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Am J Perinatol 2023; 40(09): 929-936
DOI: 10.1055/s-0043-1764206
SMFM Fellowship Series Article

Association between Diabetes in Pregnancy and Shoulder Dystocia by Infant Birth Weight in an Era of Cesarean Delivery for Suspected Macrosomia

Mahmoud Abdelwahab
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Heather A. Frey 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Courtney D. Lynch
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
2   Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
,
Mark A. Klebanoff
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
2   Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
,
Stephen F. Thung
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Maged M. Costantine 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Mark B. Landon
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Kartik K. Venkatesh 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
› Institutsangaben
Funding This study was supported by the Intramural Research Program of the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The Consortium on Safe Labor was funded by the Intramural Research Program of the NICHD, through Contract No. HHSN267200603425C. The study was funded by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Intramural investigators designed the study and data were collected by clinical site investigators. The corresponding author has full access to the data and final responsibility for preparation and submission of the paper for publication. K.K.V. was supported by the Care Innovation and Community Improvement Program at The Ohio State University.
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Abstract

Objective We estimated the association between diabetes and shoulder dystocia by infant birth weight subgroups (<4,000, 4,000–4,500, and >4,500 g) in an era of prophylactic cesarean delivery for suspected macrosomia.

Study Design A secondary analysis from the National Institute of Child Health and Human Development U.S. Consortium for Safe Labor of deliveries at ≥24 weeks with a nonanomalous, singleton fetus with vertex presentation undergoing a trial of labor. The exposure was either pregestational or gestational diabetes compared with no diabetes. The primary outcome was shoulder dystocia and secondarily, birth trauma with a shoulder dystocia. We calculated adjusted risk ratios (aRRs) with modified Poison's regression between diabetes and shoulder dystocia and the number needed to treat (NNT) to prevent a shoulder dystocia with cesarean delivery.

Results Among 167,589 assessed deliveries (6% with diabetes), pregnant individuals with diabetes had a higher risk of shoulder dystocia at birth weight <4,000 g (aRR: 1.95; 95% confidence interval [CI]: 1.66–2.31) and 4,000 to 4,500 g (aRR: 1.57; 95% CI: 1.24–1.99), albeit not significantly at birth weight >4,500 g (aRR: 1.26; 95% CI: 0.87–1.82) versus those without diabetes. The risk of birth trauma with shoulder dystocia was higher with diabetes (aRR: 2.29; 95% CI: 1.54–3.45). The NNT to prevent a shoulder dystocia with diabetes was 11 and 6 at ≥4,000 and >4,500 g, versus without diabetes, 17 and 8 at ≥4,000 and >4,500 g, respectively.

Conclusion Diabetes increased the risk of shoulder dystocia, even at lower birth weight thresholds than at which cesarean delivery is currently offered. Guidelines providing the option of cesarean delivery for suspected macrosomia may have decreased the risk of shoulder dystocia at higher birth weights.

Key Points

  • >Diabetes increased the risk of shoulder dystocia, even at lower birth weight thresholds than at which cesarean delivery is currently offered.

  • Cesarean delivery for suspected macrosomia may have decreased the risk of shoulder dystocia at higher birth weights.

  • These findings can inform delivery planning for providers and pregnant individuals with diabetes.

Keywords

diabetes - gestational diabetes - pregnancy - shoulder dystocia - birth trauma - birth weight

Note

This manuscript will be presented as a poster presentation (poster no.: 600) at the Society for Maternal Fetal Medicine Annual Meeting, February, 2022.


Authors' Contributions

M.A., M.B.L., C.D.L., and K.K.V. conceived of the study. Data collection and interpretation was conducted by M.A., H.A.F., C.D.L., M.A.K., S.F.T., M.M.C., and K.K.V. Data analysis was conducted by C.D.L., M.A.K., and K.K.V.




Publikationsverlauf

Eingereicht: 25. März 2022

Angenommen: 24. Januar 2023

Artikel online veröffentlicht:
27. Februar 2023

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