Cesarean Section Indication and Perinatal Outcomes of Infants With Macrosomia in Primiparous Women: A Retrospective Cohort Study

Background: This study aims to investigate the delivery modes, indications for cesarean section, and perinatal outcomes of infants with macrosomia in primiparous women, with a particular focus on those with gestational hyperglycemia who have achieved satisfactory glycemic control, as well as those with normal blood glucose levels. Methods: A retrospective cohort study was conducted in 269 primiparous women with infants affected with macrosomia at Haidian Maternal and Child Health Hospital in Beijing (2022–2024). These women had no prior history of uterine surgery, breech presentation, placenta previa, or any other conditions that would necessitate a cesarean section. The participants were categorized into two groups based on their blood glucose levels: a hyperglycemic group consisting of 107 cases (after excluding 2 cases due to inadequate blood glucose control) and a normal blood glucose group with 160 cases. This study compared various factors between the two groups, including basic demographic information, mode of delivery, reasons for the cesarean sections, and any complications that arose during delivery. Primary outcomes included cesarean section rates and perinatal outcomes. Results: The cesarean section rate was notably higher in the hyperglycemic group compared to those with normal blood glucose levels, while the rate of vaginal deliveries, including those assisted by forceps, was lower in the hyperglycemic group. This difference in delivery methods was statistically significant (χ2 = 4.132; p < 0.05). Additionally, within the hyperglycemic group, babies born via cesarean section due to fetal macrosomia had a significantly greater birth weight than those delivered vaginally (Z = 3.500; p < 0.05). A similar trend was observed in the normal blood glucose group, where cesarean section deliveries also resulted in higher birth weights compared to vaginal deliveries (Z = 3.750; p < 0.05). Furthermore, the hyperglycemic group exhibited a higher incidence of shoulder dystocia and intrapartum fever compared to the normal blood glucose group, with these differences being statistically significant (p < 0.05). Conclusions: For primiparous women with infants who possessed macrosomia, the cesarean section rate in the hyperglycemic group was higher than that in the normal blood glucose group, and the incidence of shoulder dystocia in the hyperglycemic group was higher than that in the normal blood glucose group. Therefore, using a fetal weight of ≥4150–4190 g as the cesarean section indication for macrosomia is recommended, whether for pregnant women with normal blood glucose levels or those with gestational hyperglycemia who have good blood glucose control.