The risk of diabetes after giving birth to a macrosomic infant: data from the NHANES cohort

Corrie Miller,Eunjung Lim

doi:10.1186/s40748-021-00132-8

Abstract

AimsGestational diabetes (GDM) increases the risk of developing type 2 diabetes and thus warrants earlier and more frequent screening. Women who give birth to a macrosomic infant, as defined as a birthweight greater than 9 lbs. (or approximately 4000 g), are encouraged to also get early type 2 diabetes screening, as macrosomia may be a surrogate marker for GDM. This study investigates whether a macrosomic infant, as defined as 9lbs, apart from GDM, increases the risk for diabetes later in life.MethodsData on parous women from the National Health and Nutrition Examination Survey (NHANES) 2007–2016 were utilized. Rates of diabetes were compared in those with and without macrosomic infants in Rao-Scott’s chi-square test. Multiple logistic regression was used to test the independent effect of macrosomia on type 2 diabetes controlling for the confounding covariates and adjusting for the complex sampling design. To investigate how onset time affects diabetes, we implemented Cox proportional hazard regressions on time to have diabetes.ResultsAmong 10,089 parous women, macrosomia significantly increased the risk of maternal diabetes later in life in the chi-square test and logistic regression. Independent of GDM, women who deliver a macrosomic infant have a 20% higher chance of developing diabetes compared to women who did not. The expected hazards of having type 2 diabetes is 1.66 times higher in a woman with macrosomic infant compared to counterparts.ConclusionsWomen who gave birth to a macrosomic infant in the absence of GDM should be offered earlier and more frequent screening for type 2 diabetes.

Highlights

Screening for Type 2 diabetes and impaired glucose tolerance in the adult patient is imperative to prevent longstanding complications of the condition
Women who are unable to control GDM may give birth to large for gestational age (LGA) infants due persistent maternal hyperglycemia or a birthweight in the 90th percentile for gestational age. This is preceded by fetal macrosomia in utero, which refers to excessive fetal growth between 4000 and 4500 g regardless of gestational age [7]
Data from the National Center for Health Statistics show that 8% of all live-born infants in the United States weigh 4000 g or more [8], and not all neonates with increased birth weight result from GDM affected pregnancies

Summary

Introduction

Screening for Type 2 diabetes and impaired glucose tolerance in the adult patient is imperative to prevent longstanding complications of the condition. Women who are unable to control GDM may give birth to large for gestational age (LGA) infants due persistent maternal hyperglycemia or a birthweight in the 90th percentile for gestational age This is preceded by fetal macrosomia in utero, which refers to excessive fetal growth between 4000 and 4500 g regardless of gestational age [7]. In a large retrospective cohort study of nearly 10,000 women, the rate of LGA newborns without GDM ranged from 7.7% in normal-weight women to 12.7% in obese women, compared to 13.6% in normal-weight women and 22.3% in obese women affected by GDM [13] In this particular cohort, among women without GDM, 21.6% of LGA infants were attributable to increased maternal body mass index (BMI)

Methods

Results

Conclusion