(510) Dysglycemia Phenotypes in Pregnancy and the Risk of Fetal Shoulder Dystocia at Birth

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Jasmine Hitt, MD (she/her/hers)

Resident
University of Maryland Department of OBGYN
Baltimore, Maryland, United States

Coauthor(s)

Eric K. BRONI, MD, MPH (he/him/his)

Postdoctoral Research Fellow
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA, United States
MS

Maria Som, BS

University of Maryland School of Medicine
Baltimore, Maryland, United States
CS

Cassandra Seifert, BS

University of Maryland School of Medicine
Baltimore, Maryland, United States
MB

May Blanchard, MD

University of Maryland Department of OBGYN
Baltimore, Maryland, United States

Objective: Maternal diabetes is a well-established risk factor for fetal shoulder dystocia (ShD). However, data on the differential risk of ShD among women with dysglycemia subtypes in pregnancy are scarce. We evaluated whether the risk of fetal ShD differs by maternal dysglycemia subtype.

Study Design: We investigated 202 mothers who delivered infants with ShD and 747 randomly selected controls from a cohort of women who received antenatal care at an urban, tertiary medical center from 2012- 2023. Maternal dysglycemia phenotypes include [Type 1 diabetes (T1D), Type 2 diabetes (T2D), Gestational diabetes controlled by diet and exercise (GDMA1), Gestational diabetes requiring hypoglycemic agents (GDMA2)], Elevated 1-hour GCT without 3-hour GTT (E1GCT) and Elevated 1-hour GCT with normal 3-hour GTT (E1N3GTT). We used adjusted logistic regression models to estimate the risk of infant ShD among women in the different dysglycemia subgroups.

Results: Pregnant women who had infants with ShD were younger (27 vs 31 years, p< 0.001), more likely to be Black (72.8% vs 46.5%), delivered at later gestational age (39.3 vs 38.4 wks, p< 0.001), were more likely to have vaginal delivery (96% vs 53%, p< 0.001) and a history of smoking (17.3% vs 7.4%) Table 1. Compared to pregnant women with normoglycemia, those with E1GCT had a 4.4-fold [aOR, 4.35 (1.23 – 15.45)] higher risk of delivering an infant with ShD, even after controlling for maternal age, gestational age at delivery, race/ethnicity, parity, mode of delivery, prior delivery with ShD. Similarly, those with T2D had a 2.6-fold [aOR, 2.62 (1.19 – 5.75)] higher odds of delivering an infant with ShD. Additionally, women with E1N3GTT had a 3.4-fold [aOR, 3.36 (1.33-8.44)] higher odds of delivering an infant with ShD. Table 2.

Conclusion: Different dysglycemia phenotypes in pregnancy are independently associated with a higher risk of shoulder dystocia at birth. Continuous surveillance of pregnant women with dysglycemia, especially those with T2D and elevated 1-hour GCT (± 3-hour GTT), will reduce the risk of fetal shoulder dystocia and concomitant perinatal complications.