SEQUELAE OF UNRECOGNIZED GESTATIONAL DIABETES

OBJECTIVE: Prior studies have suggested that macrosomia is the only mo rbid condition associated with gestational diabetes and that this asso ciation is the result of confounding by maternal obesity rather than a result of gestational diabetes itself. We sought to determine whether unrecognized gestational diabetes is an independent predictor of macr osomia and other perinatal morbid conditions after controlling for con founding variables. STUDY DESIGN: A retrospective analysis of 472 cons ecutive cases of gestational diabetes diagnosed between 24 and 30 week s' gestation was undertaken including 16 prospectively identified but clinically unrecognized cases, 297 cases treated with diet alone, and 76 treated with diet plus insulin. Unrecognized cases were matched to 64 nondiabetic controls for race, age, body mass index, parity, pregna ncy weight gain, and gestational age at delivery. RESULTS: In the unre cognized gestational diabetes group versus the nondiabetic control ver sus gestational diabetes diet groups rates of large for gestational ag e infants (44% vs 5% vs 9%, p<0.0005), macrosomia (44% vs 8% vs 15%, p <0.01) were all significantly increased. These differences remained si gnificant after controlling for maternal age, race, parity, body mass index, pregnancy weight gain, and gestational age at delivery. CONCLUS IONS: This study suggests that unrecognized gestational diabetes incre ases risks of large for gestational age infants, macrosomia, shoulder dystocia, and birth trauma independent of maternal obesity and other c onfounding variables. Clinical recognition and dietary control of gest ational diabetes are associated with a reduction in these perinatal mo rbid conditions.