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Am J Perinatol 2010; 27(8): 603-610
DOI: 10.1055/s-0030-1249362
© Thieme Medical Publishers

Asymmetric Large-for-Gestational-Age Infants of Type 1 Diabetic Women: Morbidity and Abdominal Growth

Sureka Bollepalli1 , Lawrence M. Dolan1 , Menachem Miodovnik2 , Maisa Feghali2 , Jane C. Khoury3
  • 1Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine, Cincinnati, Ohio
  • 2Department of Obstetrics and Gynecology, Professor of Obstetrics and Gynecology, Georgetown University, Washington Hospital Center, Washington, DC
  • 3Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine, Cincinnati, Ohio
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Publication History

Publication Date:
11 March 2010 (online)

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ABSTRACT

We sought to examine neonatal morbidity in four groups of offspring (asymmetric large for gestational age [LGA], symmetric LGA, asymmetric non-LGA, symmetric non-LGA) exposed in utero to maternal type 1 diabetes, and the association between rate of fetal abdominal circumference growth and asymmetric LGA. We performed a secondary analysis of 302 singleton pregnancies. Neonatal morbidity (respiratory distress syndrome, polycythemia, hypoglycemia, hyperbilirubinemia, acidosis, and composite morbidity [any of the five]) was assessed. Serial ultrasound examinations after 20 weeks' gestation were available for 35 fetuses. Logistic regression and general linear mixed modeling were used for analysis. Asymmetric LGA infants had 3.5-, 2.2-, and 3.2-fold greater odds of hypoglycemia, hyperbilirubinemia, and composite morbidity, respectively, compared with symmetric non-LGA infants. The rate of growth of the abdominal circumference in asymmetric LGA infants (1.11 cm/wk) was greater than for both the symmetric LGA infants (0.87 cm/wk, p = 0.09) and the symmetric non-LGA infants (0.87 cm/wk, p = 0.03). Asymmetric LGA infants are at higher risk for morbidity than symmetric LGA and non-LGA infants. Intrauterine growth rate of the abdominal circumference may potentially be used as a marker to identify the asymmetric LGA and thereby aid in the identification of newborns at greatest risk for perinatal complications.

KEYWORDS

Large for gestational age - type 1 diabetes - abdominal circumference - ultrasound

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Sureka BollepalliM.D. 

Division of Endocrinology, Clinical Fellow, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine

MLC 7012, 3333 Burnet Avenue, Cincinnati, OH 45208

Email: surekabollepalli@yahoo.com