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Excessive birth weight and maternal glucose tolerance--a 19-year review
D C Shelley-Jones1, N A Beischer, M T Sheedy
1Mercy Hospital for Women, East Melbourne, Victoria.
Insights
The incidence of high birth-weight infants increased, but this was linked to maternal hyperglycemia, not gestational diabetes. High birth-weight babies were not strongly associated with the later development of diabetes in mothers.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Perinatal Medicine
Background:
- Observed increase in infants with birth-weight of 4,540 g or more (10 lb) between 1971-1977 and 1978-1989.
- Concomitant rise in maternal hyperglycemia within the antenatal population during the same period.
Purpose of the Study:
- To investigate the relationship between excessive birth-weight and maternal glucose tolerance.
- To determine if increased incidence of high birth-weight infants correlates with gestational diabetes or later diabetes development in mothers.
Main Methods:
- Compared glucose tolerance test results of 510 women with infants weighing >= 4,540 g to 5,003 controls.
- Assessed glucose tolerance in subsequent pregnancies and screened for permanent diabetes mellitus in the study group.
Main Results:
- Excessive birth-weight was associated with maternal hyperglycemia (p < 0.05), but not gestational diabetes.
- 79% of infants with birth-weight >= 4,540 g were born to mothers without hyperglycemia.
- No increased glucose intolerance in subsequent pregnancies; only 2 of 49 women developed diabetes mellitus.
- High birth-weight occurred in 1.1% of the total population and was linked to maternal hyperglycemia in approximately 20% of cases.
Conclusions:
- The rise in excessive birth-weight infants is not directly related to an increased incidence of gestational diabetes.
- Maternal hyperglycemia, rather than gestational diabetes, is associated with high birth-weight infants.
- High birth-weight has a poor association with the later development of diabetes in mothers.
Abstract:
The incidence of birth-weight of 4,540 g (10 lb) or more rose from 0.87% in the years 1971 to 1977 to 1.16% in the 12 years from 1978 to 1989 with a concomitant increase in hyperglycaemia in our antenatal population. The relationship between excessive birth-weight and maternal glucose tolerance was investigated in the light of these observations. The results from glucose tolerance tests performed routinely during the pregnancies of 510 women who delivered infants with a birth-weight of 4,540 g or more were compared with those from a control series of 5,003 women with consecutively tested pregnancies. Glucose tolerance in subsequent pregnancies was also compared with the control series, and in 1991 the study group women were investigated for emergence of permanent diabetes mellitus. Excessive birth-weight was associated with maternal hyperglycaemia (p < 0.05) but not with gestational diabetes; 79% of infants with birth-weight > or = 4,540 g were born to mothers who were not hyperglycaemic. There was no increase in glucose intolerance in subsequent pregnancies in the study group and only 2 of 49 women with follow-up testing had diabetes mellitus. Birth-weight > or = 4,540 g occurred in 1.1% of the total population and 1.1% of women with gestational diabetes, and was related to maternal hyperglycaemia in about 1 in 5 cases. The increased incidence of excessive birth-weight infants was not related to the increased incidence of gestational diabetes in our pregnant population. Birth-weight > or = 4,540 g had a poor association with later development of diabetes.