title: Large-for-Gestational-Age Ultrasound Diagnosis and Risk for Cesarean Delivery in Women With Gestational Diabetes Mellitus.
abstract: OBJECTIVE
  To assess the accuracy of a large-for-gestational-age (LGA) ultrasound diagnosis and the subsequent risk for cesarean delivery associated with ultrasound diagnosis of LGA among women with gestational diabetes mellitus.
  
  
  METHODS
  This was a retrospective cohort study of 903 women with GDM who delivered after 36 weeks of gestation with an ultrasound-estimated fetal weight within 31 days of delivery. Delivery outcomes were compared between women with an ultrasound diagnosis of LGA and a non-LGA ultrasound diagnosis.
  
  
  RESULTS
  Based on ultrasound assessments, we identified 248 women with an LGA fetus and 655 women with a non-LGA fetus. Among women with an LGA ultrasound diagnosis, 56 of 248 (22.6%) delivered an LGA neonate, whereas, of women with a non-LGA ultrasound diagnosis, 18 of 655 (2.8%) delivered an LGA neonate. Ultrasound diagnosis of LGA was associated with increased risk for cesarean delivery (adjusted odds ratio [OR] 3.13, 95% confidence interval [CI] 2.10-4.67, P<.001) after adjusting for relevant covariates. Stratified analyses demonstrated that ultrasound diagnosis of LGA was associated with an increased risk for cesarean delivery whether the birth weight was between 2,500 and 3,499 g (OR 2.82, 95% CI 1.62-4.84, P<.001) or between 3,500 and 4,500 g (OR 3.47, 95% CI 2.06-5.88, P<.001).
  
  
  CONCLUSIONS
  Ultrasonography significantly overestimates the prevalence of LGA in women with gestational diabetes mellitus, and an ultrasound diagnosis of LGA is associated with an increased risk for cesarean delivery independent of birth weight.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, and the Harold Hamm Diabetes Center, Oklahoma City, Oklahoma; and the Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Women's Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Scifres
authors.forename: Maisa
authors.initials: M
authors.lastname: Feghali
authors.forename: Tina
authors.initials: T
authors.lastname: Dumont
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Althouse
authors.forename: Paul
authors.initials: P
authors.lastname: Speer
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Janet M
authors.initials: JM
authors.lastname: Catov
mesh_terms: D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005189:False Positive Reactions; D005260:Female; D005320:Fetal Macrosomia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D010414:Pennsylvania / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D014463:Ultrasonography