Am J Perinatol 2018; 35(05): 515-520
DOI: 10.1055/s-0037-1608811
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Morbidity Associated with Fetal Macrosomia among Women with Diabetes Mellitus

Zachary B. Jenner
1   Division 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
,
Amy E. O'Neil Dudley
1   Division 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
2   Department of Family Medicine, Texas A&M College of Medicine, Bryan, Texas
,
Hector Mendez-Figueroa
1   Division 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
,
Viviana S. Ellis
1   Division 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
3   Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Han-Yang Chen
1   Division 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
1   Division 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
› Institutsangaben
Weitere Informationen

Publikationsverlauf

04. April 2017

12. Oktober 2017

Publikationsdatum:
28. November 2017 (online)

Abstract

Objective This article aims to compare the composite maternal and neonatal morbidities (CMM and CNM, respectively) between macrosomic (≥4,000 g) and nonmacrosomic (<4,000 g) newborns among women with diabetes mellitus (DM).

Methods Maternal demographic and peripartum outcome data (N = 1,260) were collected from a retrospective cohort. CMM included chorioamnionitis/endometritis, wound infection, shoulder dystocia, eclampsia, pulmonary edema, admission for hypoglycemia, 3rd/4th degree perineal laceration, and death. CNM included 5-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score of <4, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, mechanical ventilation, intraventricular hemorrhage grade III/IV, necrotizing enterocolitis stage II/III, hypoglycemia, hypocalcemia, bronchopulmonary dysplasia, sepsis, seizures, hyperbilirubinemia, and death. Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI).

Results The study population consisted of 967 subjects, including 854 (88.3%) nonmacrosomic and 113 (11.7%) macrosomic infants. After adjustment, the risk of CMM was higher among macrosomic deliveries (aRR = 4.08, 95% CI = 2.45–6.80). The risk of CNM was also higher among macrosomic deliveries (aRR = 1.77, 95% CI = 1.39–2.24). Macrosomia was associated with an increased risk in NICU admission, hypoglycemia, and hyperbilirubinemia.

Conclusion Among DM deliveries, macrosomia was associated with a fourfold higher risk of CMM and almost twofold higher risk of CNM.

Note

Preliminary data presented at the Central Association of Obstetricians and Gynecologists 83rd Annual Meeting, Las Vegas, NV (October 2016).


 
  • References

  • 1 Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab 2015; 66 (Suppl. 02) 14-20
  • 2 Coustan DR, Lowe LP, Metzger BE, Dyer AR. .; International Association of Diabetes and Pregnancy Study Groups. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol 2010; 202 (06) 654.e1-654.e6
  • 3 McFarland MB, Trylovich CG, Langer O. Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers. J Matern Fetal Med 1998; 7 (06) 292-295
  • 4 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. Births: final data for 2008. Natl Vital Stat Rep 2010; 59 (01) 1 , 3–71
  • 5 El Hajj N, Pliushch G, Schneider E. , et al. Metabolic programming of MEST DNA methylation by intrauterine exposure to gestational diabetes mellitus. Diabetes 2013; 62 (04) 1320-1328
  • 6 Kim SY, Sharma AJ, Sappenfield W, Wilson HG, Salihu HM. Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births. Obstet Gynecol 2014; 123 (04) 737-744
  • 7 Asplund CA, Seehusen DA, Callahan TL, Olsen C. Percentage change in antenatal body mass index as a predictor of neonatal macrosomia. Ann Fam Med 2008; 6 (06) 550-554
  • 8 Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the United States: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol 2003; 188 (05) 1372-1378
  • 9 Weissmann-Brenner A, Simchen MJ, Zilberberg E. , et al. Maternal and neonatal outcomes of macrosomic pregnancies. Med Sci Monit 2012; 18 (09) PH77-PH81
  • 10 Sørensen HT, Sabroe S, Rothman KJ, Gillman M, Fischer P, Sørensen TI. Relation between weight and length at birth and body mass index in young adulthood: cohort study. BMJ 1997; 315 (7116): 1137
  • 11 Darendeliler F, Poyrazoglu S, Sancakli O. , et al. Adiponectin is an indicator of insulin resistance in non-obese prepubertal children born large for gestational age (LGA) and is affected by birth weight. Clin Endocrinol (Oxf) 2009; 70 (05) 710-716
  • 12 Mohammadbeigi A, Farhadifar F, Soufi Zadeh N, Mohammadsalehi N, Rezaiee M, Aghaei M. Fetal macrosomia: risk factors, maternal, and perinatal outcome. Ann Med Health Sci Res 2013; 3 (04) 546-550
  • 13 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 14 StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP;
  • 15 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014; 12 (12) 1495-1499
  • 16 Ju H, Chadha Y, Donovan T, O'Rourke P. Fetal macrosomia and pregnancy outcomes. Aust N Z J Obstet Gynaecol 2009; 49 (05) 504-509
  • 17 Kenny LC, Lavender T, McNamee R, O'Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One 2013; 8 (02) e56583
  • 18 Henriksen T. The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand 2008; 87 (02) 134-145
  • 19 Hedderson MM, Weiss NS, Sacks DA. , et al. Pregnancy weight gain and risk of neonatal complications: macrosomia, hypoglycemia, and hyperbilirubinemia. Obstet Gynecol 2006; 108 (05) 1153-1161
  • 20 Tydén O, Eriksson UJ, Berne C. Fetal lung maturation in diabetic pregnancy. Acta Endocrinol Suppl (Copenh) 1986; 277: 101-106