U. M. Schaefer-Graf, R. Heuer, Ö. Kilavuz, A. Pandura, W. Henrich, K. Vetter
Maternal obesity not maternal glucose values correlates best with high rates of fetal macrosomia in pregnancies complicated by gestational diabetes
Aim: The current therapeutic strategies to reduce macrosomia
rates in gestational diabetes (GDM) have focused
on the normalizing of maternal glucose levels. The aim of
our study was 1.) to compare maternal glycemic values
with the presence of fetal macrosomia at different gestational
ages (GA) and with LGA at birth in a cohort of
women with glucose intolerance and standard diabetic
therapy.
Methods: 306 women with GDM and 97 with impaired
glucose tolerance underwent ultrasound examinations at
entry and, after initiation of therapy, monthly in addition
to standard diabetic therapy. Measurements from the entry
diagnostic oGTT, glucose profile and HbA1c and from
subsequent glucose profiles obtained within 3 days of the
ultrasound at 5 categories of GA age (20–23, 24–27 etc)
were retrospectively compared between pregnancies
with and without fetal macrosomia, defined as an abdominal
circumference (AC) ?90th percentile. Maternal
prepregnancy BMI was adjusted for and BMI ?30 kg/m2
was defined as obesity.
Results: At entry, neither the hourly oGTT values, HbA1c,
nor the entry glucose profile differed significantly between
pregnancies with and without fetal macrosomia. In a total
of 919 pairs of ultrasound/glucose profiles there was no significant
difference in glucose levels at every GA category
neither in lean nor in obese woman except for the fasting
glucose of 32–35 GA. The fetal macrosomia rate in each
GA category and the rate of LGA were significantly higher
in obese women: e.g. 14.5 vs 28% at diagnosis, 15.7 vs
26.7% at 32–35 weeks, 15.5 vs 25.0% at birth (p < 0.05 for
each comparison).
Conclusion: The association of maternal glucose values
and fetal macrosomia was limited to the fasting glucose
values between 32–35 weeks while maternal obesity appeared
to be a strong risk factor for macrosomia
throughout pregnancies with GDM. In obese women the
high fetal macrosomia rate did not appear to be normalized
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 30, 07/2002
Pages: 313 - 321
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