Macrosomia in Infants of Insulin-Dependent Diabetic Mothers

PEDIATRICS ◽  
1989 ◽  
Vol 83 (6) ◽  
pp. 1029-1034
Author(s):  
Michael A. Berk ◽  
Francis Mimouni ◽  
Menachem Miodovnik ◽  
Vicki Hertzberg ◽  
Jennifer Valuck
Keyword(s):  
Glycemic Control ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Large For Gestational Age ◽  
Third Trimester ◽  
The Third ◽  
Appropriate For Gestational Age ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic ◽  
Diabetic Mothers

The purpose of the present study was to evaluate factors affecting the rate of macrosomia and related complications in a population of infants of insulin-dependent diabetic mothers. The following factors were hypothesized to be predisposing to macrosomia: increased maternal weight gain during gestation, increased number of births until infant No. 3, white race, increased maternal age, poor glycemic control from the 20th week of gestation, and increased insulin dose. Advance White classification and increased duration of diabetes were predicted to be inversely related. In addition, macrosomia was hypothesized to predispose to selected adverse perinatal outcomes including premature labor, birth asphyxia, birth injury, hypoglycemia, polycythemia, and respiratory distress syndrome. From 1978 to 1986, 127 pregnancies were prospectively studied, 86 of the total number of women were entered prior to 10 weeks' gestation, and 41 were entered after 10 weeks' gestation. Patients monitored blood glucose at least twice daily with glycemic control achieved by "split-dosage" regimens of insulin. Glycohemoglobin was measured monthly. Pregnancy dating was based on the date of the last menstrual period and the Ballard score of the infant at birth. Macrosomia was defined as a birth weight greater than the 90th percentile of the intrauterine growth curves of Lubchenco. Of the babies born to mothers with insulin-dependent diabetes, 43% were large for gestational age and 57% were appropriate for gestational age. Maternal factors predisposing to an infant being large for gestational age included glycohemoglobin measurement at the time of delivery (large for gestational age = 8.4% ± 0.3%, appropriate for gestational age = 7.6% ± 0.2%, P < .05, normal = 5.5% to 8.5%), reflecting poorer glycemic control during the third trimester, weight gain in the third trimester, and advanced White classification by univariate analysis compared to mothers of babies with birth weights appropriate for gestational age. However, only glycohemoglobin at the time of delivery was significant when these variables were subjected to multiple logistical regression. Macrosomic infants had higher rates of both polycythemia (large for gestational age = 23.6%, appropriate for gestational age = 6.9%, P < .008) and hyperbilirubinemia (large for gestational age = 29.6%, appropriate for gestational age = 12.7%, P < .02) than nonmacrosomic infants but did not differ in other perinatal outcomes. The data suggest that, in spite of improvements in glycemic control in the recent past, macrosomia still exists at an increased rate in infants of diabetic mothers and is significantly related to poorer glycemic control in the third trimester. In addition, large for gestational age infants are at an increased risk for both polycythemia and hyperbilirubinemia.

Hyperbilirubinemia in Infants of Diabetic Mothers

PEDIATRICS ◽  
1980 ◽  
Vol 66 (3) ◽  
pp. 417-419
Author(s):  
Keith J. Peevy ◽  
Stephen A. Landaw ◽  
Steven J. Gross
Keyword(s):  
Gestational Age ◽  
Serum Bilirubin ◽  
Mode Of Delivery ◽  
Hemoglobin Concentration ◽  
Large For Gestational Age ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic ◽  
Diabetic Mothers

Large for gestational age (LGA) infants of insulin-dependent diabetic mothers (IDM), appropriate for gestational age (AGA) IDM, and infants of nondiabetic mothers were compared for the incidence of neonatal hyperbilirubinemia and related etiologic factors. At 60 hours of age, LGA IDM had significantly higher serum bilirubin concentrations (12.3 ± 2.1 mg/100 ml) than AGA IDM (7.6 ± 3.9 mg/100 ml) or control infants (7.8 ± 2.8 mg/100 ml) (P < .001). Peak serum bilirubin concentrations were also significantly higher in LGA IDM (14.4 ± 2.1 mg/100 ml) than in AGA IDM (8.4 ± 3.7 mg/100 ml) or control infants (8.6 ± 3.3 mg/100 ml) (P < .001). Mean percent of carboxyhemoglobin was used as an indicator of hemolysis and showed a significant elevation in LGA IDM (1.51 ± 0.19) when compared to AGA IDM (1.10 ± 0.27) and control infants (1.19 ± 0.33) (P < .05). No significant differences were found among the three groups with respect to mode of delivery, frequency of pitocin administration, 5-minute Apgar scores, incidence of isoimmunization, incidence of enclosed hemorrhage, hemoglobin concentration, bilirubin concentrations at 12 hours, and percent of weight loss. Our data suggest that only LGA IDM are at increased risk for hyperbilirubinemia and that increased heme turnover is a significant factor in the pathogenesis.

