestational diabetes (GDM<\/jats:styled-content>) is an independent risk factor when considering birthweight mode of birth and episiotomy.<\/jats:p><\/jats:sec>Aims<\/jats:title>To compare rates of OASI<\/jats:styled-content>s between women with GDM<\/jats:styled-content> and women without GDM<\/jats:styled-content> by mode of birth and birthweight. To investigate the association between episiotomy, mode of birth and the risk of OASI<\/jats:styled-content>s.<\/jats:p><\/jats:sec>Methods<\/jats:title>A population\u2010based cohort study of women who gave birth vaginally in NSW<\/jats:styled-content>, from 2007 to 2013. Rates of OASI<\/jats:styled-content>s were compared between women with and without GDM<\/jats:styled-content>, stratified by mode of birth, birthweight and a multi\u2010categorical variable of mode of birth and episiotomy. Adjusted odds ratios (aOR<\/jats:styled-content>) and 95% confidence intervals (CI<\/jats:styled-content>) were calculated by multivariable logistic regression.<\/jats:p><\/jats:sec>Results<\/jats:title>The rate of OASI<\/jats:styled-content>s was 3.6% (95% CI:<\/jats:styled-content> 2.6\u20132.7) vs 2.6% (95% CI:<\/jats:styled-content> 3.4\u20132.8; P\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.001) among women with and without GDM<\/jats:styled-content>, respectively. Women with GDM<\/jats:styled-content> and a macrosomic baby (birthweight\u00a0\u2265\u00a04000\u00a0g) had a higher risk of OASI<\/jats:styled-content>s with forceps (aOR<\/jats:styled-content> 1.76, 95% CI:<\/jats:styled-content> 1.08\u20132.86, P\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.02) or vacuum (aOR<\/jats:styled-content> 1.89, 95% CI:<\/jats:styled-content> 1.17\u20133.04, P\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.01), compared with those without GDM<\/jats:styled-content>. For primiparous women with GDM<\/jats:styled-content> and all women without GDM<\/jats:styled-content>, an episiotomy with forceps was associated with lower odds of OASI<\/jats:styled-content>s than forceps only (primiparous GDM<\/jats:styled-content>, forceps\u2010episiotomy aOR<\/jats:styled-content> 2.49, 95% CI:<\/jats:styled-content> 2.00\u20133.11, forceps aOR<\/jats:styled-content> 5.30, 95% CI:<\/jats:styled-content> 3.72\u20137.54), (primiparous without GDM<\/jats:styled-content>, forceps\u2010episiotomy aOR<\/jats:styled-content> 2.71, 95% CI:<\/jats:styled-content> 2.55\u20132.89, forceps aOR<\/jats:styled-content> 5.95, 95% CI:<\/jats:styled-content> 5.41\u20136.55) and (multiparous without GDM<\/jats:styled-content>, forceps\u2010episiotomy aOR<\/jats:styled-content> 3.75, 95% CI:<\/jats:styled-content> 3.12\u20134.50, forceps aOR<\/jats:styled-content> 6.20, 95% CI:<\/jats:styled-content> 4.96\u20137.74).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Women with GDM<\/jats:styled-content> and a macrosomic baby should be counselled about the increased risk of OASI<\/jats:styled-content>s with both vacuum and forceps. With forceps birth, this risk can be partially mitigated by performing a concomitant episiotomy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.12950","type":"journal-article","created":{"date-parts":[[2019,2,18]],"date-time":"2019-02-18T08:00:12Z","timestamp":1550476812000},"page":"662-669","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Obstetric anal sphincter injuries among women with gestational diabetes and women without gestational diabetes: A NSW<\/scp> population\u2010based cohort study"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6319-2500","authenticated-orcid":false,"given":"Reem","family":"Zeki","sequence":"first","affiliation":[{"name":"The Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7622-150X","authenticated-orcid":false,"given":"Zhuoyang","family":"Li","sequence":"additional","affiliation":[{"name":"The Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"The Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7454-3011","authenticated-orcid":false,"given":"Caroline S.E.","family":"Homer","sequence":"additional","affiliation":[{"name":"Centre for Midwifery, Child and Family Health Faculty of Health University of Technology Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy J.N.","family":"Oats","sequence":"additional","affiliation":[{"name":"Melbourne School of Population and Global Health University of Melbourne Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew","family":"Marshall","sequence":"additional","affiliation":[{"name":"Westmead Hospital Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"The Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2,17]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Australia's mothers and babies 2012","author":"Hilder L","year":"2014"},{"key":"e_1_2_7_3_1","unstructured":"Royal College of Obstetricians and Gynaecologists (RCOG).Clinical Green Top Guideline. 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