Risk factors and adverse pregnancy outcomes associated with large for gestational age infants in pregnant women with type 2 diabetes mellitus.

OBJECTIVE

To investigate the risk factors for delivering large for gestational age (LGA) infants in patients with type 2 diabetes mellitus (T2DM) and their pregnancy outcomes.

METHODS

This was a retrospective cohort study of T2DM patients who registered for regular prenatal care and delivered at the Beijing Obstetrics and Gynecology Hospital from January 1, 2012, to December 31, 2020. Patients were divided into the LGA and non-LGA groups to explore the risk factors and pregnancy outcomes associated with delivering LGA infants in T2DM patients.

RESULTS

(1)A total of 691 T2DM patients were included, of which 257 delivered LGA infants, accounting for 37.19%. (2) Pre-pregnancy body mass index (OR: 1.067, 95%CI: 1.026-1.109), multiparity (OR: 2.455, 95%CI: 1.704-3.538), history of polycystic ovary syndrome (PCOS) (OR: 2.211, 95%CI: 1.283-3.810), late pregnancy glycosylated hemoglobin (HbA1c) (OR: 2.168, 95%CI: 1.567-3.001), gestational weight gain (OR: 1.073, 95%CI: 1.034-1.114), and female newborns (OR: 1.571, 95%CI: 1.109-2.225) were independent risk factors for delivering LGA infants in T2DM patients. (3) After adjusting for pre-pregnancy BMI, multiparity, history of PCOS, gestational weight gain, and late pregnancy HbA1c, delivering LGA infants in T2DM patients increased the risk of postpartum hemorrhage (OR: 1.872, 95%CI: 1.171-2.992), shoulder dystocia (OR: 6.046, 95%CI: 1.767-20.681), admission to the neonatal intensive care unit (OR: 1.542, 95%CI: 1.061-2.242), and neonatal hypoglycemia (OR: 1.991, 95%CI: 1.250-3.170).

CONCLUSION

Strengthening the identification of risk factors, improving pre-pregnancy weight management, ensuring adequate weight gain during pregnancy, and maintaining good glycemic control are important measures for T2DM patients to avoid delivering LGA infants and adverse pregnancy outcomes.