scholarly journals Perinatal Adverse Effects in Newborns with Estimated Loss of Weight Percentile between the Third Trimester Ultrasound and Delivery. The GROWIN Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4643
Author(s):  
María Sonsoles Galán Arévalo ◽  
Ignacio Mahillo-Fernández ◽  
Luis Mariano Esteban ◽  
Mercedes Andeyro-García ◽  
Roi Piñeiro Pérez ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Late Gestation ◽  
Third Trimester ◽  
Loss Of Weight ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Adverse Perinatal Outcomes ◽  
Weight Percentile

Fetal growth restriction has been associated with an increased risk of adverse perinatal outcomes (APOs). We determined the importance of fetal growth detention (FGD) in late gestation for the occurrence of APOs in small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. For this purpose, we analyzed a retrospective cohort study of 1067 singleton pregnancies. The newborns with higher APOs were SGA non-FGD and SGA FGD in 40.9% and 31.5% of cases, respectively, and we found an association between SGA non-FGD and any APO (OR 2.61; 95% CI: 1.35–4.99; p = 0.004). We did not find an increased APO risk in AGA FGD newborns (OR: 1.13, 95% CI: 0.80, 1.59; p = 0.483), except for cesarean delivery for non-reassuring fetal status (NRFS) with a decrease in percentile cutoff greater than 40 (RR: 2.41, 95% CI: 1.11–5.21) and 50 (RR: 2.93, 95% CI: 1.14–7.54). Conclusions: Newborns with the highest probability of APOs are SGA non-FGDs. AGA FGD newborns do not have a higher incidence of APOs than AGA non-FGDs, although with falls in percentile cutoff over 40, they have an increased risk of cesarean section due to NRFS. Further studies are warranted to detect these newborns who would benefit from close surveillance in late gestation and at delivery.

Perinatal outcome in diabetic mothers with relation to glycemic control during pregnancy.

2021 ◽  
Vol 28 (03) ◽  
pp. 382-386
Author(s):  
Jawaria Rasheed ◽  
Saira Isa ◽  
Faizza Rasheed ◽  
Kashif Siddiq ◽  
Zahida Saqlain ◽  
...  
Keyword(s):  
Gestational Age ◽  
Plasma Glucose ◽  
Birth Asphyxia ◽  
Perinatal Outcomes ◽  
High Plasma ◽  
Large For Gestational Age ◽  
Mean Values ◽  
Glucose Levels ◽  
High Plasma Glucose ◽  
Diabetic Mothers

Objective: To determine the frequency of perinatal outcomes (macrosomia, large for gestational age, birth asphyxia) in pregnant diabetic women with low and high plasma glucose levels between 36-40 weeks. Study Design: Cross-sectional study. Setting: Department of Obstetrics & Gynaecology, DHQ Hospital, Lodhran. Period: 2017 to 2019. Material & Methods: Total 285 diabetic women of age 25-40 years with singleton pregnancy of gestational age 36-40 weeks were selected. Patients with multiple pregnancies, GDM, renal disease and hypertension were excluded. Plasma glucose levels (fasting & 2 hour post-prandial) measured and mean values (fasting + postprandial/2) calculated. The mean values falling between 100-139 mg/dl were taken as low plasma glucose level where as ≥140 mg/dl noted as high plasma glucose level. The perinatal outcomes (macrosomia, large for gestational age, birth asphyxia) were assessed at the time of delivery. Results: Mean age was 29.44 ± 6.01 years. Mean plasma glucose levels were 109.77 ± 6.81 mg/dl. Perinatal outcome i.e. macrosomia, large for gestational age infants and birth asphyxia was found in 7.72%, 27.37% and 22.81% respectively. In this study that pregnant women with mean plasma glucose of 100-139 mg/dl showed frequency of macrosomia by 3.59%, large for gestational age 16.17% and birth asphyxia 14.35% while women with mean plasma glucose of ≥140 mg/dl showed frequency of macrosomia by 13.56%, large for gestational Age 43.22% and birth asphyxia 34.75%. Conclusion: Pregnant diabetic women with high plasma glucose levels have significantly high percentage of large for gestational age, birth asphyxia and macrosomia as compared to diabetic mothers with low plasma blood glucose levels. Consider diabetic mothers at risk and implement efficacious treatment in order to reduce the perinatal complications.

scholarly journals Frequency of Neonatal Hypoglycemia in Large for Gestational Age Infants of Non-Diabetic Mothers in a Community Maternity Hospital

2006 ◽  
Vol 49 (4) ◽  
pp. 237-239 ◽  
Author(s):  
Nilgun Araz ◽  
Mustafa Araz
Keyword(s):  
Blood Glucose ◽  
Gestational Age ◽  
Maternity Hospital ◽  
Large For Gestational Age ◽  
Control Group ◽  
Neonatal Hypoglycemia ◽  
Glucose Levels ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Diabetic Mothers

