ABSTRACT
Macrosomic infants still suffer birth trauma in excess of the general population;
thus, while debated, the medical and legal sequelae of macrosomia appear to be costly.
The clinical role of maternal hyperglycemia below the threshold for the diagnosis
of gestational diabetes (GDM) in the etiology of macrosomia remains an area of controversy.
Based on the hypothesis that increasing glucose levels result in an increasing prevalence
of macrosomia, we designed a study to observe the impact on birth weight and on cost
of a treatment program for glucose-intolerant pregnant women in The Santa Barbara
County Health Care Services (SBCHCS). In 1985, 18% of 4364 births (85% Mexican-American
in origin) in the SBCHCS were >90th percentile birth weight. In 1986, we began a program
to treat all glucose-intolerant pregnant women who had a positive glucose challenge
test (GCT > 140 mg/dL after a 50-g oral glucose load), even if they had a negative
glucose tolerance test. All glucose-tolerant pregnant women were placed on a 40% carbohydrate,
1800 kcal diet and taught to monitor their blood glucose. Insulin was begun if the
fasting blood glucose was >90 mg/dL and/or the 1-hour post meal was >120 mg/dL. After
introduction of the screening/ treatment program, the prevalence of macrosomia in
1992 was 7% and the cesarean section rate had dropped from 30 to 20%. The cost to
SBCHC to educate and treat the additional glucose-intolerant women was $233,650. Assuming
that there would have been an additional 398 macrosomic infants with some requiring
cesarean delivery and intensive care, total potential savings could be estimated at
$833,870 per year. Thus, treatment of glucose-intolerant pregnant women was associated
with a decrease in macrosomia and may be cost-effective.
Keywords
Gestational diabetes mellitus - glucose intolerance - impaired glucose tolerance -
screening - macrosomia
