Association between Sonographic Estimated Fetal Weight and the Risk of Cesarean Delivery among Nulliparous Women with Diabetes in Pregnancy

Am J Perinatol. 2018 Nov;35(13):1297-1302. doi: 10.1055/s-0038-1649482. Epub 2018 May 4.


Objective: The objective of this study was to examine the association between an ultrasound-estimated fetal weight (US-EFW) and mode of delivery among nulliparous diabetic women.

Study design: This is a retrospective cohort study of nulliparous women with medication-requiring gestational or pregestational diabetes who delivered term, singleton gestations following a trial of labor. We determined whether having had an US-EFW within 35 days of delivery was associated with cesarean delivery.

Results: Of 304 women who met the eligibility criteria, 231 (76.0%) had an US-EFW within 35 days of delivery. An US-EFW was associated with increased likelihood of intrapartum cesarean (51.5% for those with an ultrasound vs. 27.4% for those without, p < 0.001); this finding persisted even when controlling for birth weight and other confounding factors (adjusted odds ratio: 2.23, 95% confidence interval: 1.16-4.28). Among women with a recent US-EFW, a diagnosis of a large-for-gestational-age (LGA) fetus was associated with overall intrapartum cesarean frequency (65.2% for women with an LGA fetus vs. 46.1% for those without, p = 0.009), but this association did not remain significant in multivariable models.

Conclusion: An US-EFW within 35 days of delivery among nulliparous women with medication-requiring diabetes was positively associated with intrapartum cesarean delivery.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cesarean Section* / methods
  • Cesarean Section* / statistics & numerical data
  • Correlation of Data
  • Diabetes, Gestational* / drug therapy
  • Diabetes, Gestational* / epidemiology
  • Diabetes, Gestational* / physiopathology
  • Female
  • Fetal Macrosomia* / diagnosis
  • Fetal Macrosomia* / epidemiology
  • Fetal Macrosomia* / etiology
  • Fetal Weight*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Labor, Induced / methods
  • Labor, Induced / statistics & numerical data
  • Parity
  • Pregnancy
  • Pregnancy in Diabetics* / drug therapy
  • Pregnancy in Diabetics* / epidemiology
  • Pregnancy in Diabetics* / physiopathology
  • Risk Assessment
  • Ultrasonography, Prenatal / methods
  • United States / epidemiology


  • Hypoglycemic Agents