Is shoulder dystocia-associated brachial plexus palsy more severe among infants of diabetics?

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MORE SEVERE AMONG INFANTS OF DIABETICS? SCOTT PETERSEN, ROBERT ALLEN, MICHELE DONITHAN, PATRICIA MOORE, LEORA ALLEN, KATHERINE OUTLAND, EDITH GUREWITSCH, Johns Hopkins University, Gyn/Ob, Baltimore, MD Johns Hopkins University, Biomed Eng, Baltimore, MD Johns Hopkins University, Epidemiology, Baltimore, MD Johns Hopkins University, Gyn/Ob, Baltimore, MD Johns Hopkins University, Nursing, Baltimore, MD OBJECTIVE: Diabetic gravidas are at increased risk for shoulder dystocia (SD). Infants of diabetic mothers (IDM) are at risk for abnormalities of their nervous system. To test the hypothesis that among neonates with SD-associated brachial plexus palsy (BPP) permanent and severe BPP ismore prevalent among IDM, we compared rates of permanent and severe BPP between IDM and nonIDM. STUDY DESIGN: Cases of SD-associated BPP culled from 2 databases (all SD deliveries [1993-2003] from a single institution and litigated cases of SDassociated permanent BPP from multiple U.S. institutions) were classified as temporary if BPP resolved by 2 yrs of age (TBPP). Permanent BPP was classified as severe if it lasted more than 2 yrs and involved the complete brachial plexus (C5-C8/T1) and/or a nerve root avulsion (SBPP). Mild permanent BPI lasted $2 yrs but did not involve the lower nerve roots or an avulsion (MBPP). NonIDM and IDM were compared for rates of permanent BPP and of SBPP, using chi-square with significance set at P < 0.05. A stepwise linear regression model was used to evaluate the effect of diabetes on permanence and severity of BPP. RESULTS: Of 218 cases of SD-associated BPP, the maternal diabetic status was known in 208 (95.4%). Of these, 56 were TBPP, 89 were MBPP, and 63 were SBPP. While macrosomia was equally prevalent among TBPP as among permanent BPP, infants with SBPP were more likely to be macrosomic than infants with TBPP or MBPP (77.2% vs 61.2%, P = 0.02). However, macrosomia was no more common among diabetics than among non-diabetics in this select population of infants with SD-associated BPP. After controlling for maternal weight and birth weight, infants of diabetics were no more likely to have either permanent or severe BPP than infants of non-diabetics. CONCLUSION: IDM with SD-associated BPP are not at increased risk for either permanent or severe BPP.