Adverse outcomes among pregnancies with large for gestational age neonates: stratified by diabetes status

Abstract

While the association of maternal diabetes and large for gestational age (LGA; birth weight above 90% based on Duryea et al nomogram) neonates is recognized, there is paucity of data regarding whether adverse outcomes of laboring people with an LGA neonate are related to maternal diabetes (DM). We aimed to describe the trend in the rate of LGA and compare adverse outcomes in laboring people with LGA neonates by maternal DM status (pregestational or gestational diabetes versus no diabetes). A population-based retrospective cohort study using the U.S. Vital Statistics data set (2014-2020) evaluated individuals with a non-anomalous LGA neonate, who labored and delivered at 24–41 weeks. The co-primary outcomes were composite maternal adverse outcome (cesarean delivery, intensive care unit admission, blood transfusion, uterine rupture or unplanned hysterectomy) and composite neonatal adverse outcome (Apgar score < 5 at 5 minutes, assisted ventilation >6h, seizure or death). Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Average annual percent change (AAPC) was obtained using JointPoint Regression to assess changes over time. Among 1.8 million singletons with LGA neonates, maternal DM was identified in 186,579 people (10%). There was a downward trend in the rate of LGA in people with DM compared to a stable rate among people without (Figure 1). An increased risk of composite maternal adverse outcome (aRR1.37, 95% CI 1.36-1.38) and composite neonatal adverse outcome (aRR1.57, 95% CI 1.53-1.62) was found in those with DM compared to those without (Table 1). An upward trend in the rate of composite neonatal adverse outcomes among both groups was observed(Figure 1). Using a nationally representative sample of the U.S., 1 out of 10 LGA neonates were born to people with DM. The risk of composite adverse maternal and neonatal outcomes was significantly higher in those with DM and LGA neonate. Interventional trials are needed to identify and reduce the adverse outcomes among people with DM and LGA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)