In Pregnancy Issues and Concerns

Close on the heels of the previous study comes a Medscape report on a study of the effects of a  large-for-gestational-age (LGA) diagnosis, meaning the baby’s estimated weight is in the upper 10% for that week of pregnancy, in women with gestational diabetes (GD) . Only 23% of the 248 women with an LGA diagnosis had an LGA baby and only 17% of those women had a baby weighing more than 4000 g (8 lb 13 oz). Compared with estimated appropriate-for-gestational-age babies (AGA) (655 women), the LGA diagnosis increased:

  • term delivery before 39 completed weeks (58% vs. 38%)
  • cesarean rate (44% vs. 21%)
  • cesarean rate in 1st-time mothers (61% vs. 29%)
  • cesarean rate in women with prior births and no prior cesarean (22% vs. 8%)
  • planned cesarean rate (22% vs. 3%)

After adjustment for correlating factors, the LGA diagnosis tripled the likelihood of cesarean delivery regardless of the actual weight of the baby.

None of this did mothers or babies any good. The excess use of intervention failed to reduce adverse outcomes associated with large babies, including maternal anal sphincter tear rates (2% in both LGA and AGA), newborn admission to intensive care (7% LGA vs. 8% AGA), or shoulder dystocia (3% vs. 2%).

Teaser: One of CBU’s lectures will definitely be “Gestational Diabetes: Is the Cure Worse Than the Disease?” in which I will argue that the answer is “yes” for almost all women. If you want a sneak preview, Peaceful Parenting has an article I wrote in 1996 for the Birth Gazette, now long gone, in its archives. 

 

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