Large for Gestational Age and Adverse Outcomes: Stratified By Diabetes Status.

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY American journal of perinatology Pub Date : 2025-01-01 Epub Date: 2024-04-30 DOI:10.1055/a-2316-9007

Sarah A Nazeer, Han-Yang Chen, Joycelyn Ashby Cornthwaite, Suneet P Chauhan, Baha Sibai, Stephen Wagner, Michal F Bartal

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引用次数: 0

Abstract

Objective: To examine the association of adverse outcomes among parturients with large for gestational age (LGA; birth weight ≥ 90^th) newborns, stratified by diabetes status. Additionally, we described the temporal trends of adverse outcomes among LGA neonates.

Study design: This retrospective cohort study used the U.S. Vital Statistics dataset between 2014 and 2020. The inclusion criteria were singleton, nonanomalous LGA live births who labored and delivered at 24 to 41 weeks with known diabetes status. The coprimary outcomes were composite neonatal adverse outcomes of the following: Apgar score < 5 at 5 minutes, assisted ventilation > 6 hours, seizure, or neonatal or infant mortality, and maternal adverse outcomes of the following: maternal transfusion, ruptured uterus, unplanned hysterectomy, admission to intensive care unit, or unplanned procedure. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Average annual percent change (AAPC) was calculated to assess changes in rates of LGA and morbidity over time.

Results: Of 27 million births in 7 years, 1,843,467 (6.8%) met the inclusion criteria. While 1,656,888 (89.9%) did not have diabetes, 186,579 (10.1%) were with diabetes. Composite neonatal adverse outcomes (aRR = 1.48, 95% CI = 1.43, 1.52) and composite maternal adverse outcomes (aRR = 1.37, 95% CI = 1.36, 1.38) were significantly higher among individuals with diabetes, compared with those without diabetes. From 2014 to 2020, the LGA rate was stable among people without diabetes. However, there was a downward trend of LGA in people with diabetes (AAPC = - 2.4, 95% CI = - 3.5, -1.4).

Conclusion: In pregnancies with LGA newborns, composite neonatal and maternal morbidities were higher in those with diabetes, compared with those without diabetes.

Key points: · Large for gestational age stratified by diabetes status.. · Composite neonatal and maternal adverse outcomes are worse among individuals with diabetes as compared to those without.. · During 2014 to 2020, the trend of LGA in individuals without diabetes increased..

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妊娠年龄过大与不良结局：按糖尿病状态分层。

目的根据糖尿病状况分层，研究胎龄偏大（LGA；出生体重>90th）新生儿产妇不良预后的相关性。此外，我们还描述了 LGA 新生儿不良结局的时间趋势：这项回顾性队列研究使用了 2014-2020 年间的美国生命统计数据集。纳入标准为单胎、非异常 LGA 活产，分娩时间为 24-41 周，已知患有糖尿病。共同主要结果为以下新生儿不良综合结果：Apgar评分<5分（5分钟）、辅助通气>6小时、癫痫发作、新生儿或婴儿死亡，以及产妇不良结局：产妇输血、子宫破裂、计划外子宫切除术、入住重症监护室或计划外手术。多变量泊松回归模型用于估算调整后相对风险 (aRR) 和 95% 置信区间 (CI)。计算了年均百分比变化（AAPC），以评估 LGA 和发病率随时间的变化：在 7 年中出生的 2700 万新生儿中，有 1843467 例（6.8%）符合纳入标准。有 1656888 名新生儿（89.9%）未患糖尿病，其中有 186579 名新生儿（10.1%）患有糖尿病。与非糖尿病患者相比，糖尿病患者的新生儿综合不良后果（aRR 1.57，95% CI 1.53-1.62）和孕产妇综合不良后果（aRR 1.37，95% CI= 1.36-1.38）明显更高。从 2014 年到 2020 年，非糖尿病患者的 LGA 率保持稳定。然而，糖尿病患者的LGA呈下降趋势（AAPC= -2.4，95% CI -3.5，-1.4）：结论：与非糖尿病患者相比，在妊娠合并 LGA 新生儿的情况下，糖尿病患者的新生儿和孕产妇综合发病率更高。

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来源期刊

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.