Fetal macrosomia and pregnancy outcomes

Water Fluoridation and Birth Outcomes in California

BACKGROUND

There is a lack of research on the relationship between water fluoridation and pregnancy outcomes.

OBJECTIVES

We assessed whether hypothetical interventions to reduce fluoride levels would improve birth outcomes in California.

METHODS

We linked California birth records from 2000 to 2018 to annual average fluoride levels by community water system. Fluoride levels were collected from consumer confidence reports using publicly available data and public record requests. We estimated the effects of a hypothetical intervention reducing water fluoride levels to 0.7  ppm (the current level recommended by the US Department of Health and Human Services) and 0.5  ppm (below the current recommendation) on birth weight, birth-weight-for-gestational age z-scores, gestational age, preterm birth, small-for-gestational age, large-for-gestational age, and macrosomia using linear regression with natural cubic splines and G-computation. Inference was calculated using a clustered bootstrap with Wald-type confidence intervals. We evaluated race/ethnicity, health insurance type, fetal sex, and arsenic levels as potential effect modifiers.

RESULTS

Fluoride levels ranged from 0 to 2.5  ppm , with a median of 0.51  ppm . There was a small negative association on birth weight with the hypothetical intervention to reduce fluoride levels to 0.7  ppm [- 2.2 g ; 95% confidence interval (CI): - 4.4 , 0.0] and to 0.5  ppm (- 5.8 g ; 95% CI: - 10.0 , - 1.6 ). There were small negative associations with birth-weight-for-gestational-age z-scores for both hypothetical interventions (0.7  ppm : - 0.004 ; 95% CI: - 0.007 , 0.000 and 0.5  ppm : - 0.006 ; 95% CI: - 0.013 , 0.000). We also observed small negative associations for risk of large-for-gestational age for both the hypothetical interventions to 0.7  ppm [risk difference  ( RD ) = - 0.001 ; 95% CI: - 0.002 , 0.000 and 0.5  ppm (- 0.001 ; 95% CI: - 0.003 , 0.000)]. We did not observe any associations with preterm birth or with being small for gestational age for either hypothetical intervention. We did not observe any associations with risk of preterm birth or small-for-gestational age for either hypothetical intervention.

CONCLUSION

We estimated that a reduction in water fluoride levels would modestly decrease birth weight and birth-weight-for-gestational-age z-scores in California. https://doi.org/10.1289/EHP13732.

Reducing macrosomia-related birth complications in primigravid women: ultrasound- and magnetic resonance imaging-based models

BACKGROUND

Many complications increase with macrosomia, which is defined as birthweight of ≥4000 g. The ability to estimate when the fetus would exceed 4000 g could help to guide decisions surrounding the optimal timing of delivery. To the best of our knowledge, there is no available tool to perform this estimation independent of the currently available growth charts.

OBJECTIVE

This study aimed to develop ultrasound- and magnetic resonance imaging-based models to estimate at which gestational age the birthweight would exceed 4000 g, evaluate their predictive performance, and assess the effect of each model in reducing adverse outcomes in a prospectively collected cohort.

STUDY DESIGN

This study was a subgroup analysis of women who were recruited for the estimation of fetal weight by ultrasound and magnetic resonance imaging at 36 0/7 to 36 6/7 weeks of gestation. Primigravid women who were eligible for normal vaginal delivery were selected. Multiparous patients, patients with preeclampsia spectrum, patients with elective cesarean delivery, and patients with contraindications for normal vaginal delivery were excluded. Of note, 2 linear models were built for the magnetic resonance imaging- and ultrasound-based models to predict a birthweight of ≥4000 g. Moreover, 2 formulas were created to predict the gestational age at which birthweight will reach 4000 g (predicted gestational age); one was based on the magnetic resonance imaging model, and the second one was based on the ultrasound model. This study compared the adverse birth outcomes, such as intrapartum cesarean delivery, operative vaginal delivery, anal sphincter injury, postpartum hemorrhage, shoulder dystocia, brachial plexus injury, Apgar score of <7 at 5 minutes of life, neonatal intensive care unit admission, and intracranial hemorrhage in the group of patients who delivered after the predicted gestational age according to the magnetic resonance imaging-based or the ultrasound-based models with those who delivered before the predicted gestational age by each model, respectively.

