engleski

Significance of disproportionate macrosomia in gestational diabetic pregnancies

Disproportionate macrosomia refers to excessive weight characterised by a high weight/length ratio, and is known to be associated with an increased likelihood of neonatal complications. OBJECTIVE: (1) investigate foetal growth pattern of GDM pregnancies, and (2) identify additional pregnancy risks associated with macrosomia or disproportionate macrosomia in GDM pregnancies. STUDY DESIGN: 473 consecutive cases of gestational diabetes and 1419 nondiabetic control pregnancies were studied retrospectively, 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 28-44 weeks. Gestational age and maturational examination according to Farr was consistent in all cases within 2 weeks of each other. Oral glucose tolerance test was performed according to WHO protocol between 24th-28th week of gestation. Birthweight age was assessed according to reference growth curve by Dražančić, and adjusted for sex, parity and gestational age. Macroscomia was defined as neonatal birth weight greater that the 90th percentile value. Ponderal index under 10th and above 90th percentile was considered disproportional. RESULTS: Mean birth age 39.41ą1.2 wks, mean birth weight (ą SD) in GDM group was 3474.0ą762.4 compared to 3190.2ą578.9 gr of control group (F=72.04 ; p<0.001), mean birth length 50.11ą3.43 vrs. 49.30ą3.04 cm (F=23.76 ; p<0.001), mean ponderal index 2.71ą0.29 vrs. 2.63ą0.23 (F=39.11 ; p<0.001), rate of Apgar score <7 was 6.3% vrs. 4.6% (c2=3.28 ; p>0.05). Rate of macrosomia in GDM group was 35.7% vrs. 2.7% of controls (c2=386.00 ; p<0.001) OR 47.90 (95% CI 24.86-92.30) with mean birth weight of term neonates 4242.87ą389.78 vrs. 3974.89ą106.93 (F=13.44 ; p<0.005) and ponderal indices 2.90ą2.55 vrs. 2.74ą0.15 ; (F=11.40 ; p<0.01) ; rate of disproportionate macrosomia in GDM group 31.95% vrs. 10.53% of control group (c2=7.03 ; p<0.01) OR 3.99 (95%CI 1.27-13.99) with mean birth weight of term neonates 4428.86ą489.26 vrs. 3990.00ą14.14 (F=1.57 ; p>0.05) and ponderal indices 3.19ą0.20 vrs. 3.01ą0.10 ; (F=1.58 ; p>0.05). With regard of treatment modus comparisons of GDM diet vrs. CTRL, and GDM diet vrs. GDM insulin subsets of macrosomic and macrosomic disproportionate neonates significant differences of birth weight and subsequently of ponderal indices were identified. Caesarean section rate of term infants in GDM group was 26.30% vrs. 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% vrs. 0.00% (c2=1.44 ; p>0.05) ; in disproportionate macrosomic neonates 43.18% vrs. 0.00% (c2=49.89 ; p<0.001). Rate of neonatal complications of term infants in GDM group was 30.73% vrs 14.58% of controls (c2=49.89 ; p<0.001) OR 2.60 (95% CI 1.96-3.43) ; in term macrosomic neonates subgroup 42.65% vrs. 17.24% (c2=6.50 ; p<0.05) OR 3.57 (95% CI 1.23-12.62), in term disproportionate macrosomic neonates 59.09% vrs. 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 groups, regardless of gestational age, macrosomia or disproportionate macrosomia. CONCLUSION: Significantly higher rate of macrosomic neonates was found among GDM than among control infants after 37 weeks of gestation. The rate of disproportionate macrosomic infants significantly differs among study groups.

Gestational diabetes; macrosomia; foetal growth; ponderal index; birth weight

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