Incidence of large-for-gestational-age newborns and its association with maternal gestational diabetes mellitus and obesity. Cohort study in a hospital in Buenos Aires
DOI:
https://doi.org/10.47196/diab.v56i3.659Keywords:
fetal macrosomia, gestational diabetes, obesity, incidenceAbstract
Introduction: two terms are used to describe excessive fetal growth: “large for gestational age” (LGA) and “macrosomia”. LGA generally implies a birth weight greater than the 90th percentile for a given gestational age.
Objectives: to estimate the incidence of LGA newborns and to assess whether obesity and gestational diabetes mellitus (GDM) are associated factors.
Materials and methods: retrospective cohort study of pregnant women with and without GDM and their live newborns between 2015-2018 evaluated at the Italian Hospital in the City of Buenos Aires, Argentina. The incidence of LGA and macrosomia newborns is presented as percentages and 95% confidence intervals (95% CI), as well as their complications. Multiple logistic regression was used to assess whether GDM and obesity are factors associated with LGA newborns.
Results: the incidence of LGA was 15.9% (95% CI; 14.1-17.9) and of macrosomia 6.7% (95% CI; 5.5-8.1). The incidence of LGA newborns was higher in women with GDM and obesity. Obesity represented a higher risk per se with and without association with GDM. Obesity, in the presence of GDM, increases the chance of LGA newborns compared to women with GDM and without obesity (OR 2.41; p<0.001).
Conclusions: diabetes and maternal obesity increase the risk of LGA. It is important to implement preventive measures and interventions on women of childbearing age with the aim of promoting the health of the mother and her offspring.
References
I. American College of Obstetricians and Gynecologists. Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol 2020 Jan;135(1):e18-35. doi: 10.1097/AOG.0000000000003606.
II. Akanmode AM, Mahdy H. Macrosomia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/32491509.
III. Koyanagi A, Zhang J, Dagvadorj A, Hirayama F, Shibuya K, Souza JP, et al. Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet. 2013 Feb 9;381(9865):476-83. doi: 10.1016/S0140-6736(12)61605-5.
IV. Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the united states: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol 2003 May;188(5):1372-8. doi: 10.1067/mob.2003.302.
V. Gillean JR, Coonrod DV, Russ R, Bay RC. Big infants in the neonatal intensive care unit. Am J Obstet Gynecol 2005 Jun;192(6):1948-53; discussion 1953-5. doi: 10.1016/j.ajog.2005.02.032.
VI. Kc K, Kamana KC, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia. A literature review. Ann Nutr Metab 2015;66(2):14-20. doi: 10.1159/000371628.
VII. Gaudet L, Wen SW, Walker M. The combined effect of maternal obesity and fetal macrosomia on pregnancy outcomes. J Obstet Gynaecol Can 2014. Sep;36(9):776-84. doi: 10.1016/S1701-2163(15)30479-5.
VIII. Cruz-Hernández J, Hernández-García P, Yanes-Quesada M, Rimbao-Torres G, Lang-Prieto J, Márquez-Guillén A. Macrosomía neonatal en el embarazo complicado con diabetes. REVCOG 2009;14(1):5-10. Disponible en: http://www.fecasog.com/sites/default/files/2016-12/La%20Macrosonomia%201.pdf.
IX. Catalano P, Kirwan J, Mouzon S, Haugel-de K, King J. Gestational diabetes and insulin resistance. Role in short- and long-term implications for mother and fetus. J Nutr 2003;133(5):1674S-1683S. doi: 10.1093/jn/133.5.1674S.
X. Catalano P, McIntyre H, Cruickshank J, McCance D, Dyer A, Metzger B, et al. The Hyperglycemia and Adverse Pregnancy Outcome Study. Associations of GDM and obesity with pregnancy outcomes. The HAPO Study Cooperative Research Group. Diabetes Care 2012;35(4):780-6. doi: 10.2337/dc11-1790.
XI. Revollo G, Martínez J, Grandi C, Alfaro-Gómez E, Dipierri J. Prevalencias de bajo peso y pequeño para la edad gestacional en Argentina: comparación entre el estándar INTERGROWTH-21st y una referencia argentina. Arch Argent Pediatr 2017;115(6):5547-55. doi: 10.5546/aap.2017.547.
XII. Urquia ML, Alazraqui M, Spinelli HG, Frank JW. Referencias poblacionales argentinas de peso al nacer según multiplicidad del parto, sexo y edad gestacional. Rev Panam Salud Publica 2011;29:108-19. Disponible en: https://iris.paho.org/bitstream/handle/10665.2/9565/a06v29n2.pdf?sequence=1&isAllowed=y.
