ll nt th ostasis; Type 2 diabetes mellitus adults worldwide have diabetes mellitus. The incidence of diabetes is escalating to epidemic proportions and by 2035, the figure is expected effects of breastfeeding in women, including protection against diabetes [5], osteoporosis [6], and cancer [7]. T2DM in women with GDM. We also describe the effects of breast-feeding on the metabolic profile of women with GDM. 2000. The proportion of mothers with GDM who breastfed their children was significantly lower (75 % vs. 86%) and it was continued for a shorter duration (median duration of breastfeeding: 9 vs. 17 weeks) compared er in women with GDM who required insulin therapy during pregnancy or if they were obese [8]. cial use, distribution, and

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Background: Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women’s clinical diagnoses. Methods and Findings: Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20 % sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0 % (95% confidence interval 22.0 % to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95 % credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95 % credible interval 0.14 to

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