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Delivery outcomes of large‐for‐gestational‐age newborns stratified by the presence or absence of gestational diabetes mellitus
Author(s) -
Rosen Hadar,
Shmueli Anat,
Ashwal Eran,
Hiersch Liran,
Yogev Yariv,
Aviram Amir
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12387
Subject(s) - medicine , gestational diabetes , obstetrics , shoulder dystocia , pregnancy , gestational age , fetal macrosomia , odds ratio , vaginal delivery , retrospective cohort study , gynecology , gestation , surgery , genetics , biology
Objective To evaluate separate and combined contributions of gestational diabetes mellitus ( GDM ) and large‐for‐gestational age ( LGA ) on delivery outcomes. Methods In a retrospective cohort study of term singleton deliveries between 2007 and 2014 in Tel Aviv, Israel, outcomes were compared between non‐ GDM / AGA pregnancies (reference) and three study groups: non‐ GDM / LGA , GDM /appropriate for gestational age ( AGA ) and GDM / LGA . Results Overall, there were 62 102 deliveries, of which 53 201 (85.7%) were eligible for inclusion. Of these, 43 775 (82.3%) were non‐ GDM / AGA , 6441 (12.1%) non‐ GDM / LGA , 2351 (4.4%) GDM / AGA , and 634 (1.2%) GDM / LGA . Compared with the reference group, the study groups had higher mean maternal age and higher rates of previous cesarean delivery, polyhydramnios, induction of labor, and cesarean delivery. Considering only women attempting vaginal delivery, the three groups were independently associated with adverse outcomes including cesarean delivery (adjusted odds ratio [ aOR ], 1.5, 1.6, and 2.6 for non‐ GDM / LGA , GDM / AGA , and GDM / LGA , respectively), mainly for prolonged first stage of labor, and hypoglycemia ( aOR , 1.9, 2.5, and 4.6, respectively). LGA with and without GDM was associated with shoulder dystocia ( aOR , 14.5 and 6.9, respectively), prolonged second stage, and jaundice. Conclusion GDM and LGA share similarities in pregnancy complications. The presence of both has a cumulative impact.