TY - JOUR
T1 - Parturients with diabetes and associated outcomes with Macrosomic newborns
AU - Zullo, Fabrizio
AU - Logue, Teresa C.
AU - Di Mascio, Daniele
AU - Rizzo, Giuseppe
AU - Giancotti, Antonella
AU - Hoffman, Matthew K.
AU - Sorrenti, Sara
AU - Mendez Figueroa, Hector
AU - Sciscione, Anthony C.
AU - Fishel Bartal, Michal
AU - Chauhan, Suneet P.
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2025/9
Y1 - 2025/9
N2 - Background: Adverse neonatal and maternal outcomes are understudied for parturients with diabetes who deliver macrosomic newborns. Objective: We hypothesized that composite-neonatal (CNAO) and maternal adverse outcomes (CMAO) would be significantly higher for individuals with diabetes macrosomic newborns. Study Design: This was a secondary analysis of APEX cohorts. The inclusion criteria were parturients with diabetes that were at least 34.0 weeks. CNAO included: Apgar score < 7 at 5 min, neonatal fracture, intracranial hemorrhage, neonatal brachial plexus palsy (NBPP), treated hypotension, or hypoxic encelopathy. CMAO included: chorioamnionitis, EBL ≥ 1,000 mL or 3rd/4th degree lacerations. Multivariate Poisson regression with robust error variance was used to calculate incidence-rate-ratios (IRR), and adjusted IRR (aIRR) Results: Among the 118,422 cohorts in APEX study, 8,410(7.5 %) had diabetes. The inclusion criteria were met by 584 (6.9 %) diabetic parturients, and among them 491 (84.0 %) delivered category I macrosomia, and 93 (16.0 %) with category II/III. The overall CNAO was 7.2 %, and it was significantly higher for parturients who delivered newborns with BW ≥ 4,500 g (15.0%) versus 4,000–4,499 g (5.7%; aIRR2.64; 95 %-CI 1.39–5.01; p: 0.006). The overall CMAO was 29.9 % and it was similar when BW ≥ 4,500 g (32.2 %) versus when BW was 4,000–4,499 (29.5 %; aIRR 1.05; 0.71–1.57). The overall rate of shoulder dystocia (SD) among macrosomic newborns was 14.7 % and it was significantly higher among those with birthweight ≥ 4,500g (28.0%) versus those with 4,000–4,449 g (12.2 %; aIRR2.21; 95 %CI 1.39–3.53). The rate of cesarean delivery did not differ between the two groups(aIRR 1.24;95 % CI 0.89–1.72). Conclusions: Among parturients with diabetes, who delivered newborns with birthweight ≥ 4,500 g versus 4,000–4,499 g, CNAO and SD were twofold higher. Thus, there is an imperative to identify newborns among individuals with diabetes whose newborn will be 4,000–4,499 versus ≥ 4,500 g.
AB - Background: Adverse neonatal and maternal outcomes are understudied for parturients with diabetes who deliver macrosomic newborns. Objective: We hypothesized that composite-neonatal (CNAO) and maternal adverse outcomes (CMAO) would be significantly higher for individuals with diabetes macrosomic newborns. Study Design: This was a secondary analysis of APEX cohorts. The inclusion criteria were parturients with diabetes that were at least 34.0 weeks. CNAO included: Apgar score < 7 at 5 min, neonatal fracture, intracranial hemorrhage, neonatal brachial plexus palsy (NBPP), treated hypotension, or hypoxic encelopathy. CMAO included: chorioamnionitis, EBL ≥ 1,000 mL or 3rd/4th degree lacerations. Multivariate Poisson regression with robust error variance was used to calculate incidence-rate-ratios (IRR), and adjusted IRR (aIRR) Results: Among the 118,422 cohorts in APEX study, 8,410(7.5 %) had diabetes. The inclusion criteria were met by 584 (6.9 %) diabetic parturients, and among them 491 (84.0 %) delivered category I macrosomia, and 93 (16.0 %) with category II/III. The overall CNAO was 7.2 %, and it was significantly higher for parturients who delivered newborns with BW ≥ 4,500 g (15.0%) versus 4,000–4,499 g (5.7%; aIRR2.64; 95 %-CI 1.39–5.01; p: 0.006). The overall CMAO was 29.9 % and it was similar when BW ≥ 4,500 g (32.2 %) versus when BW was 4,000–4,499 (29.5 %; aIRR 1.05; 0.71–1.57). The overall rate of shoulder dystocia (SD) among macrosomic newborns was 14.7 % and it was significantly higher among those with birthweight ≥ 4,500g (28.0%) versus those with 4,000–4,449 g (12.2 %; aIRR2.21; 95 %CI 1.39–3.53). The rate of cesarean delivery did not differ between the two groups(aIRR 1.24;95 % CI 0.89–1.72). Conclusions: Among parturients with diabetes, who delivered newborns with birthweight ≥ 4,500 g versus 4,000–4,499 g, CNAO and SD were twofold higher. Thus, there is an imperative to identify newborns among individuals with diabetes whose newborn will be 4,000–4,499 versus ≥ 4,500 g.
KW - APEX cohort
KW - Birthweight thresholds
KW - Cesarean delivery
KW - Composite outcomes
KW - Gestational diabetes
KW - Macrosomia complications
KW - Maternal morbidity
KW - Neonatal brachial plexus palsy
KW - Perinatal outcomes
KW - Shoulder dystocia
UR - https://www.scopus.com/pages/publications/105011706895
U2 - 10.1016/j.ejogrb.2025.114598
DO - 10.1016/j.ejogrb.2025.114598
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C2 - 40729889
AN - SCOPUS:105011706895
SN - 0301-2115
VL - 313
JO - European Journal of Obstetrics and Gynecology and Reproductive Biology
JF - European Journal of Obstetrics and Gynecology and Reproductive Biology
M1 - 114598
ER -
