Objective: To determine obstetric outcomes by birthweight (BW) among individuals with and without diabetes mellitus (gestational or pre-existing diabetes) in pregnancy.

Study Design: Retrospective cohort study of singleton, non-anomalous, live births in the U.S. from 2012-2018 registered in the National Vital Statistics System. Infants weighing > 3,000g at 37-42 week gestation were included. BW was stratified into four categories: 3,000-3,999g, 4,000-4,499g, 4,500-4,999g and ≥5,000g. Association of BW with outcomes was examined among women with and without diabetes mellitus (DM) . Chi-squared and multivariable logistic regression analyses were performed for statistical comparisons.

Results: Of 18,397,3deliveries included in this analysis, 6.3% had DM. Higher BW were associated with higher odds of cesarean delivery, maternal blood transfusion, anal sphincter injury, APGAR <7 at 5 minutes, NICU admission, and assisted ventilation. At ≥5,000g, there were higher odds of neonatal seizures and death. Although findings among pregnant persons without DM were similar, the strength of association for most adverse perinatal outcomes was greater among persons with DM.

Conclusion: Fetal macrosomia is associated with significant adverse perinatal outcomes, with even greater odds among deliveries impacted by maternal DM. Prenatal intervention studies to optimize pregnancy health are necessary to improve perinatal outcomes.


K.Fitch: None. A.R.Hersh: None. B.Garg: None. A.M.Valent: None.

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