Abstract
Aimsto identify potentially modifiable risk factors associated with the persistency of macrosomia and/or shoulder dystocia in infants born to women treated for gestational diabetes mellitus (GDM). Methodsthis case-control retrospective study included 113 cases complicated by macrosomia (ponderal index ≥97th percentile) and/or shoulder dystocia, and 226 controls without these complications. Factors associated with macrosomia and/or shoulder dystocia and with failure of diabetes management were assessed by multivariable analyses. ResultsMacrosomia and/or shoulder dystocia were associated with previous delivery of a large for gestational age (LGA) infant (adjusted odds ratio, 2.34, 95% confidence interval [1.01–5.45]), three abnormal glucose values during oral glucose tolerance test (2.83 [1.19–6.72]), a higher gestational weight gain before treatment (1.08 [1.01–1.15]), and failure of diabetes management (2.68 [1.32–5.45]). A non-Euro Caucasian origin (3.08 [1.37–6.93]), previous delivery of a LGA infant (3.21 [1.31–7.87]), institution of treatment after 32 weeks of gestation (3.92 [1.86–8.25]), and insulin therapy (2.91 [1.20–7.03]) were associated with failure of diabetes management. Conclusionssupportive care in at risk women, limitation of weight gain in early pregnancy, shortened delay between diagnosis and treatment of GDM, and intensive insulin dosage adjustments might be means to improve the neonatal prognosis of GDM.
Highlights
Gestational diabetes mellitus (GDM) is associated with an increased risk of adverse neonatal outcomes, mainly macrosomia, shoulder dystocia and birth trauma [1]
The aim of our study was to identify risk factors associated with macrosomia and/or shoulder dystocia in infants born to women treated for GDM, with special emphasis on potentially modifiable factors such as observance of self-monitoring of capillary blood glucose (SMBG) and achievement of blood glucose targets
Screening for GDM was performed as follows: fasting plasma glucose was measured at the first prenatal visit and an oral glucose tolerance test (OGTT) with 75 g of glucose with glycemic measurements at 0, 1 and 2 h was performed between 24-28 weeks of gestation (WG) if previous fasting glucose was normal or had not been performed
Summary
Gestational diabetes mellitus (GDM) is associated with an increased risk of adverse neonatal outcomes, mainly macrosomia, shoulder dystocia and birth trauma [1]. In a recent population-based study, the risks of macrosomia (odds ratio, 1.6) and of birth injury (odds ratio 1.2) were increased compared to pregnancies not complicated by GDM [5]. This may be due to risk factors other than blood glucose control, as demonstrated for an increased prepregnancy body weight or an excessive gestational weight gain [6, 7, 8]. Few studies assessed the impact of the quality of maternal blood glucose control on the occurrence of these adverse outcomes [9, 10]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
