Perinatal outcome in large-for-gestational-age infants. Is it influenced by gestational impaired glucose tolerance?
OBJECTIVE
To examine the relationship between the World Health Organization category of impaired glucose tolerance (IGT) (two-hour value of the 75-g oral glucose tolerance test at 8-10.9 mmol/L) and outcome in large-for-gestational age (LGA) infants to determine whether IGT affects perinatal morbidity in addition to affecting infant size.


METHODS
A retrospective study was performed on 461 LGA newborns (birth weight > 90th percentile) from singleton pregnancies delivering after 36 completed weeks in a 12-month period to determine the difference in perinatal outcome between nondiabetic pregnancies (n = 382) and pregnancies with diet-treated IGT (n = 79).


RESULTS
The IGT group had significantly higher mean maternal age, prepregnancy weight and body mass index (BMI) but lower absolute and percent gestational weight gain and no difference in infant gestational age, birth weight, BMI, incidence of macrosomia (birth weight > or = 4,000 g) or obstetric complications. However, the IGT group had an increased incidence of Erb's palsy (OR 7.81, 95% CI 1.76-34.62), meconium aspiration syndrome (OR 5.29, 95% CI 1.27-22.02), phototherapy (OR 2.10, 95% CI 1.03-5.69), sepsis (OR 2.90, 95% CI 1.25-6.74) and shoulder dystocia (OR 5.64, 95% CI 1.06-29.89) after adjusting for confounding factors (maternal age and BMI, postdate pregnancy, mode of delivery and infant sex).


CONCLUSIONS
Despite dietary treatment, maternal IGT is associated with increased perinatal morbidity independent of its effect on fetal size.
Lao
Terence T
TT
Department of Obstetrics and Gynaecology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, P.R.C. laotth@hkucc.hku.hk
Wong
Kar-Yin
KY
D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D001835:Body Weight; D015986:Confounding Factors, Epidemiologic; D016640:Diabetes, Gestational / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy*; D005260:Female; D005320:Fetal Macrosomia / Q000209:etiology*; D005865:Gestational Age; D018149:Glucose Intolerance / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy*; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008403:Mass Screening; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors