Asymmetric large-for-gestational-age infants of type 1 diabetic women: morbidity and abdominal growth.
We sought to examine neonatal morbidity in four groups of offspring (asymmetric large for gestational age [LGA], symmetric LGA, asymmetric non-LGA, symmetric non-LGA) exposed in utero to maternal type 1 diabetes, and the association between rate of fetal abdominal circumference growth and asymmetric LGA. We performed a secondary analysis of 302 singleton pregnancies. Neonatal morbidity (respiratory distress syndrome, polycythemia, hypoglycemia, hyperbilirubinemia, acidosis, and composite morbidity [any of the five]) was assessed. Serial ultrasound examinations after 20 weeks' gestation were available for 35 fetuses. Logistic regression and general linear mixed modeling were used for analysis. Asymmetric LGA infants had 3.5-, 2.2-, and 3.2-fold greater odds of hypoglycemia, hyperbilirubinemia, and composite morbidity, respectively, compared with symmetric non-LGA infants. The rate of growth of the abdominal circumference in asymmetric LGA infants (1.11 cm/wk) was greater than for both the symmetric LGA infants (0.87 cm/wk, P = 0.09) and the symmetric non-LGA infants (0.87 cm/wk, P = 0.03). Asymmetric LGA infants are at higher risk for morbidity than symmetric LGA and non-LGA infants. Intrauterine growth rate of the abdominal circumference may potentially be used as a marker to identify the asymmetric LGA and thereby aid in the identification of newborns at greatest risk for perinatal complications.
Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine, Cincinnati, OH 45208, USA. surekabollepalli@yahoo.com
Sureka
S
Bollepalli
Lawrence M
LM
Dolan
Menachem
M
Miodovnik
Maisa
M
Feghali
Jane C
JC
Khoury
D001724:Birth Weight / Q000502:physiology; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000235:genetics* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018743:Perinatal Care; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011254:Pregnancy in Diabetics / Q000453:epidemiology / Q000235:genetics* / Q000503:physiopathology / Q000628:therapy; D011295:Prenatal Care; D012307:Risk Factors; D016216:Ultrasonography, Prenatal