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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 1

(259) Fetal growth trajectories in pregnancies complicated by type 2 diabetes

Thursday, January 30, 2025
10:30 AM – 12:30 PM  
Objective: We evaluated factors associated with small for gestational age (SGA) and large for gestational age (LGA) birth weight and ultrasound growth trajectories to better understand fetal growth among pregnancies with type 2 diabetes (T2DM). 

Study Design: We conducted a retrospective cohort study of individuals with T2DM and a singleton gestation between 2018-2020 who had biometry measured between 16-23 weeks gestation. Maternal demographics, clinical factors, and serial ultrasound measurements were abstracted from the electronic health record. Birth weight was classified as small for gestational age (SGA), large for gestational age (LGA), and appropriate for gestational age (AGA) using a US birth weight standard. Multinomial logistic regression was used to assess the relationship between maternal characteristics and newborn birth weight category. Covariance pattern models with linear and quadratic terms were used to assess differences in fetal growth trajectories.  

Results: LGA birth weight occurred in 81/300 (27%) and SGA birth weight in 25/300 (8.3%). After adjustment for covariates, a higher BMI at the first prenatal visit (aOR 0.91, 95% CI 0.83-0.99) and higher maternal weight gain across gestation (aOR 0.88, 95% CI 0.79-0.98) were associated with reduced risk for SGA birth weight, and a higher HbA1c after 20 weeks’ gestation was associated with increased risk for LGA birth weight (aOR 1.41, 95% CI 1.06-1.87). In the mid-trimester, the EFW was higher in LGA birth weight infants compared to those born AGA, but there were no differences between those born AGA and SGA. EFW trajectories differed significantly over time by birth weight categories (Figure 1). Similar patterns were seen for the abdominal circumference, with no differences in head circumference and femur length either at baseline or over time.  

Conclusion: Patterns of fetal overgrowth in pregnancies complicated by T2DM are established in early pregnancy. Further studies are needed to assess whether interventions to improve maternal glycemia in the second half of pregnancy can reduce the risk for LGA birth weight.