Macrosomia Risk Factors and Perinatal Outcomes: A 1-year Cohort Study

Merita Isaku; Enxhi Vrapi; Ina Cala; Kizjona Perdja; Astrit Bimbashi

doi:10.3889/oamjms.2023.11396

Authors

Merita Isaku Department of Obstetrics and Gynecology, S.U.O.GJ “Koco Gliozheni”, Tirana, Albania https://orcid.org/0000-0001-9629-3087
Enxhi Vrapi Department of Obstetrics and Gynecology, S.U.O.GJ “Koco Gliozheni”, Tirana, Albania https://orcid.org/0000-0002-2767-5599
Ina Cala Department of Obstetrics and Gynecology, S.U.O.GJ “Koco Gliozheni”, Tirana, Albania https://orcid.org/0000-0003-2044-2263
Kizjona Perdja Department of Obstetrics and Gynecology, S.U.O.GJ “Koco Gliozheni”, Tirana, Albania https://orcid.org/0000-0002-0810-6112
Astrit Bimbashi Department of Obstetrics and Gynecology, S.U.O.GJ “Koco Gliozheni”, Tirana, Albania https://orcid.org/0000-0002-1498-7497

DOI:

https://doi.org/10.3889/oamjms.2023.11396

Keywords:

Macrosomia Risk Factors, Perinatal Outcomes, One-Year Cohort Study

Abstract

AIM: This study aims to identify possible risk factors and concurrently investigates how macrosomia impacts mothers and neonates.

STUDY DESIGN: The study is a retrospective cohort of data obtained in a large tertiary obstetrics and neonatal unit over 1 year, from anuary 1, 2019 to December 31, 2019. Data of all deliveries conducted at the institution were accessed. In addition, singleton and term pregnancies were included for further analysis. Multiple pregnancies, premature births, stillbirths, non-vertex presentations, and being lost to follow-up served as exclusion criteria. A database of the cases was constructed and data regarding maternal constitutional parameters, mode of delivery, shoulder dystocia, perineal trauma, and postpartum hemorrhage were collected. Further on, pregnancies were divided accordingly into two groups: Macrosomic fetuses (>4000 g) and non-macrosomic fetuses (<4000 g). The two groups were compared to assess possible macrosomia risk factors and maternal-neonatal outcomes. Statistical analysis is done using the Mann–Whitney-U and Chi-square tests. Significance was set as p < 0.05.

RESULTS: A total of 3408 deliveries met the inclusion criteria of the study. The macrosomia rate is 10.3%. The mean age (30.1 ± 5.17 years vs. 28.9 ± 8.4 years, p < 0.05) and, body mass index (29.2 ± 3.54 vs. 26.1 ± 2.78, p < 0.05) was significantly higher in the macrosomia group. Women that gained more than 12.5 kg have nearly twice the odds of delivering a big baby (odds ratio [OR] 1.86, confidence interval [CI] 1.47–2.36, p < 0.001). No statistically significant differences were noted regarding cases of gestational diabetes (p = 0.56). Cesarean sections were preferred to vaginal deliveries in the macrosomic group (39.3% vs. 29.7%, OR 1.53, CI 1.2–1.9, p = 0.001). The risk of undergoing an emergency procedure is 6-fold higher in pregnancies with macrosomic newborns (20.5% vs. 13.6%, OR 6.1, CI 4.45–8.36, p < 0.001). Both episiotomy rate (40.45% vs. 31.9%, OR 1.44, CI 1.15–1.81, p = 0.001) and lacerations (3.13 % vs. 1.44%, OR 2.21, CI 1.13–4.33, p = 0.02) were higher in the macrosomic group.

CONCLUSION: The study concludes that macrosomia is associated with an increase in maternal and neonatal adverse outcomes.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics: William H. Barth Jr Practice bulletin no. 173 summary: Fetal macrosomia. Obstet Gynecol. 2016;128:1191-2.

Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the United States: Determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol. 2003;188(5):1372-8. https://doi.org/10.1067/mob.2003.302 PMid:12748514 DOI: https://doi.org/10.1067/mob.2003.302

Agudelo-Espitia V, Parra-Sosa BE, Restrepo-Mesa SL. Factors associated with fetal macrosomia. Rev Saude Publica. 2019;53:100. https://doi.org/10.11606/s1518-8787.2019053001269 PMid:31800911 DOI: https://doi.org/10.11606/s1518-8787.2019053001269

Koyanagi A, Zhang J, Dagvadorj A, Hirayama F, Shibuya K, Souza JP, et al. Macrosomia in 23 developing countries: analysis of a multicountry, facility- based, cross-sectional survey. Lancet. 2013;381(9865):476-83. https://doi.org/10.1016/ S0140-6736(12)61605-5 PMid:23290494 DOI: https://doi.org/10.1016/S0140-6736(12)61605-5

Baugh N, Harris DE, Aboueissa AM, Sarton C, Lichter E. The impact of maternal obesity and excessive gestational weight gain on maternal and infant outcomes in Maine: Analysis of pregnancy risk assessment monitoring system results from 2000 to 2010. J Pregnancy. 2016;2016:5871313. https://doi.org/10.1155 / 2016/5871313 PMid:27747104 DOI: https://doi.org/10.1155/2016/5871313

Cunha AJ, Sobrino Toro M, Gutiérrez C, Alarcón Villaverde J. Prevalencia y factores asociados a macrosomía en Perú, 2013. Rev Peru Med Exp Salud Publica. 2017;34(1):36-42. https://doi.org/10.17843/rpmesp.2017.341.2765 PMid:28538844 DOI: https://doi.org/10.17843/rpmesp.2017.341.2765

Pacce S, Saure C, Mazza CS, Garcia S, Tomzig RG, Lopez AP, et al. Impact of maternal nutritional status before and during pregnancy on neonatal body composition: A cross-sectional study. Diabetes Metab Syndr. 2016;1 1 Suppl 1:S7-12. https://doi.org/10.1016/j.dsx.2015.08.015 PMid:26431950 DOI: https://doi.org/10.1016/j.dsx.2015.08.015

Lima RJ, Batista RF, Ribeiro MR, Ribeiro CC, Simões VM, Lima Neto PM, et al. Prepregnancy body mass index, gestational weight gain, and birth weight in the BRISA cohort. Rev Saude Publica. 2018;52:46. https://doi.org/10.11606/S1518-8787.2018052000125 PMid:29723385 DOI: https://doi.org/10.11606/S1518-8787.2018052000125

Godoy AC, Nascimento SL, Surita F. A systematic review and meta-analysis of gestational weight gain recommendations and related outcomes in Brazil. Clinics (Sao Paulo). 2015;70(11):758-64. https://doi.org/10.6061/clinics/2015(11)08 PMid:26602524 DOI: https://doi.org/10.6061/clinics/2015(11)08

Yang S, Peng A, Sheem W, Wu J, Zhao J, Zhang Y, et al. Pre-pregnancy body mass index, gestational weight gain, and birth weight: A cohort study in China. PLoS One. 2015;10(6):e0130101. https://doi.org/10.1371/journal.pone.0130101 PMid:26115015 DOI: https://doi.org/10.1371/journal.pone.0130101

Kominiarek MA, Peaceman AM. Gestational weight gain. Am J Obstet Gynecol. 2017;217(6):642-51. https://doi.org/10.1016/j.ajog.2017.05.040 PMid:28549978 DOI: https://doi.org/10.1016/j.ajog.2017.05.040

Luke B, Hediger ML, Nugent C, Newman RB, Mauldin JG, Witter FR, et al. Body mass index-specific weight gains associated with optimal birth weights in twin pregnancies. J Reprod Med. 2003;48:217-24. PMid:12746982

Lozano Bustillo A, Betancourth Melendez WR, Turcios Urbina LJ, Cueva Nuñez JE, Ocampo Eguigurems DM, Portillo Pineda CV, et al. Sobrepeso y obesidad en el embarazo: Complicaciones y manejo. Arch Med. 2016;12(3):11.

