Fetal macrosomia greater than or equal to 4000 grams. Comparing maternal and neonatal outcomes in diabetic and nondiabetic women

OBJECTIVE: To compare maternal and neonatal outcomes of fetal macrosomia in diabetic and nondiabetic women.

METHODS: A retrospective case-control study was conducted at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia from January 2004 to December 2006. A total of 766 macrosomic newborns met the inclusion criteria. We compared maternal and neonatal characteristics and outcomes between diabetic (group 1, n=207) and nondiabetic (group 2, n=559) women.

RESULTS: There were significantly more macrosomic newborns in nondiabetic women; 73% versus 27% in diabetic women, p=0.0001. Cesarean deliveries were significantly higher in diabetic women compared to nondiabetic women (30.4% versus 19.5%, p=0.002). There were no significant differences between either group in total maternal morbidity (12.6% versus 14.1%, p=0.7). There were significantly more severe cases of shoulder dystocia occurring in newborns of diabetic women compared to nondiabetic women (1.9% versus 0.2%, p=0.03).

CONCLUSION: Elective cesarean delivery for estimated fetal weight >/=4500g for nondiabetic women and >/=4250 g for diabetic women may avoid severe shoulder dystocia without increasing maternal morbidity rates.