Risk factors associated with altered fetal growth in patients with pregestational diabetes mellitus

Abstract

Objective: To assess the risk factors for abnormal fetal growth in patients with pregestational diabetic mellitus (DM). Methods: A retrospective study was performed in 336 patients with pregestational DM. Small-for-gestational-age (SGA) and large-for-gestational-age (LGA) infants were defined as newborns with birth weights < 10th percentile and > 90th percentile, respectively. Logistic regression analysis was performed to identify risk factors for SGA and LGA. Results: Multivariate analysis of the patients with pregestational DM revealed a significant difference between patients who delivered SGA and appropriate-for-gestational-age (AGA) infants in terms of retinopathy (OR = 5.73, 95%CI = 1.39–23.59) and hemoglobin A1C (HbA1C) before delivery (OR = 0.80, 95%CI = 0.68 – 0.94, with a 0.1% increase in DCCT unit). Multivariate analysis revealed a significant difference between patients who delivered LGA and AGA infants in terms of primipara (OR = 3.40, 95%CI = 1.47–7.87) and HbA1C before delivery (OR = 1.14, 95%CI = 1.07–1.21, with a 0.1% increase in DCCT unit). Conclusions: HbA1C before delivery influenced both SGA and LGA infants in patients with pregestational DM. Tight glycemic control might be harmful to fetal growth in pregestational diabetic patients, especially when complicated with retinopathy.

Keywords::

• Pregestational diabetes mellitus
• fetal growth
• retinopathy
• hemoglobin A1C

We thank Mr Sugimoto for kindly providing analyses of the database.

Declaration of Interest: The authors declare no conflicts of interest.