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Ponderal index and disproportionate fetal growth in IDDM pregnancies
J Djelmis1, D Buković, D Pfeifer
1Department of Obstetrics and Gynaecology, School of Medicine, University of Zagreb, Croatia.
Insights
Maternal diabetes (IDDM) significantly increases the risk of disproportionate macrosomia in newborns, leading to higher rates of neonatal complications. This study highlights the critical impact of IDDM on fetal growth and birth outcomes.
Area of Science:
- Perinatology
- Neonatal Health
- Endocrinology
Background:
- Disproportionate macrosomia, defined by a high weight/length ratio, is linked to increased neonatal complications.
- Maternal diabetes mellitus (IDDM) is a known risk factor for fetal overgrowth.
- Understanding the incidence of disproportionate fetal growth in IDDM pregnancies is crucial for risk assessment.
Purpose of the Study:
- To investigate the incidence of ponderal indexes and disproportionate fetal growth rates in newborns from IDDM pregnancies compared to healthy pregnancies.
- To assess the impact of IDDM on fetal growth patterns and identify associated risks.
- To compare the rates of macrosomia and disproportionate macrosomia between IDDM and control groups.
Main Methods:
- A case-control study comparing 144 IDDM pregnancies with 432 matched healthy pregnancies.
- Matching criteria included gestational age, newborn sex, maternal parity, and year of delivery.
- Analysis focused on birth weight, length, ponderal index, Apgar scores, and rates of macrosomia and disproportionate macrosomia.
Main Results:
- Newborns from IDDM pregnancies exhibited significantly higher mean birth weight (3558g vs 3132g) and ponderal index (2.82 vs 2.63) compared to controls.
- The incidence of macrosomia was substantially higher in the IDDM group (53.4% vs 8.33%).
- Disproportionate macrosomia occurred significantly more often in infants of mothers with IDDM (35.24% vs 5.79%), alongside a higher rate of low Apgar scores (21.14% vs 5.08%).
Conclusions:
- Maternal IDDM is associated with a significantly higher incidence of both proportional and disproportionate macrosomia.
- Infants born to mothers with IDDM demonstrate altered fetal growth patterns, increasing the risk of disproportionate macrosomia.
- The findings underscore the importance of monitoring fetal growth in pregnancies complicated by IDDM to mitigate neonatal risks.
Abstract:
Disproportionate macrosomia refers to excessive weight characterized by a high weight/length ratio. Disproportionate macrosomia is associated with an increased likelihood of neonatal complications. The aim of the study was to investigate incidence of ponderal indexes and disproportionate fetal growth rate in newborns originating from IDDM and healthy pregnancies. 144 IDDM pregnancies and 432 uneventful pregnancies with normal findings of oral glucose tolerance test were studied, and matched 1:3 for gestational age, sex of newborn, mothers's parity and year of delivery. The pregnancies selected terminated between 30-40th gestational week and resulted with live birth. Mean birth weight (+/- SD) in IDDM group was 3558 +/- 817.6 compared to 3132.4 +/- 534.4 grams of control group (F = 51.49; p < 0.001), mean birth length was 49.8 +/- 3.5 vrs 49.1 +/- 2.5 (F = 8.55; p < 0.005), mean gestation age by examination for both study groups 37.9 +/- 1.9, mean ponderal index of IDDM group was 2.82 +/- 0.28 vrs. 2.63 +/- 0.24 (F = 64.52; p < 0.001) of control group, rate of Apgar score < 7 was 21.14% vrs. 5.08% (chi 2 = 30.30; p < 0.001). 53.4% of IDDMs had macrosomia compared with 8.33% of control infants (chi 2 = 140.25; p < 0.001), and 35.24% of IDDMs had disproportionate macrosomia compared with 5.79% of control infants. Significantly higher rate of both proportionally and disproportionally grown infants with macrosomia was found among IDDMs than among control infants. The rate of disproportionate macrosomic infants significantly differ among study group.