Journal List > Korean J Obstet Gynecol > v.53(12) > 1006370

Korean J Obstet Gynecol. 2010 Dec;53(12):1078-1084. Korean.
Published online December 21, 2010.  https://doi.org/10.5468/kjog.2010.53.12.1078
Copyright © 2010 Korean Society of Obstetrics and Gynecology
Comparison of birth-weight between diabetic and non-diabetic pregnant women based on gestational weeks
Byung Chul Hwang, M.D., Ho Hyoung Lee, M.D., Deul Lae Min, M.S., Soon Pyo Lee, M.D., Jong Min Park, M.D. and Suk Young Kim, M.D.
Department of Obstetrics and Gynecology, Gil Hospital, Gachon University of Medicine and Science, Graduate School of Medicine, Incheon, Korea.

Corresponding author (Email: ksyob@gilhospital.com )
Received July 26, 2010; Revised October 12, 2010; Accepted November 15, 2010.

Abstract

Objective

The risk of macrosomia in diabetic complicated pregnancy is increased perinatal morbidity. But it is difficult to predict adverse outcomes after birth with conventional diagnostic tools of diabetes in pregnant women. We evaluated the birth-weight between diabetic and non-diabetic pregnant women based on gestational weeks to determine adverse pregnancy outcome.

Methods

We selected 166 diabetic complicated pregnant women delivered between January 2005 and December 2008 and 248 non-diabetic pregnant women at same period. We compared the birth-weight between two groups in relation to the gestational age below and over 37 weeks. Fetal anomalies, fetal death, and multifetal pregnancy were excluded in this study. And we also evaluated the incidence of baby who had birth-weight 3.8 kg or more and their neonatal outcomes between two groups.

Results

There were 4.9% (166/3404) of diabetic complicated pregnancies. The preterm births (birth before 37 weeks of gestation) were occurred 32.5% (54/166) and term births (birth after 37 weeks of gestation) were 67.5% (112/166). The mean birth-weight in preterm birth showed 2,492 g of gestational diabetes, 3,315 g of pregestational diabetes and 2,118 g of control group (P=0.001). The mean birth-weight and gestational age at delivery in term birth showed pregestational diabetes and gestational diabetes were heavier and shorter than those of control group (P=0.002). The incidence of 3.8 kg or more of birth-weighted baby appeared 43.5% (10/23) of pregestional diabetes, 16.8% (24/143) of gestational diabetes and 8.5% (21/248) of control group (P=0.000). The Apgar score less than 7 at minutes of neonate were more frequent in pregestational and gestational diabetes than that of control group (P=0.013).

Conclusion

It is important to classify the type of diabetes during pregnancy and there should be needed to predict adverse pregnancy outcomes including macrosomia.

Keywords: Gestational diabetes; Birth-weight; Premature birth; Pregnancy outcome

Figures


Fig. 1
The correlation between BMI and birth-weight in gestational diabetes mellitus and Type I/II diabetes mellitus. BW: birth weight, BMI: body mass index (R=0.298, P=0.009, 95% confidence interval; 11.159~76.817).
Click for larger image

Tables


Table 1
Incidence and distribution of diabetes during pregnancy
Click for larger image


Table 2
Perinatal data of the study and control group
Click for larger image


Table 3
Comparison with gestational weeks at birth and birth-weight in preterm birth and term birth among GDM, Type I/II DM in pregnancy and control
Click for larger image


Table 4
The incidence of 3.8 kg or more in birth-weight among GDM, Type I/II DM in pregnancy and control
Click for larger image

