Hadar Rosen1,2, Anat Shmueli2,3, Eran Ashwal1,2, Liran Hiersch1,2, Yariv Yogev1,2, Amir Aviram1,2. 1. Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. 2. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 3. Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.
Abstract
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.
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.
Authors: Björg Ásbjörnsdóttir; Marianne Vestgaard; Lene Ringholm; Lise Lotte Torvin Andersen; Dorte Møller Jensen; Peter Damm; Elisabeth R Mathiesen Journal: BMJ Open Diabetes Res Care Date: 2019-11-07