Fetal overgrowth in women with type 1 and type 2 diabetes mellitus

PLoS One. 2017 Nov 9;12(11):e0187917. doi: 10.1371/journal.pone.0187917. eCollection 2017.


Objectives: Despite improved glycemic control, the rate of large-for-gestational-age (LGA) infants remains high in pregnancies complicated by diabetes mellitus type 1 (T1DM) and type 2 (T2DM). Poor glycemic control, obesity, and excessive gestational weight gain are the main risk factors. The aim of this study was to determine the relative contribution of these risk factors for LGA in women with T1DM and T2DM, after controlling for important confounders such as age, smoking, and parity.

Methods: In this retrospective chart review study, we analyzed the medical files of pregnant women with T1DM and T2DM who attended the antenatal care program at Skåne University Hospital during the years 2006 to 2016. HbA1c was used as a measure of glycemic control. Maternal weight in early pregnancy and at term was registered. LGA was defined as birth weight > 2 standard deviations of the mean. Univariable and multivariable logistic regression analysis was used to calculate odds ratios (OR's) and 95% confidence intervals (CIs) for LGA.

Results: Over the 11-year period, we identified 308 singleton pregnancies in 221 women with T1DM and in 87 women with T2DM. The rate of LGA was 50% in women with T1DM and 23% in women with T2DM. The multivariable regression model identified gestational weight gain and second-trimester HbA1c as risk factors for LGA in T1DM pregnancies (OR = 1.107, 95% CI: 1.044-1.17, and OR = 1.047, 95% CI: 1.015-1.080, respectively) and gestational weight gain as a risk factor in T2DM pregnancies (OR = 1.175, 95% CI: 1.048-1.318), independent of body mass index.

Conclusions: Gestational weight gain was associated with LGA in women with T1DM and T2DM, independent of maternal body mass index. The findings suggest that monitoring and regulation of gestational weight gain is important in the clinical care of these women, to minimize the risk of fetal overgrowth.

MeSH terms

  • Adult
  • Body Mass Index
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Female
  • Fetal Macrosomia / epidemiology*
  • Fetal Macrosomia / etiology
  • Glycated Hemoglobin A / analysis*
  • Humans
  • Odds Ratio
  • Pregnancy
  • Pregnancy Trimester, Second
  • Pregnancy in Diabetics
  • Retrospective Studies
  • Risk Factors
  • Young Adult


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human

Grant support

This study was supported by grants from the research funds of Skåne University Hospital and from the Skåne County Council and Development Foundation.