engleski

Significance of disproportionate macrosomia in gestational diabetic pregnancies

Disproportionate macrosomia refers to excessive weight characterized by a high weight/length ratio. Disproportionate macrosomia is known to be associated with an increased likelihood of neonatal complications. OBJECTIVE. To (1) investigate fetal growth pattern of GDM pregnancies, and (2) identify additional risks associated with macrosomia in GDM pregnancies. STUDY DESIGN. 473 GDM pregnancies and 1419 uneventful pregnancies with normal outcome of oral glucose tolerance test were studied, and matched 1:3 for gestational age, sex of newborn, mother's parity and year of delivery. Births were singleton for both groups and were terminated between 26-44 weeks. Gestational age and maturational examination was consistent in all cases within 2 weeks of each other. RESULTS. Mean birth age 39.41 +/- 1.2 wks, mean birth weight (+/- SD) in GDM group was 3474.0 +/- 762.4 compared to 3190.2 +/- 578.9 g of control group (F=72.04 ; p<0.001), mean birth length 50.11 +/- 3.43 vs. 49.30 +/- 3.04 cm (F=23.76 ; p<0.001), mean ponderal index 2.71 +/- 0.29 vs. 2.63 +/- 0.23 (F=39.11 ; p<0.001), rate of Apgar score <7 was 6.3% vs. 4.6% (c2=3.28 ; p>0.05). Rate of macrosomia in GDM group was 35.7% vs. 2.7% of controls (c2=386.00 ; p<0.001) OR 47.90 (95% CI 24.86-92.30) with mean birth weight rate of term neonates 4242.87 +/- 389.78 vs. 3974.89 +/- 106.93 (F=13.44 ; p<0.005) and ponderal indices 2.90 +/- 2.55 vs. 2.74 +/- 0.15 ; (F=11.40 ; p<0.01) ; rate of disproportionate macrosomia in GDM group 31.95% vs. 10.53% of control group (c2=7.03 ; p<0.01) OR 3.99 (95% CI 1.27-13.99) with mean birth weight rate of term neonates 4428.86 +/- 489.26 vs. 3990.00 +/- 14.14 (F=1.57 ; p>0.05) and ponderal indices 3.19 +/- 0.20 vs. 3.01 +/- 0.10 ; (F=1.58 ; p>0.05). Caesarean section rate of term infants in GDM group was 26.30% vs. 8.18% of controls (c2=85.87 ; p<0.001) OR 4.00 (95% CI 2.90-5.51) ; in macrosomic neonates subgroup 33.82% vs. 0.00% (c2=1.44 ; p>0.05) ; in disproportionate macrosomic neonates 43.18% vs. 0.00% (c2=49.89 ; p<0.001). Rate of neonatal complications of term infants in GDM group was 30.73% vs. 14.58% of controls (c2=49.89 ; p<0.001) OR 2.60 (95% CI 1.96-3.43) ; in macrosomic neonates subgroup 42.65% vs. 17.24% (c2=6.50 ; p<0.05) OR 3.57 (95% CI 1.23-12.62), in disproportionate macrosomic neonates 59.09% vs. 0.00% (c2=2.66 ; p>0.05). No difference was identified with respect to mean Apgar 1 min score or rate of <7 score between study group and regardless of macrosomia or disproportionate macrosomia. CONCLUSION. Significantly higher rate of macrosomic neonates was found among GDM than among control infants. The rate of disproportionate macrosomic infants significantly differs among study groups.

gestational diabetes; macrosomia

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