Potential modifiable risk factors for macrosomia in patients with gestational diabetes mellitus

PATIENTS WITH GESTATIONAL DIABETES MELLITUS K. JENNIFER VOSS, JUDITH CHUNG, PAMELA RUMNEY, KIRK KEEGAN, CAROL MAJOR, University of California, Irvine, Obstetrics & Gynecology, Orange, CA Long Beach Memorial Medical Center, Obstetrics & Gynecology, Long Beach, CA OBJECTIVE: Treatment of patients with gestational diabetes mellitus has not necessarily been shown to reduce the risk of macrosomia in this population. This study evaluates the contribution of potentially modifiable interventions that may help to reduce the risk of macrosomia in gestational diabetics. STUDY DESIGN: A retrospective cohort study (June 2001-December 2002) was performed using data from the California Department of Health Services, Maternal Child Health Branch, and the California Diabetes and Pregnancy Program Data System (the system collects data from all patients referred to the California Sweet Success Program). Logistic regression was performed to estimate the odds of macrosomia, defined as >4000 grams. The following factors were evaluated in the multivariate model: ethnicity, parity, education, gestational age at delivery, maternal weight, and the interaction between ethnicity and preferred language. RESULTS: Of 8790 patients, there were 6406 gestational diabetics that met inclusion criteria. The incidence of macrosomia was 11.6%. Ethnicity, preferred language, and the interaction of ethnicity and preferred language did not appear to be predictive of macrosomia. However, when compared to patients with a college education ormore, the odds ofmacrosomia in patients with a high school education were 1.53 (95% CI 1.24-1.90). In patients with less than a high school education, the odds were 1.79 (95% CI 1.34-2.38). CONCLUSION:Gestational diabetics with a lower level of education appear to have an increased risk of macrosomia. Interventions directed towards improving communication and knowledge of the disease process in such patients may prove to be beneficial. (This analysis, interpretation, and conclusion are that of the authors and not of the California Department of Health Services, Maternal Child Health Branch, or the California Diabetes and Pregnancy Program).