The effects of first-trimester diabetes control on the incidence of macrosomia.
OBJECTIVE
The aim of this study was to explore the association between glycosylated hemoglobin concentrations during pregnancy and macrosomia.


METHODS
One hundred thirty-six pregnancies in 120 women with type 1 or type 2 diabetes were studied longitudinally between January 1, 1991, and December 31, 1996. Glycosylated hemoglobin concentration and several maternal variables of mothers of neonates who were large for gestational age were compared with those of neonates who were appropriate for gestational age. Receiver-operator characteristic curves and regression analyses were used to determine a threshold related to macrosomia and to assess its predictive value.


RESULTS
Glycosylated hemoglobin concentrations throughout pregnancy were higher in mothers of neonates who were large for gestational age (n = 65) than in mothers of neonates who were appropriate for gestational age (n = 71, P <. 001). A first-trimester glycosylated hemoglobin concentration of >/=5.5% (3 SD above the normal mean) was established by receiver-operator characteristic curves as the strongest predictor of macrosomia and yielded an odds ratio of 24 in multiple logistic regression analysis.


CONCLUSIONS
Macrosomia is determined mainly by first-trimester diabetes control.
Departments of Obstetrics and Gynecology and Clinical Chemistry, Sainte-Justine Hospital, University of Montréal, Canada.
E
E
Rey
C
C
Attié
A
A
Bonin
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005260:Female; D005320:Fetal Macrosomia / Q000517:prevention & control*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011254:Pregnancy in Diabetics; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity
D006442:Glycated Hemoglobin