In pregnancies with gestational diabetes mellitus and intensive therapy, perinatal outcome is worse in small-for-gestational-age newborns


      OBJECTIVE: This study analyzed the relationship between birth weight and perinatal outcome among women with gestational diabetes mellitus.
      STUDY DESIGN: The relationship between perinatal outcome and birth weight was analyzed for 821 pregnancies of women with gestational diabetes mellitus attended in a tertiary hospital and receiving intensive metabolic therapy (normocaloric diet, self-monitoring of blood glucose level and individually tailored insulin regimen when needed). The Mantel-Haenszel test was used to adjust for preterm delivery.
      RESULTS: Seven percent of neonates were small for gestational age, 85% were appropriate for gestational age, and 8% were large for gestational age. After adjustment for preterm delivery the rates of adverse fetal outcome, low 1-minute Apgar score, and hypoglycemia were greater among small for gestational age neonates than among appropriate and large for gestational age infants (odds ratios 3.08, 2.51, and 3.17, respectively).
      CONCLUSION: Among women with gestational diabetes mellitus who are receiving intensive therapy, perinatal outcome is worse for small for gestational age neonates than for appropriate and large for gestational age neonates. (Am J Obstet Gynecol 1998;179:481-5.)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jacobson JD
        • Cousins L.
        A population-based study of maternal and perinatal outcome in patients with gestational diabetes.
        Am J Obstet Gynecol. 1989; 161: 981-986
        • Stenninger E
        • Schollin J
        • Aman J.
        Neonatal macrosomia and hypoglycemia in children of mothers with insulin-treated gestational diabetes mellitus.
        Acta Paediatr Scand. 1991; 80: 1014-1018
        • Sosenko IR
        • Kitzmiller JL
        • Loo SW
        • Blix P
        • Rubenstein A
        • Gabbay KH.
        The infant of diabetic mother: correlation of increased cord C-peptide levels with macrosomia and hypoglycemia.
        N Engl J Med. 1979; 301: 859-862
        • Megía A
        • Luna R
        • López A
        • Grande C
        • Jáñez M
        • Pallardo LF
        Macrosomía fetal en la gestante diabética.
        Av Diabetol. 1991; 4: 43-49
        • Langer O
        • Levy S
        • Brustman L
        • Anyaegbunam A
        • Merkatz R
        • Divon M
        Glycemic control in gestational diabetes mellitus—how tight is tight enough: small for gestational age versus large for gestational age?.
        Am J Obstet Gynecol. 1989; 161: 646-653
        • Driscoll SG
        • Benirschke K
        • Curtis GW.
        Neonatal deaths among infants of diabetic mothers.
        Am J Dis Child. 1960; 100: 818-835
        • National Diabetes Data Group
        Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance.
        Diabetes. 1979; 28: 1039-1057
        • Food and Nutrition Board
        in: Raciones dietéticas recomendadas. Ediciones Consulta SA, Barcelona (Spain):1991: 23-37
        • Durnin JG.
        Energy requirements of pregnancy.
        Diabetes. 1991; 40: 152-156
        • Weiner CP
        • Faustich MW
        • Burns J
        • Fraser M
        • Whitaker L
        • Klugman M.
        Diagnosis of gestational diabetes by capillary blood samples and a portable reflectance meter: derivation of threshold values and prospective validation.
        Am J Obstet Gynecol. 1987; 156: 1085-1089
        • Carr S
        • Coustan DR
        • Martelly P
        • Brosco F
        • Rotondo L.
        Precision of reflectance meters in screening for gestational diabetes.
        Obstet Gynecol. 1989; 73: 727-731
        • Working group on the very low birthweight infant
        European Community collaborative study of outcome of pregnancy between 22 and 28 weeks gestation.
        Lancet. 1990; 336: 782-784
        • Lubchenco LO
        • Hansman C
        • Dressler M
        • Boyd E.
        Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation.
        Pediatrics. 1963; 32: 793-800
        • Cornblath M
        • Reisner SH.
        Blood glucose in the neonate and its clinical significance.
        N Engl J Med. 1965; 273: 378-381
        • Robson AM
        Consideraciones generales sobre la asistencia del niño enfermo: tetania hipocalcémica.
        in: Tratado de pediatría. Interamericana–McGraw-Hill, Madrid (Spain):1992: 254-256
        • Maisels MJ.
        Bilirubin: on understanding and influencing its metabolism in the newborn infant.
        Pediatr Clin North Am. 1972; 19: 447-503
        • Ramamurthy RS
        • Brans YW.
        Neonatal polycythemia I. Criteria for diagnosis and treatment.
        Pediatrics. 1981; 68: 168-173
        • Catlin EA
        • Carpenter MW
        • Brann BS
        • Mayfield SR
        • Shaul PW
        • Goldstein M
        • et al.
        The Apgar score revisited: influence of gestational age.
        J Pediatr. 1986; 109: 865-868
        • Lubchenco LO
        • Bard H.
        Incidence of hypoglycemia in newborn infants classified by birthweight and gestational age.
        Pediatrics. 1971; 47: 831-838
        • Wigton TR
        • Tamura RK
        • Wickstrom E
        • Atkins V
        • Deddish R
        • Socol ML.
        Neonatal morbidity after preterm delivery in the presence of documented lung maturity.
        Am J Obstet Gynecol. 1993; 169: 951-955
        • Friedman L
        • Lewis PJ
        • Clifton P
        • Bulpitt CJ.
        Factors influencing the incidence of neonatal jaundice.
        BMJ. 1978; 2 ([letter]): 1235-1237
        • Hod M
        • Merlob P
        • Friedman S
        • Schoenfeld A
        • Ovadia J.
        Gestational diabetes mellitus: a survey of perinatal complications in the 1980s.
        Diabetes. 1991; 40: 74-78
        • Robinson S
        • Walton RJ
        • Clark PM
        • Barker DJ
        • Hales CN
        • Osmond C.
        The relation of fetal growth to plasma glucose in young men.
        Diabetologia. 1992; 35: 444-446
        • Piper JM
        • Xenakis EM
        • McFarland M
        • Elliott BD
        • Berkus MD
        • Langer O.
        Do growth-retarded premature infants have different rates of perinatal morbidity and mortality than appropriately grown premature infants?.
        Obstet Gynecol. 1996; 87: 169-174
        • Lin YS
        • Chang FM
        • Liu CH.
        Comparison of umbilical blood gas and acid-base status of small-for-dates and normal Chinese newborns.
        J Formos Med Assoc. 1992; 91: 396-399