Downloaded from http://journals.lww.com/greenjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 05/08/2022 Anthropometric Parameters in Infants of Gestational Diabetic Women With Strict Glycemic Control Raed Salim, MD, Jamal Hasanein, MD, Zohar Nachum, MD, and Eliezer Shalev, MD OBJECTIVE: Differences in weight and body composition have been reported between infants of nondiabetic and diabetic mothers. These differences may explain the pro- pensity for shoulder dystocia in the diabetic population. We investigated whether differences in anthropometric measurements still exist between infants of nondiabetic and diabetic mothers following strict glycemic control. METHODS: This was a prospective cohort study. The study group included infants of well-controlled gestational dia- betic mothers (mean capillary glucose less than 100 mg/ dL). Controls were infants of nondiabetic mothers matched for gender, gestational age, ethnicity, and birth weight. Only singleton term pregnancies were included. Both groups were studied within 24 hours of delivery. The following measurements were obtained: birth weight, in- fant length, femur length, head, chest, abdomen and thigh circumferences, and biacromial distance. Student t tests were used to compare the measured parameters between groups. P < .05 was considered significant. A sample size of 63 subjects in each group was needed to demonstrate a difference of 0.5 cm ( 1.0 cm) of the biacromial distance between the 2 groups, which we considered clinically sig- nificant, with a probability of 95% and power of 80%. RESULTS: Sixty seven infants in each group were included in the study. Anthropometric measurements did not differ significantly between the groups. We did a secondary anal- ysis on neonates who weighed 4,000 g or more at birth. Anthropometric measurements again did not differ signif- icantly between the groups. CONCLUSION: Anthropometric measurements of infants of mothers with well-controlled gestational diabetes do not differ from infants of nondiabetic mothers. (Obstet Gy- necol 2004;104:1021– 4. © 2004 by The American College of Obstetricians and Gynecologists.) LEVEL OF EVIDENCE: II-2 Diabetes mellitus complicates approximately 4% of all pregnancies. Gestational diabetes mellitus (GDM) repre- sents approximately 90% of all cases, and pregestational diabetes mellitus accounts for the remaining 10%. 1 The risk of neonatal morbidity increases greatly if hypergly- cemia is left untreated. Because glucose crosses the pla- centa rapidly, even mild degrees of maternal hypergly- cemia can cause fetal hyperglycemia. The fetal pancreas responds by increasing production and release of insulin. Fetal hyperinsulinism stimulates fetal growth, causing macrosomia. It can also cause neonatal hypoglycemia and respiratory distress syndrome. 2 Diabetic women diagnosed with a macrosomic infant are more likely to have a cesarean delivery or difficult vaginal delivery. 2 McFarland et al 3 reported that macrosomic infants of diabetic mothers were characterized by larger shoulder and a decreased head-to-shoulder ratio than nondiabetic control infants of similar birth weight and birth length. Differences in body composition and weight distribution may explain the propensity for shoulder dystocia and the lower threshold used for estimated fetal weight in the diabetic population compared with nondiabetic for rec- ommending delivery by cesarean. In recent years there has been a significant improvement in perinatal outcome in pregnancies complicated by diabetes. This improve- ment is attributed to better understanding of pregnancy- related changes in diabetes and the effect of the glycemic control on fetal and maternal outcome. Our specific aim in this prospective study was to investigate whether anthropometric measurements still differ between in- fants of nondiabetic and diabetic mothers following strict glycemic control. MATERIALS AND METHODS The study was performed prospectively at the depart- ment of obstetrics and gynecology and the neonatology unit at Ha’Emek Medical Center between 2002 and 2003. Diabetic women were recruited from our high-risk diabetic clinic, which treats approximately 120 diabetic patients annually. The study group included infants of women with gestational diabetes. Only singleton term pregnancies were included. Controls were infants of nondiabetic healthy mothers who had normal (less than 140 mg/dL) 50 gram, 1 hour glucose challenge tests. In the controls, GDM was diagnosed by an abnormal 50 From the Ha’Emek Medical Center, Obstetrics and Gynecology, Afula; Ha’Emek Medical Center, Neonatology Unit, Afula; and Rappaport Faculty of Medicine, Technion, Haifa, Israel. VOL. 104, NO. 5, PART 1, NOVEMBER 2004 1021 © 2004 by The American College of Obstetricians and Gynecologists. 0029-7844/04/$30.00 Published by Lippincott Williams & Wilkins. doi:10.1097/01.AOG.0000143821.00194.ad