Disproportionate body composition and perinatal outcome in large-for-gestational-age infants to mothers with type 1 diabetes.
OBJECTIVE
To determine if disproportionate body composition is a risk factor for perinatal complications in large-for-gestational-age infants born to mothers with type 1 diabetes.


METHODS
Population-based cohort study.


METHODS
Data from the Swedish Medical Birth Registry from 1998 to 2007.


METHODS
National cohort of 3517 infants born to mothers with type 1 diabetes. Only singletons with gestational age 32-43 weeks were included.


METHODS
Large for gestational age (LGA) was defined as birthweight > 90th centile and appropriate for gestational age (AGA) as birthweight between 10th and 90th centiles. Disproportionate (D) infants were defined as having a ponderal index [PI: calculated as birthweight in grams/(length in cm)(3) > 90th centile] and proportionate (P) as PI ≤ 90th centile. LGA infants were classified as P-LGA or D-LGA. Odds ratios were calculated for D-LGA and P-LGA infants, with AGA infants as the reference category. Odds ratios were adjusted for mode of delivery, fetal distress and stratified by gestational age.


METHODS
The primary outcome was a composite of neonatal morbidities, i.e. any of the following diagnoses: Apgar score < 7 at 5 minutes, birth trauma (Erb's palsy or clavicle fracture), respiratory disorder, hyperbilirubinaemia or hypoglycaemia requiring treatment.


RESULTS
Composite morbidity was significantly more frequent in LGA as opposed to AGA infants, but there was no difference in risk between P-LGA and D-LGA infants.


CONCLUSIONS
High birthweight, irrespective of body proportionality, is a risk factor for neonatal complications in offspring of women with type 1 diabetes.
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden. martina.persson@ki.se
M
M
Persson
D
D
Pasupathy
U
U
Hanson
M
M
Norman
D001034:Apgar Score; D001720:Birth Injuries / Q000209:etiology; D001823:Body Composition / Q000502:physiology*; D002585:Cesarean Section / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D005260:Female; D005320:Fetal Macrosomia / Q000503:physiopathology*; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D009772:Obstetrical Forceps / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D047928:Premature Birth / Q000503:physiopathology; D012120:Respiration Disorders / Q000209:etiology; D012307:Risk Factors