References
1. American Diabetes Association Clinical Practice Recommendations 2001. Diabetes Care 2001;24 Suppl 1:S1–S133.
2. Hoffman L, Nolan C, Wilson JD, Oats JJ, Simmons D. The Australasian Diabetes in Pregnancy Society. Gestational diabetes mellitus-management guidelines. Med J Aust 1998;169:93–97.
3. Silverman BL, Metzger BE, Cho NH, Loeb CA. Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes Care 1995;18:611–617.
4. Petitt DJ, Bennett PH, Knowler WC, Baird HR, Aleck KA. Gestational diabetes mellitus and impaired glucose tolerance during pregnancy. Long-term effects on obesity and glucose tolerance in the offspring. Diabetes 1985;34 Suppl 2:119–122.
5. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002.
6. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care 1998;21 Suppl 2:B161–B167.
7. Harris MI. Gestational diabetes may represent discovery of preexisting glucose intolerance. Diabetes Care 1988;11:402–411.
8. Hod M, Merlob P, Friedman S, Schoenfeld A, Ovadia J. Gestational diabetes mellitus. A survey of perinatal complications in the 1980s. Diabetes 1991;40 Suppl 2:74–78.
9. HAPO Study Cooperative Research Group. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Int J Gynaecol Obstet 2002;78:69–77.
10. Pettitt DJ, Knowler WC, Baird HR, Bennett PH. Gestational diabetes: infant and maternal complications of pregnancy in relation to third-trimester glucose tolerance in the Pima Indians. Diabetes Care 1980;3:458–464.
11. Sacks DA, Greenspoon JS, Abu-Fadil S, Henry HM, Wolde-Tsadik G, Yao JF. Toward universal criteria for gestational diabetes: the 75-gram glucose tolerance test in pregnancy. Am J Obstet Gynecol 1995;172:607–614.
12. Sermer M, Naylor CD, Gare DJ, Kenshole AB, Ritchie JW, Farine D, et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. The Toronto Tri-Hospital Gestational Diabetes Project. Am J Obstet Gynecol 1995;173:146–156.
13. Metzger BE. Biphasic effects of maternal metabolism on fetal growth. Quintessential expression of fuel-mediated teratogenesis. Diabetes 1991;40 Suppl 2:99–105.
14. Weiss PA, Hofmann HM, Winter RR, Lichtenegger W, Purstner P, Haas J. Diagnosis and treatment of gestational diabetes according to amniotic fluid insulin levels. Arch Gynecol 1986;239:81–91.
15. Silverman BL, Rizzo T, Green OC, Cho NH, Winter RJ, Ogata ES, et al. Long-term prospective evaluation of offspring of diabetic mothers. Diabetes 1991;40 Suppl 2:121–125.
16. Pettitt DJ, Baird HR, Aleck KA, Bennett PH, Knowler WC. Excessive obesity in offspring of Pima Indian women with diabetes during pregnancy. N Engl J Med 1983;308:242–245.
17. Lee GH, Kim YW, Lee KB, Seo EJ, Son MS, Ahn HG, et al. Change of birth weight-gestational age table. Korean J Obstet Gynecol 2001;44:1851–1856.
18. Naylor CD, Sermer M, Chen E, Sykora K. Toronto Trihospital Gestational Diabetes Investigators. Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? JAMA 1996;275:1165–1170.
19. Sibai BM, Caritis S, Hauth J, Lindheimer M, VanDorsten JP, MacPherson C, et al. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. Am J Obstet Gynecol 2000;182:364–369.
20. Yang J, Cummings EA, O'Connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol 2006;108:644–650.
21. Armstrong J, Reilly JJ. Breastfeeding and lowering the risk of childhood obesity. Lancet 2002;359:2003–2004.
22. Butte NF, Wong WW, Treuth MS, Ellis KJ, O'Brian Smith E. Energy requirements during pregnancy based on total energy expenditure and energy deposition. Am J Clin Nutr 2004;79:1078–1087.
23. Catalano PM. Management of obesity in pregnancy. Obstet Gynecol 2007;109:419–433.
24. Kinoshita T, Itoh M. Longitudinal variance of fat mass deposition during pregnancy evaluated by ultrasonography: the ratio of visceral fat to subcutaneous fat in the abdomen. Gynecol Obstet Invest 2006;61:115–118.
25. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004;103:219–224.
26. Chu SY, Kim SY, Lau J, Schmid CH, Dietz PM, Callaghan WM, et al. Maternal obesity and risk of stillbirth: a metaanalysis. Am J Obstet Gynecol 2007;197:223–228.
27. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001;25:1175–1182.
28. Cnattingius S, Bergstrom R, Lipworth L, Kramer MS. Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 1998;338:147–152.
29. Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM. Prevalence of maternal obesity in an urban center. Am J Obstet Gynecol 2002;187:1189–1193.
30. Freinkel N, Lewis NJ, Akazawa S, Roth SI, Gorman L. The honeybee syndrome-implications of the teratogenicity of mannose in rat-embryo culture. N Engl J Med 1984;310:223–230.
31. Eriksson UJ. The pathogenesis of congenital malformations in diabetic pregnancy. Diabetes Metab Rev 1995;11:63–82.
32. Pinter E, Reece EA, Leranth CZ, Garcia-Segura M, Hobbins JC, Mahoney MJ, et al. Arachidonic acid prevents hyperglycemia-associated yolk sac damage and embryopathy. Am J Obstet Gynecol 1986;155:691–702.
33. Van Assche FA, Holemans K, Aerts L. Long-term consequences for offspring of diabetes during pregnancy. Br Med Bull 2001;60:173–182.
34. Padmanabhan R, Shafiullah M. Intrauterine growth retardation in experimental diabetes: possible role of the placenta. Arch Physiol Biochem 2001;109:260–271.