DOI: 10.1097/AOG.0b013e3182176774

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Issn Print: 0029-7844

Publication Date: 2011/05/01


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The Relationship Between Maternal Glycemia and Perinatal Outcome

Jim Greenberg

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In the recent study by Landon et al,1 the authors seem intent on demonstrating the ill effects of maternal glycemia on newborns even though their data do not clearly support that contention. I believe using the phrase “perinatal morbidity” requires authors to choose only those conditions that are, in themselves, significantly deleterious to the health of a neonate. In my opinion, examples of acceptable conditions that qualify as perinatal morbidity include stillbirth, perinatal mortality, asphyxia, and brachial plexus injury. Hyperbilirubenia might make the list, but hypoglycemia and hyperinsulinemia have no place being grouped with the first category because they are transient and easily treated in the newborn period. Shoulder dystocia is an obstetric diagnosis that, in itself, is not a condition that ever should be grouped into perinatal morbidity. Similarly, “large for gestational age” is a description but not, in itself, a morbid condition.
Although I do not discount the large body of data that suggest that maternal glycemia may have significant implications for the long-term health of children and mothers (particularly as it relates to adult-onset diabetes), I also believe it is important to be clearer about the exact nature of those health implications so that practitioners can counsel their patients appropriately about the need for interventions vis-à-vis maternal glycemic control, especially when we are aware that labeling a patient with a diagnosis can lead to more interventions and worse outcomes.2
Is it likely that there is a continuous relationship between maternal hyperglycemia and birth weight? Yes. Does maternal hyperglycemia represent a complex metabolic disorder that likely has considerable implications for future health? Yes. Are we all in agreement that good outcomes are preferable to adverse outcomes? Yes. But determining where cutoffs should be placed and what criteria of cost and benefit we use seem worthy enough topics of investigation within this context without the need for trumped-up charges about “perinatal morbidity.” In a world of exploding health care costs and rising cesarean delivery rates, I believe it is essential to define the ill effects we are preventing before we create new interventions based solely on the specter of adverse outcomes.
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