Parturients with diabetes and associated outcomes with Macrosomic newborns.

BACKGROUND

Adverse neonatal and maternal outcomes are understudied for parturients with diabetes who deliver macrosomic newborns.

OBJECTIVE

We hypothesized that composite-neonatal (CNAO) and maternal adverse outcomes (CMAO) would be significantly higher for individuals with diabetes macrosomic newborns.

STUDY

DESIGN

This was a secondary analysis of APEX cohorts. The inclusion criteria were parturients with diabetes that were at least 34.0 weeks. CNAO included: Apgar score < 7 at 5 min, neonatal fracture, intracranial hemorrhage, neonatal brachial plexus palsy (NBPP), treated hypotension, or hypoxic encelopathy. CMAO included: chorioamnionitis, EBL ≥ 1,000 mL or 3rd/4th degree lacerations. Multivariate Poisson regression with robust error variance was used to calculate incidence-rate-ratios (IRR), and adjusted IRR (aIRR)

RESULTS

Among the 118,422 cohorts in APEX study, 8,410(7.5 %) had diabetes. The inclusion criteria were met by 584 (6.9 %) diabetic parturients, and among them 491 (84.0 %) delivered category I macrosomia, and 93 (16.0 %) with category II/III. The overall CNAO was 7.2 %, and it was significantly higher for parturients who delivered newborns with BW ≥ 4,500 g (15.0%) versus 4,000-4,499 g (5.7%; aIRR2.64; 95 %-CI 1.39-5.01; p: 0.006). The overall CMAO was 29.9 % and it was similar when BW ≥ 4,500 g (32.2 %) versus when BW was 4,000-4,499 (29.5 %; aIRR 1.05; 0.71-1.57). The overall rate of shoulder dystocia (SD) among macrosomic newborns was 14.7 % and it was significantly higher among those with birthweight ≥ 4,500g (28.0%) versus those with 4,000-4,449 g (12.2 %; aIRR2.21; 95 %CI 1.39-3.53). The rate of cesarean delivery did not differ between the two groups(aIRR 1.24;95 % CI 0.89-1.72).

CONCLUSIONS

Among parturients with diabetes, who delivered newborns with birthweight ≥ 4,500 g versus 4,000-4,499 g, CNAO and SD were twofold higher. Thus, there is an imperative to identify newborns among individuals with diabetes whose newborn will be 4,000-4,499 versus ≥ 4,500 g.