TY - JOUR
T1 - Shoulder dystocia in babies born to Aboriginal mothers with diabetes
T2 - A population-based cohort study, 1998–2015
AU - Ahmed, Marwan Awad
AU - Bailey, Helen D.
AU - Pereira, Gavin
AU - White, Scott W.
AU - Wong, Kingsley
AU - Marriott, Rhonda
AU - Hare, Matthew J.L.
AU - McNamara, Bridgette J.
AU - Shepherd, Carrington C.J.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/12
Y1 - 2024/12
N2 - Background Australian Aboriginal and Torres Strait Islander women with diabetes in pregnancy (DIP) are more likely
to have glycaemic levels above the target range, and their babies are thus at higher risk of excessive fetal growth.
Shoulder dystocia, defned by failure of spontaneous birth of fetal shoulder after birth of the head requiring obstetric maneuvers, is an obstetric emergency that is strongly associated with DIP and fetal size. The aim of this study
was to investigate the epidemiology of shoulder dystocia in Aboriginal babies born to mothers with DIP. Methods Stratifying by Aboriginal status, characteristics of births complicated by shoulder dystocia in women
with and without DIP were compared and incidence and time-trends of shoulder dystocia were described. Compliance with guidelines aiming at preventing shoulder dystocia in women with DIP were compared. Post-logistic regression estimation was used to calculate the population attributable fractions (PAFs) for shoulder dystocia associated
with DIP and to estimate probabilities of shoulder dystocia in babies born to mothers with DIP at birthweights>3 kg. Results Rates of shoulder dystocia from vaginal births in Aboriginal babies born to mothers with DIP were double that of their non-Aboriginal counterparts (6.3% vs 3.2%, p<0.001), with no improvement over time. Aboriginal
mothers with diabetes whose pregnancies were complicated by shoulder dystocia were more likely to have a history
of shoulder dystocia (13.1% vs 6.3%, p=0.032). Rates of guideline-recommended elective caesarean section in pregnancies with diabetes and birthweight>4.5 kg were lower in the Aboriginal women (28.6% vs 43.1%, p=0.004). PAFs
indicated that 13.4% (95% CI: 9.7%-16.9%) of shoulder dystocia cases in Aboriginal (2.7% (95% CI: 2.1%-3.4%) in nonAboriginal) women were attributable to DIP. Probability of shoulder dystocia among babies born to Aboriginal mothers with DIP was higher at birthweights>3 kg. Conclusions Aboriginal mothers with DIP had a higher risk of shoulder dystocia and a stronger association
between birthweight and shoulder dystocia. Many cases were recurrent. These factors should be considered in clinical
practice and when counselling women.
AB - Background Australian Aboriginal and Torres Strait Islander women with diabetes in pregnancy (DIP) are more likely
to have glycaemic levels above the target range, and their babies are thus at higher risk of excessive fetal growth.
Shoulder dystocia, defned by failure of spontaneous birth of fetal shoulder after birth of the head requiring obstetric maneuvers, is an obstetric emergency that is strongly associated with DIP and fetal size. The aim of this study
was to investigate the epidemiology of shoulder dystocia in Aboriginal babies born to mothers with DIP. Methods Stratifying by Aboriginal status, characteristics of births complicated by shoulder dystocia in women
with and without DIP were compared and incidence and time-trends of shoulder dystocia were described. Compliance with guidelines aiming at preventing shoulder dystocia in women with DIP were compared. Post-logistic regression estimation was used to calculate the population attributable fractions (PAFs) for shoulder dystocia associated
with DIP and to estimate probabilities of shoulder dystocia in babies born to mothers with DIP at birthweights>3 kg. Results Rates of shoulder dystocia from vaginal births in Aboriginal babies born to mothers with DIP were double that of their non-Aboriginal counterparts (6.3% vs 3.2%, p<0.001), with no improvement over time. Aboriginal
mothers with diabetes whose pregnancies were complicated by shoulder dystocia were more likely to have a history
of shoulder dystocia (13.1% vs 6.3%, p=0.032). Rates of guideline-recommended elective caesarean section in pregnancies with diabetes and birthweight>4.5 kg were lower in the Aboriginal women (28.6% vs 43.1%, p=0.004). PAFs
indicated that 13.4% (95% CI: 9.7%-16.9%) of shoulder dystocia cases in Aboriginal (2.7% (95% CI: 2.1%-3.4%) in nonAboriginal) women were attributable to DIP. Probability of shoulder dystocia among babies born to Aboriginal mothers with DIP was higher at birthweights>3 kg. Conclusions Aboriginal mothers with DIP had a higher risk of shoulder dystocia and a stronger association
between birthweight and shoulder dystocia. Many cases were recurrent. These factors should be considered in clinical
practice and when counselling women.
KW - Aboriginal
KW - Diabetes in pregnancy
KW - Shoulder dystocia
UR - http://www.scopus.com/inward/record.url?scp=85194994258&partnerID=8YFLogxK
U2 - 10.1186/s12884-024-06484-1
DO - 10.1186/s12884-024-06484-1
M3 - Article
C2 - 38816708
AN - SCOPUS:85194994258
SN - 1471-2393
VL - 24
SP - 1
EP - 11
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
IS - 1
M1 - 395
ER -