Large for Gestational Age and Adverse Outcomes: Stratified By Diabetes Status

Sarah A. Nazeer; Han-Yang Chen; Joycelyn Ashby Cornthwaite; Suneet P. Chauhan; Baha Sibai; Stephen Wagner; Michal F. Bartal

doi:10.1055/a-2316-9007

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(01): 014-024
DOI: 10.1055/a-2316-9007

Original Article

Large for Gestational Age and Adverse Outcomes: Stratified By Diabetes Status

Sarah A. Nazeer

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

,

Han-Yang Chen

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

,

Joycelyn Ashby Cornthwaite

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

,

Suneet P. Chauhan

⁴Department of Obstetrics and Gynecology, Delaware Center of Maternal-Fetal Medicine, Newark, Delaware

,

Baha Sibai

⁵Department of Obstetrics & Gynecology, University of Texas Health Sciences Center at Houston, Houston, Texas

,

Stephen Wagner

³Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts

,

Michal F. Bartal

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

²Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

› Author Affiliations

Abstract

Objective To examine the association of adverse outcomes among parturients with large for gestational age (LGA; birth weight ≥ 90^th) newborns, stratified by diabetes status. Additionally, we described the temporal trends of adverse outcomes among LGA neonates.

Study Design This retrospective cohort study used the U.S. Vital Statistics dataset between 2014 and 2020. The inclusion criteria were singleton, nonanomalous LGA live births who labored and delivered at 24 to 41 weeks with known diabetes status. The coprimary outcomes were composite neonatal adverse outcomes of the following: Apgar score < 5 at 5 minutes, assisted ventilation > 6 hours, seizure, or neonatal or infant mortality, and maternal adverse outcomes of the following: maternal transfusion, ruptured uterus, unplanned hysterectomy, admission to intensive care unit, or unplanned procedure. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Average annual percent change (AAPC) was calculated to assess changes in rates of LGA and morbidity over time.

Results Of 27 million births in 7 years, 1,843,467 (6.8%) met the inclusion criteria. While 1,656,888 (89.9%) did not have diabetes, 186,579 (10.1%) were with diabetes. Composite neonatal adverse outcomes (aRR = 1.48, 95% CI = 1.43, 1.52) and composite maternal adverse outcomes (aRR = 1.37, 95% CI = 1.36, 1.38) were significantly higher among individuals with diabetes, compared with those without diabetes. From 2014 to 2020, the LGA rate was stable among people without diabetes. However, there was a downward trend of LGA in people with diabetes (AAPC = − 2.4, 95% CI = − 3.5, −1.4).

Conclusion In pregnancies with LGA newborns, composite neonatal and maternal morbidities were higher in those with diabetes, compared with those without diabetes.

Key Points

Large for gestational age stratified by diabetes status.
Composite neonatal and maternal adverse outcomes are worse among individuals with diabetes as compared to those without.
During 2014 to 2020, the trend of LGA in individuals without diabetes increased.

Keywords

LGA - macrosomia - diabetes adverse outcomes - diabetes trend

Full Text

References

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Supplementary Material