ABSTRACT
Infants of insulin-dependent diabetic mothers are considered to be at high risk for
birth trauma, presumably due to macrosomia. With current management of diabetes in
pregnancy, including strict glycemic control, the rate and the severity of macrosomia
should be decreased. The frequent use of ultrasound to assess fetal growth and weight
and the use of cesarean delivery in case of fetal macrosomia should further decrease
the risk for birth trauma in these infants. We therefore undertook this study to test
the null hypothesis that with current management, insulin-dependent diabetic mothers
have a rate of birth trauma similar to that of infants of nondiabetic mothers (normal
glucose challenge test at 28 weeks' gestation) matched for gestational age at birth,
presence or absence of labor, delivery method (vaginal versus cesarean), and race.
We studied 118 insulin-dependent diabetic mothers (White classes B-RT) and 354 control
subjects (three matches for each insulin-dependent diabetic mother). The rate of birth
trauma was 3.4% in insulin-dependent diabetic mothers, not significantly different
from controls (2.5%). Logistic regression analysis in which birth trauma was the dependent
variable and diabetes, race, presence or absence of labor, mode of delivery (vaginal
versus cesarean), infant weight, and infant head circumference were independent variables
revealed that only vaginal delivery was a significant risk factor for birth trauma
in infants in both groups (p = 0.01). Most frequently observed birth traumas were
brachial plexus injury, facial nerve injury, and cephalohematoma. Of the three infants
with brachial plexus injury (insulin-dependent diabetic mothers, two; controls, one),
two were delivered with use of midforceps. We conclude that with current management,
the risk for birth trauma in diabetic pregnancies is not significantly different from
nondiabetic pregnancies. As reported previously, midforceps delivery appears to be
a significant risk factor for brachial plexus injury.
