837: Large-for-gestational-age as a marker for adverse perinatal outcomes in pregnancy complicated by gestational diabetes mellitus

Abstract

We sought to examine the strength of large-for-gestational-age (LGA) measuring neonates as a marker for adverse perinatal outcomes associated with poor glycemic control in women with gestational diabetes mellitus (GDM). A retrospective cohort study of 141,670 women in California with singleton, vertex, non-anomalous gestations was performed in order to assess prevalence of adverse perinatal outcomes in GDM with LGA neonates. LGA was defined as birth weight greater than or equal to the 90th percentile for a given gestational age. Maternal outcomes examined included preeclampsia, post-partum hemorrhage (PPH) and chorioamnionitis. Neonatal outcomes examined included respiratory distress syndrome (RDS), hypoglycemia, jaundice and intrauterine fetal demise (IUFD). Confounding variables including pre-gestational diabetes mellitus were controlled for and a p-value of less than 0.05 was considered statistically significant. Overall, LGA gestation in women with GDM was a reliable marker for an increased risk of perinatal complications (Table 1). Statistically significant increased complications included neonatal RDS (2.64% vs 1.77% p=0.001), hypoglycemia (1.06% vs 0.05% p< 0.001), jaundice (21.52% vs 19.18% p=0.003), IUFD (0.49% vs 0.14% p< 0.001), PPH (4.07% vs 2.95% p=0.001) and a decreased risk of chorioamnionitis (1.87% vs 2.68% p=0.014). Most notably, the risk of IUFD (Figure 1) and RDS steadily increase as the size of the fetus increases proportional to gestational age. Maternal complications were less statistically significant in the extremes of LGA. Large-for-gestational-age measurements in women with GDM are reliable markers for adverse perinatal outcomes. Of particular concern is the risks of IUFD and RDS, which decidedly increase with LGA centile greater than 90th. Women should be counseled about these risks and providers prepared to give additional respiratory support to neonates at delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)