XIII. Aguirre Unceta-Barrenechea A, Aguirre-Condez A, Pérez-Legórburu A, Echániz-Urcelay I. Recién nacido de peso elevado. Asociación Española de Pediatría 2008;159-168. Disponible en: https://www.aeped.es/sites/default/files/documentos/10_1.pdf.
XIV. Pérez G, Meritano J, Rubio C, Gutiérrez S, Mariani M, Brener P, et al. Hipoglucemia neonatal: revisión de las prácticas habituales. Arch Argent Pediatr. 2019;117(5):S195-204. Disponible en: https://www.sap.org.ar/uploads/consensos/consensos_hipoglucemia-neonatal-revision-de-las-practicas-habituales-97.pdf.
XV. Rodríguez J, Josep M, Aloy F. Ictericia neonatal. Asociación Española de Pediatría. 2008;38:372-83. Disponible en: https://www.aeped.es/sites/default/files/documentos/38.pdf.
XVI. Coto-Cotallo G, López-Sastre J, Fernández-Colomer B, Álvarez-Caro F, Ibáñez-Fernández A. Recién nacido a término con dificultad respiratoria: enfoque diagnóstico y terapéutico. Asociación Española de Pediatría. 2008;30:285-350. Disponible en: https://www.aeped.es/sites/default/files/documentos/30.pdf
XVII. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet 2017 Oct 14;390(10104):1770-80. doi: 10.1016/S0140-6736(17)31002-4.
XVIII. Zea-Vera A, Turin CG, Ochoa TJ. Unifying criteria for late neonatal sepsis: proposal for an algorithm of diagnostic surveillance. Rev Peru Med Exp Salud Publica. 2014 Apr;31(2):358-63. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25123879/.
XIX. Salzberg S, Alvariñas J, López G, Lapertosa L, Linari M, Falcón E, et al. Guías de diagnóstico y tratamiento de diabetes gestacional. ALAD 2016. Rev ALAD 2016;6:155-69. Disponible en: https://www.revistaalad.com/abstract.php?id=343.
XX. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy. Rasmussen KM, Yaktine AL, editors. Washington, DC: The National Academies Press; 2009. doi: 10.17226/12584.
XXI. Henriksen T. The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand 2008;87(2):134-45. doi: 10.1080/00016340801899289.
XXII. Scifres CM. Short- and long-term outcomes associated with large for gestational age birth weight. Obstet Gynecol Clin North Am 2021 Jun;48(2):325-37. doi: 10.1016/j.ogc.2021.02.005.
XXIII. Gómez-Bouza G. Recomendación: hipoglucemia neonatal. Rev Hosp Mat Inf Ramón Sardá. 2017;1(1):22-8. Disponible en: https://www.sarda.org.ar/images/2017/22%20RECOMENDACION.pdf.
XXIV. Fernández-Lorenzo JR, Couce-Pico M, Fraga-Bermúdez JM. Hipoglucemia neonatal. Protocolos Diagnóstico Terapeúticos de la AEP: Neonatología. Disponible en: https://www.aeped.es/sites/default/files/documentos/18_1.pdf.
XXV. Hermann GM, Dallas LM, Haskell SE, Roghair RD. Neonatal macrosomia is an independent risk factor for adult metabolic syndrome. Neonatology 2010;98(3):238-44. doi: 10.1159/000285629.
XXVI. Barker DJP, Eriksson JG, Forsén T, Osmond C. Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol 2002 Dec;31(6):1235-9. doi: 10.1093/ije/31.6.1235.
XXVII. Gillman MW. Developmental origins of health and disease. N Engl J Med. 2005 Oct 27;353(17):1848-50. doi: 10.1056/NEJMe058187.
XXVIII. Vats H, Saxena R, Sachdeva MP, Walia GK, Gupta V. Impact of maternal pre-pregnancy body mass index on maternal, fetal and neonatal adverse outcomes in the worldwide populations: A systematic review and meta-analysis. Obes Res Clin Pract 2021 Nov;15(6):536-45. doi: 10.1016/j.orcp.2021.10.005.
XXIX. Sharp GC, Lawlor DA. Paternal impact on the life course development of obesity and type 2 diabetes in the offspring. Diabetologia. 2019 Oct;62(10):1802-10. doi: 10.1007/s00125-019-4919-9.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 in the name of the authors. Reproduction rights: Argentine Diabetes Society
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Dirección Nacional de Derecho de Autor, Exp. N° 5.333.129. Instituto Nacional de la Propiedad Industrial, Marca «Revista de la Sociedad Argentina de Diabetes - Asociación Civil» N° de concesión 2.605.405 y N° de disposición 1.404/13.
La Revista de la SAD está licenciada bajo Licencia Creative Commons Atribución – No Comercial – Sin Obra Derivada 4.0 Internacional.
Por otra parte, la Revista SAD permite que los autores mantengan los derechos de autor sin restricciones.