RESULTS

Of 2378 patients, 732 (30.8%) were eligible for inclusion in the current study. The median gestational age at birth was 39.86 weeks of gestation (interquartile range, 39.00-40.57), the median birthweight was 3340 g (interquartile range, 3080-3650), and 63 patients (8.6%) had a birthweight of ≥4000 g. Prepregnancy body mass index, geographic origin, gestational age at birth, and fetal body volume were retained for the optimal magnetic resonance imaging-based model, whereas maternal age, gestational diabetes mellitus, diabetes mellitus type 1 or 2, geographic origin, fetal gender, gestational age at birth, and estimated fetal weight were retained for the optimal ultrasound-based model. The performance of the first model was significantly better than the second model (area under the curve: 0.98 vs 0.89, respectively; P<.001). The group of patients who delivered after the predicted gestational age by the first model (n=40) had a higher risk of cesarean delivery, postpartum hemorrhage, and shoulder dystocia (adjusted odds ratio: 3.15, 4.50, and 9.67, respectively) than the group who delivered before this limit. Similarly, the group who delivered after the predicted gestational age by the second model (n=25) had a higher risk of cesarean delivery and postpartum hemorrhage (adjusted odds ratio: 5.27 and 6.74, respectively) than the group who delivered before this limit.

CONCLUSION

The clinical use of magnetic resonance imaging- and ultrasound-based models, which predict a gestational age at which birthweight will exceed 4000 g, may reduce macrosomia-related adverse outcomes in a primigravid population. The magnetic resonance imaging-based model is better for the identification of the highest-risk patients.

Relations between maternal height, shoe size, and the success of vaginal delivery in birth weight over 4000 g

OBJECTIVE

Macrosomia is associated with increased risk of fetal and maternal complications such as trauma during birth, cesarean delivery, postpartum hemorrhage, and shoulder dystocia. Sonographic estimation of fetal weight is imprecise particularly in excessively large fetuses, prompting the need for additional measures to assess the feasibility of vaginal delivery of a macrosomic newborn and thus improve prenatal consultation.

MATERIALS AND METHODS

This retrospective case-control study included women who delivered a singleton macrosomic newborn (birth weight>4,000 g), either vaginally (N = 762) or by urgent cesarean delivery during labor (N = 109). Using multivariable analysis, we examined correlations of maternal height≥170 cm and shoe size≥40 with successful vaginal delivery.

RESULTS

Women who delivered vaginally had lower mean intrapartum BMI (p < 0.001) and lower rate of gestational diabetes (p = 0.003). Women with a shoe size≥40 were 2.2 times more likely to give birth vaginally. Cesarean section rate was 5.9 % among women with height≥170 cm and shoe size≥40; and 16.5 % among women with height<170 cm and shoe size<40. Multivariable analysis, adjusted for gestational diabetes, parity, and BMI, revealed that shoe size≥40 and maternal height≥170 cm correlated with success in vaginal delivery, OR = 3.1 (95%CI 1.3-7.3, p = 0.009).

CONCLUSION

Shoe size and maternal height may help predict success of vaginal birth of the macrosomic newborns.

Interpregnancy weight change as a potential risk factor for large-for-gestational-age infants: the Japan Environment and Children's Study

OBJECTIVE

This study aimed to estimate the impact of interpregnancy weight change from the first to the second pregnancy on the risk of infants being large for gestational age (LGA).

METHODS

This nationwide prospective birth cohort analysis included 3245 women who delivered their first two live singletons between 2011 and 2014. Interpregnancy weight change was calculated as the difference between the prepregnancy body mass index (BMI) of the first and second pregnancies. LGA infants were compared among three interpregnancy weight change groups: weight loss (a BMI loss >1 unit), weight gain (a BMI gain >1 unit), and stable weight (BMI maintained within - 1 to <1 unit). Interpregnancy weight change was assessed in mothers with a BMI <25 and ≥25 kg/m², and adjusted odds ratios (ORs) were calculated for LGA infants by multiple logistic regression.

RESULTS

The incidence of LGA infants was 8.6% (279 out of 3245). Compared with the stable weight group, interpregnancy weight gain was associated with an increased risk of infants being LGA (adjusted OR: 1.69, 95% confidence interval: 1.21-2.36) in the normal BMI (<25 kg/m²) group. In contrast, in the overweight/obese BMI (≥25 kg/m²) group, interpregnancy BMI was not a significant risk factor for LGA infants.

CONCLUSIONS

Accurate risk stratification using interpregnancy BMI could assist the clinical management of women with a normal BMI who are at risk of delivering LGA infants.

Perinatal mortality rate and adverse perinatal outcomes presumably attributable to placental dysfunction in (near) term gestation: A nationwide 5-year cohort study

INTRODUCTION

Placental dysfunction can lead to perinatal hypoxic events including stillbirth. Unless there is overt severe fetal growth restriction, placental dysfunction is frequently not identified in (near) term pregnancy, particularly because fetal size is not necessarily small. This study aimed to evaluate, among (near) term births, the burden of hypoxia-related adverse perinatal outcomes reflected in an association with birth weight centiles as a proxy for placental function.

