Prevalence and risk factors of delivery of large-for-gestational age infants among pregnant women with gestational diabetes: A systematic review and meta-analysis.

BACKGROUND

Delivery of large-for-gestational age (LGA) infants among women with gestational diabetes (GD) is a public problem that endangers mothers and children. Although numerous studies have reported various risk factors associated with LGA delivery among patients with GD, there is currently a lack in systematic summarization.

OBJECTIVES

The objective of the current study was to identify the risk factors of LGA delivery among women with GD and provide guidance for clinical personnel.

SEARCH STRATEGY: Systematic searches of PubMed, Web of Science, Cochrane Library, Scopus, EMBASE, OVID, and CINAHL were conducted from inception to August 1, 2024.

SELECTION CRITERIA: Observational studies that focused on risk factors of LGA deliveries among women with GD were included in this review.

DATA COLLECTION AND ANALYSIS: This review followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, and the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality checklist were used to evaluate the quality of the included studies. The pooled odds ratios with 95% confidence intervals were calculated by a fixed/random-effects model. To identify the sources of heterogeneity, subgroup, meta-regression, and sensitivity analyses were also conducted. The I2 statistic was used to measure heterogeneity between studies. Publication bias was assessed using funnel plots and Egger test.

MAIN

RESULTS

A total of 25 studies were included in this review, including 60 580 women with GD. The prevalence of LGA deliveries among women with GD was found to be associated with significant heterogeneity (I2 = 97.60%; P < 0.100), suggesting that caution is needed when generalizing these findings. The prevalence of LGA deliveries among women with GD was found to be more likely a result of several identified factors, including multiparity (≥2), prepregnancy overweight/obesity, excessive gestational weight gain, unstable blood glucose control during pregnancy, hypertriglyceridemia in pregnancy, and low levels of high-density lipoprotein cholesterol in pregnancy.

CONCLUSIONS

The prevalence of LGA deliveries among women with GD was approximately 14.5%. Identifying the associated risk factors allowed for more precise screening for high-risk populations, enabling timely interventions to reduce the incidence of LGA deliveries among women with GD. PROSPERO registration no. CRD42024559013.