Fetal macrosomia greater than or equal to 4000 grams. Comparing maternal and neonatal outcomes in diabetic and nondiabetic women.

OBJECTIVE To compare maternal and neonatal outcomes of fetal macrosomia in diabetic and nondiabetic women. METHODS A retrospective case-control study was conducted at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia from January 2004 to December 2006. A total of 766 macrosomic newborns met the inclusion criteria. We compared maternal and neonatal characteristics and outcomes between diabetic (group 1, n=207) and nondiabetic (group 2, n=559) women. RESULTS There were significantly more macrosomic newborns in nondiabetic women; 73% versus 27% in diabetic women, p=0.0001. Cesarean deliveries were significantly higher in diabetic women compared to nondiabetic women (30.4% versus 19.5%, p=0.002). There were no significant differences between either group in total maternal morbidity (12.6% versus 14.1%, p=0.7). There were significantly more severe cases of shoulder dystocia occurring in newborns of diabetic women compared to nondiabetic women (1.9% versus 0.2%, p=0.03). CONCLUSION Elective cesarean delivery for estimated fetal weight > or =4500g for nondiabetic women and > or =4250 g for diabetic women may avoid severe shoulder dystocia without increasing maternal morbidity rates.