Category: Diabetes
Poster Session III
While the association of maternal diabetes and large for gestational age (LGA; birth weight above 90% based on Duryea et al nomogram) neonates is recognized, there is paucity of data regarding whether adverse outcomes of laboring people with an LGA neonate are related to maternal diabetes (DM). We aimed to describe the trend in the rate of LGA and compare adverse outcomes in laboring people with LGA neonates by maternal DM status (pregestational or gestational diabetes versus no diabetes).
Study Design:
A population-based retrospective cohort study using the U.S. Vital Statistics data set (2014-2020) evaluated individuals with a non-anomalous LGA neonate, who labored and delivered at 24–41 weeks. The co-primary outcomes were composite maternal adverse outcome (cesarean delivery, intensive care unit admission, blood transfusion, uterine rupture or unplanned hysterectomy) and composite neonatal adverse outcome (Apgar score < 5 at 5 minutes, assisted ventilation >6h, seizure or death). Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Average annual percent change (AAPC) was obtained using JointPoint Regression to assess changes over time.
Results:
Among 1.8 million singletons with LGA neonates, maternal DM was identified in 186,579 people (10%). There was a downward trend in the rate of LGA in people with DM compared to a stable rate among people without (Figure 1). An increased risk of composite maternal adverse outcome (aRR1.37, 95% CI 1.36-1.38) and composite neonatal adverse outcome (aRR1.57, 95% CI 1.53-1.62) was found in those with DM compared to those without (Table 1). An upward trend in the rate of composite neonatal adverse outcomes among both groups was observed(Figure 1).
Conclusion:
Using a nationally representative sample of the U.S., 1 out of 10 LGA neonates were born to people with DM. The risk of composite adverse maternal and neonatal outcomes was significantly higher in those with DM and LGA neonate. Interventional trials are needed to identify and reduce the adverse outcomes among people with DM and LGA.
Sarah Nazeer, MD (she/her/hers)
Maternal-Fetal Medicine Fellow
Department of Obstetrics, Gynecology & Reproductive Health Sciences, University of Texas
Houston, Texas, United States
Han-Yang Chen, PhD
Department of Obstetrics, Gynecology and Reproductive Sciences
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Joy A. Ashby Cornthwaite, RD, CDE, MS
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Ghamar Bitar, MD
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Suneet P. Chauhan, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Michal Fishel Bartal, MD, MS (she/her/hers)
Maternal Fetal Medicine Faculty
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States