| Objectives:-To explore the difference between obstetrical characteristics of Gestational Diabetes Mellitus(GDM)and non-GDM mothers.-To observe if any difference in obstetrical characteristics between Chinese and Congolese women who deliver macrosomia infants.-To explore the maternal outcomes of Macrosomia in Chinese and Congolese women-To determine the influence of GDM on the macrosomia infant(Hypoglycemia,cephalo-hematoma,Brachial plexus injury,perinatal mortality)-To Examine if any difference between macrosomia infant from Chinese(GDM and non-GDM mothers)and Congolese(GDM and non-GDM mothers).-To propose some strategies for better management of macrosomiaMethods:This is a retrospective comparative study between women who deliver Macrosomia infant at University hospital and Don Bosco Clinic(Lubumbashi/DR.CONGO)and those from Jinan Central Hospital(Jinan/PR.China)from January 2014 to December 2015.Obstetrics data were obtained from the labor register.Maternal information collected were age,parity,macrosomia antecedents and GDM.Labor event considered was mode of delivery(caesarean sectional emergency or vaginal deliveries).The neonatal information collected were weight of the baby,sex of the baby,Head circumference,Apgar score at 1,at 5 and at 10 minutes.Maternal complications taken into consideration were perineal trauma,postpartum hemorrhage,infection,uterine rupture,Neonatal complication such as hypoglycemia,cephalohematoma,nerve injuries(Brachial plexus palsy)and whether the fetus was alive or dead(perinatal mortality)were also taken into consideration.SPSS software 17.00 version was used for analysis.Results:A total of 87 women(Mean age:32.73 51 ± 5.16 years old)delivered macrocosmic babies at the University Hospital and Don Bosco Clinic of Lubumbashi(DR.Congo)and 32 women(Mean age:30.47± 3.784)delivered in Jinan Central Hospital(PR.China)during the same study period.They were 54%of GDM mothers among Congolese and 62.5%among Chinese.In our study,the frequency of grant multipart(parity of>4)was high in the Congolese group(52.9%).The prevalence of cesarean section was low(29%)in Congolese women while it was high(75%)in Chinese women(X2 = 7.675 and P value = 0.000).Our study shows also that,they were 52,8%of males babies in Congolese and 53.1%of males babies in Chinese,and the weight birth mean in Congolese babies was 4194.22 ± 164.945 gr and 4523.53 ± 423.142 gr in Chinese babies.Comparing the mean birth weight of the Congolese babies,it was observed that infants from GDM mothers have a mean birth weight higher than those with Non-GDM mothers p value equal to 0.001;but the difference in head circumference between infants from GDM mothers and non-GDM mothers was not significant.Also the comparison of the mean birth weight and Head circumference between Chinese infants from GDM and non GDM mothers was not statistically significant(P value more than 0.05).However comparing Apgar means at 1;5 and 10 minute in the two groups of babies(GDM and non-GDM)from Congo as from China,the mean Apgar score was a little high in infants from Non-GDM mothers has compared to those from GDM mothers(P=0.000).This study revealed also that GDM induce hypoglycemia in newborn,the association between GDM and hypoglycemia in the Congolese infant was statistically significant(X2 = 4.252;P=0.001)but there were no association between other fetal outcome(cephalohematoma,perinatal mortality and brachial plexus injury)and GDM in Congolese as in Chinese.This study revealed that only one Congolese woman(1.1%)had infection after delivery,11 Congolese women(12.6%)suffer from post-partum hemorrhage,and one Congolese woman(1.1%)had uterine rupture.Among Congolese women who deliver vaginally 19(21.9%)had perineal trauma,(X2 = 7.675 and P value = 0.000),showing a strong association between perineal trauma and vaginal delivered.However,there was no Chinese woman who suffered from post-partum hemorrhage,infections or uterine rupture.Among Chinese women who delivered vaginally,only 2(25%)had perineal trauma,but it was not statistically significant(P value>0.05).Conclusion:GDM is strongly associated with macrosomia,and induce some complications such as low Apgar,hypoglycemia,high head circumference and weight birth which also induces some maternal complication such as perineal trauma for women who deliver vaginally.Race(Chinese or Congolese)and sex of the babies are to be consider as factors which influence the weight of macrosomia infants.Chinese baby's weight is more than Congolese babies,and males babies also weight more than females babies in both two population groups.Better management of macrosomia should include progressive labor induction and elective caesarean section on the basis of clinical and or ultrasound diagnosis for the suspected macrosomia pregnancy.Glucose control during pregnancy should be increased in order to reduce the risk of hypoglycemia in newborn.Cooperation of gynecologists,pediatricians and dieticians should be enhanced in order to minimize adverse maternal and fetal outcomes. |
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