Large for gestational age (LGA) infants are at increased risk for hypoglycemia. The aim of the study was to determine the frequency of neonatal hypoglycemia in LGA infants of non-diabetic mothers in a Community Maternity Hospital in Gaziantep, Turkey. Hospital records of 5229 infants of non-diabetic mothers were examined retrospectively. Newborns with birth weight more than 4000 g were defined as LGA. The control group consisted of 100 appropriate for gestational age (AGA) newborns. Capillary blood glucose was measured at the second hour of life. Glucose values lower than 40 mg/dL (2.2 mmol/L) were defined as hypoglycemia. Ninety-six (1.8%) of the 5229 infants were found to be LGA. The mean capillary glucose levels of the LGA newborns were significantly lower than those of the AGA newborns (54 mg/dL (3.0 mmol/L) vs. 95 mg/dL (5.2 mmol/L), p<0.0001). Neonatal hypoglycemia was established in 16 of 96 LGA infants (16.7%). In the control group hypoglycemia was absent. The rate of hypoglycemia in LGA infants was significantly higher than the rate in the AGA infants (p=0.0000). As hypoglycemia is not rare in LGA infants and can have serious consequences, blood glucose levels should be screened routinely in LGA infants.

scholarly journals Evaluation of the selected parameters of the fetal diastolic functions in normally grown or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control

2022 ◽  
pp. 1-7
Author(s):  
Seçil Karaca Kurtulmus ◽  
Ebru Sahin Gülec ◽  
Mustafa Sengül
Keyword(s):  
Glycaemic Control ◽  
Pulmonary Vein ◽  
Gestational Age ◽  
Pulsatility Index ◽  
Ductus Venosus ◽  
Control Group ◽  
Third Trimester ◽  
Poor Glycaemic Control ◽  
Appropriate For Gestational Age ◽  
Diabetic Mothers

Abstract Objective: This study aimed to investigate whether the third trimester fetal cardiac diastolic function measured by selected conventional Doppler indices is affected in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control. Methods: This cross-sectional study included 93 pregnant women divided into two groups. Group 1 included 45 appropriate-for-gestational-age or macrosomic fetuses from gestational diabetic mothers with poor glycaemic control (study group). Group 2 included 48 appropriate-for-gestational-age fetuses from gestational age-matched healthy mothers (control group). Functional fetal cardiac parameters and fetoplacental Doppler parameters were measured. Data were compared between the two groups. Results: Maternal characteristics did not differ significantly between the study and the control group. There were no significant differences in the early and late velocity, early/late velocity ratio of both mitral and tricuspid valves, the fetal pulmonary vein pulsatility index, and the ductus venosus pulsatility index between the study and the control group. Moreover, the rate of abnormal Doppler findings in pulmonary vein (pulmonary vein pulsatility index >95th centile), ductus venosus (ductus venosus pulsatility index >95th centile), and peripheral vessels (umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebra-placental index >95th centile) were comparable in both groups. Conclusions: The third trimester fetal diastolic functions measured by selected conventional Doppler techniques do not seem to be altered in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers who have poor glycaemic control.

scholarly journals Prenatal care assessment according to the Prenatal and Birth Humanization Program

2018 ◽  
Vol 18 (4) ◽  
pp. 771-780
Author(s):  
Maria Alice Tsunechiro ◽  
Marlise de Oliveira Pimentel Lima ◽  
Isabel Cristina Bonadio ◽  
Marianne Dias Corrêa ◽  
Amanda Villalba Alves da Silva ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Birth Weight ◽  
Prenatal Care ◽  
Gestational Age ◽  
Medical Records ◽  
Perinatal Outcomes ◽  
Third Trimester ◽  
The Third ◽  
Primary Health

Abstract Objectives: to analyze prenatal care process in primary health care units and compare the prenatal adequacy in the third trimester with maternal and perinatal outcomes. Methods: a cross-sectional study of 2,404 pregnant women assisted in 2011in twelve primary health care units in the South region of São Paulo city. The data was collected through medical records. The assessment was based on the indicators process of the Programa de Humanização do Pré-natal e Nascimento (PHPN) (Prenatal and Birth Humanization Program). The prenatal adequacy in the third trimester was analyzed according to three criteria (early-onset, minimum of six consultations and puerperal consultation); and the compared maternal and perinatal outcomes were: type of childbirth, gestational age, birth weight and breastfeeding. The analysis was descriptive for the PHPN indicators and comparative for the prenatal adequacy by the chi-square test. Results: early prenatal (82.9%), minimum of six consultations (73.0%) and puerperal consultation (77.9%). In the overall of the PHPN indicators, there was an expressive decrease in the medical records (10.2%). Prenatal care was adequate for 63.6% with a significant difference in relation to gestational age (p=0.037) and birth weight (p=0.001). Conclusions: There were deficiencies in prenatal care. The difference between the groups in the perinatal outcomes reinforcing the need for prenatal care according to national indicators.

Sign in / Sign up

Export Citation Format

Share Document