Claros Benítez DI, Mendoza Tascón LA. Impacto de los trastornos hipertensivos, la diabetes y obesidad materna sobre el peso, la edad gestacional al nacer y la mortalidad neonatal. Rev Chil Obstet Ginecol. 2016;81(6):480-8. https://doi.org/10.4067/S0717-75262016000600005 DOI: https://doi.org/10.4067/S0717-75262016000600005

Turkmen S, Johansson S, Dahmoun M. Foetal macrosomia and foetal-maternal outcomes at birth. J Pregnancy. 2018;2018:4790136. https://doi.org/10.1155 / 2018/4790136 PMid:30174954 DOI: https://doi.org/10.1155/2018/4790136

Santangeli L, Sattar N, Huda SS. Impact of maternal obesity on perinatal and childhood outcomes. Best Pract Res Clin Obstet Gynaecol. 2015;29(3):438-48. https://doi.org/10.1016/j.bpobgyn.2014.10.009 PMid:25497183 DOI: https://doi.org/10.1016/j.bpobgyn.2014.10.009

Spellacy WN, Miller S, Winegar A, Peterson PQ. Macrosomia– maternal characteristics and infant complications. Obstet Gynecol. 1985;66(2):158-61. PMid:4022478

Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol. 1998;179(2):476-80. https://doi.org/10.1016/s0002-9378(98)70382-5 PMid:9731856 DOI: https://doi.org/10.1016/S0002-9378(98)70382-5

King JR, Korst LM, Miller DA, Ouzounian JG. Increased composite maternal and neonatal morbidity associated with ultrasonographically suspected fetal macrosomia. J Matern Fetal Neonatal Med. 2012;25:1953-9. https://doi.org/10.3109/14767058.2012.674990 PMid:22439605 DOI: https://doi.org/10.3109/14767058.2012.674990

Irion O, Boulvain M. Induction of labour for suspected fetal macrosomia. Cochrane Database Syst Rev. 2000;(2):CD000938. https://doi.org/10.1002/14651858.CD000938 DOI: https://doi.org/10.1002/14651858.CD000938

PMid:10796221

Najafian M, Cheraghi M. Occurrence of fetal macrosomia rate and its maternal and neonatal complications: A 5-year cohort study. ISRN Obstet Gynecol. 2012;2012:353791. https://doi.org/10.5402/2012/353791 PMid:23209925 DOI: https://doi.org/10.5402/2012/353791

Boulvain M, Senat MV, Perrotin F, Winer N, Beucher G, Subtil D, et al. Induction of labour versus expectant management for large-for-date fetuses: A randomised controlled trial. Lancet. 2015;385(9987):2600-5. https://doi.org/10.1016/S0140-6736(14)61904-8 PMid:25863654 DOI: https://doi.org/10.1016/S0140-6736(14)61904-8

Lurie S, Insler V, Hagay ZJ. Induction of labor at 38 to 39 weeks of gestation reduces the incidence of shoulder dystocia in gestational diabetic patients class A2. Am J Perinatol. 1996;13(5):293-6. https://doi.org/10.1055/s-2007-994344 PMid:8863948 DOI: https://doi.org/10.1055/s-2007-994344

Gregory KD, Henry OA, Ramicone E, Chan LS, Platt LD. Maternal and infant complications in high and normal weight infants by method of delivery. Obstet Gynecol. 1998;92(4)507-13. https://doi.org/10.1016/s0029-7844(98)00224-5 PMid:9764620 DOI: https://doi.org/10.1097/00006250-199810000-00006

Ecker JL, Greenberg JA, Norwitz ER, Nadel AS, Repke JT. Birth weight as a predictor of brachial plexus injury. Obstet Gynecol. 1997;89(5):643-7. https://doi.org/10.1016/s0029-7844(97)00007-0 PMid:9166293 DOI: https://doi.org/10.1016/S0029-7844(97)00007-0

Menticoglou SM, Manning FA, Morrison I, Harman CR. Must macrosomic fetuses be delivered by a caesarean section? A review of outcome for 786 babies greater than or equal to 4,500 g. Aust N Z J Obstet Gynaecol. 1992;32(2):100-3. https://doi.org/10.1111/j.1479-828x.1992.tb01917.x PMid:1520190 DOI: https://doi.org/10.1111/j.1479-828X.1992.tb01917.x