Macrosomia as a Marker for Adverse Perinatal Outcomes in Pregnancy Complicated by Diabetes Mellitus [24D

Abstract

INTRODUCTION: We sought to examine the strength of macrosomia as a marker for adverse perinatal outcomes associated with poor glycemic control in women with a pre-gestational diagnosis of diabetes mellitus. METHODS: A retrospective cohort study of 8,535 women in California with singleton, vertex, non-anomalous gestations was performed to assess prevalence of adverse perinatal outcomes in macrosomic pregnancies complicated by diabetes mellitus. Macrosomia was defined as a birth weight greater than 4000 g. Neonatal outcomes examined included respiratory distress syndrome (RDS), hypoglycemia, jaundice, neonatal death (NND) and intrauterine fetal demise (IUFD). Maternal complications included preeclampsia, post-partum hemorrhage and chorioamnionitis. Confounding variables were controlled for and Chi-squared analyses with a P-value of less than 0.05 were considered statistically significant. RESULTS: Overall, macrosomia in pre-gestational diabetic women proved to be a reliable marker for increased perinatal complications. Neonatal complications were most pronounced, with macrosomic neonates at a significantly increased risk for RDS (3.81% vs 1.81% P<.001), hypoglycemia (1.24% vs 0.66% P=.007), jaundice (29.09% vs 23.06% P<.001), NND (0.19% vs 0.04% P=.024) and IUFD (1.38% vs 0.43% P<.001). Macrosomia characterized by birth weight of greater than 4500 g showed similar statistical significance in increased risk of each complication. Both classifications of macrosomia showed decreased incidence of chorioamnionitis (1.38% vs 2.52% P=.002, 1.06% vs. 2.36% P=.031). CONCLUSION: Macrosomia in diabetic women is a reliable marker for adverse neonatal outcomes, including increased risks for IUFD and neonatal death. Women should be counseled about these risks and managed accordingly throughout their pregnancies.