MATERIAL AND METHOD

A nationwide 5-year cohort of the Dutch national birth registry (PeriNed) including 684,938 singleton pregnancies between 36+0 and 41+6 weeks of gestation. Diabetes, congenital anomalies, chromosomal abnormalities and non-cephalic presentations at delivery were excluded. The main outcome was antenatal mortality rate according to birthweight centiles and gestational age. Secondary outcomes included perinatal hypoxia-related outcomes, including perinatal death and neonatal morbidity, analyzed according to birthweight centiles.

RESULTS

Between 2015 and 2019, 1,074 perinatal deaths (0.16%) occurred in the study population (n = 684,938), of which 727 (0.10%) antenatally. Of all antenatal- and perinatal deaths, 29.4% and 27.9% occurred in birthweights below the 10th centile. The incidence of perinatal hypoxia-related outcomes was highest in fetuses with lowest birthweight centiles (18.0%), falling gradually up to the 50th and 90th centile where the lowest rates of hypoxia-related outcomes (5.4%) were observed.

CONCLUSION

Perinatal hypoxia-related events have the highest incidence in the lowest birthweight centiles but are identifiable throughout the entire spectrum. In fact, the majority of the adverse outcome burden in absolute numbers occurs in the group with a birthweight above the 10th centile. We hypothesize that in most cases these events are attributable to reduced placental function. Additional diagnostic modalities that indicate placental dysfunction at (near) term gestation throughout all birth weight centiles are eagerly wanted.

The application of intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine birthweight inequities in New York City

Exploring the intersection of dimensions of social identity is critical for understanding drivers of health inequities. We used multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine the intersection of age, race/ethnicity, education, and nativity status on infant birthweight among singleton births in New York City from 2012 to 2018 (N = 725,875). We found evidence of intersectional effects of various systems of oppression on birthweight inequities and identified U.S.-born Black women as having infants of lower-than-expected birthweights. The MAIHDA approach should be used to identify intersectional causes of health inequities and individuals affected most to develop policies and interventions redressing inequities.

Induction of labour at or near term for suspected fetal macrosomia

BACKGROUND

Women with a suspected large-for-dates fetus or a fetus with suspected macrosomia (birthweight greater than 4000 g) are at risk of operative birth or caesarean section. The baby is also at increased risk of shoulder dystocia and trauma, in particular fractures and brachial plexus injury. Induction of labour may reduce these risks by decreasing the birthweight, but may also lead to longer labours and an increased risk of caesarean section.

OBJECTIVES

To assess the effects of a policy of labour induction at or shortly before term (37 to 40 weeks) for suspected fetal macrosomia on the way of giving birth and maternal or perinatal morbidity.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), contacted trial authors and searched reference lists of retrieved studies.

SELECTION CRITERIA

Randomised trials of induction of labour for suspected fetal macrosomia.

DATA COLLECTION AND ANALYSIS

Review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We contacted study authors for additional information. For key outcomes the quality of the evidence was assessed using the GRADE approach.

MAIN RESULTS

We included four trials, involving 1190 women. It was not possible to blind women and staff to the intervention, but for other 'Risk of bias' domains these studies were assessed as being at low or unclear risk of bias. Compared to expectant management, there was no clear effect of induction of labour for suspected macrosomia on the risk of caesarean section (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.76 to 1.09; 1190 women; four trials, moderate-quality evidence) or instrumental delivery (RR 0.86, 95% CI 0.65 to 1.13; 1190 women; four trials, low-quality evidence). Shoulder dystocia (RR 0.60, 95% CI 0.37 to 0.98; 1190 women; four trials, moderate-quality evidence), and fracture (any) (RR 0.20, 95% CI 0.05 to 0.79; 1190 women; four studies, high-quality evidence) were reduced in the induction of labour group. There were no clear differences between groups for brachial plexus injury (two events were reported in the control group in one trial, low-quality evidence). There was no strong evidence of any difference between groups for measures of neonatal asphyxia; low five-minute infant Apgar scores (less than seven) or low arterial cord blood pH (RR 1.51, 95% CI 0.25 to 9.02; 858 infants; two trials, low-quality evidence; and, RR 1.01, 95% CI 0.46 to 2.22; 818 infants; one trial, moderate-quality evidence, respectively). Mean birthweight was lower in the induction group, but there was considerable heterogeneity between studies for this outcome (mean difference (MD) -178.03 g, 95% CI -315.26 to -40.81; 1190 infants; four studies; I2 = 89%).  For outcomes assessed using GRADE, we based our downgrading decisions on high risk of bias from lack of blinding and imprecision of effect estimates.

AUTHORS' CONCLUSIONS

Induction of labour for suspected fetal macrosomia has not been shown to alter the risk of brachial plexus injury, but the power of the included studies to show a difference for such a rare event is limited. Also antenatal estimates of fetal weight are often inaccurate so many women may be worried unnecessarily, and many inductions may not be needed. Nevertheless, induction of labour for suspected fetal macrosomia results in a lower mean birthweight, and fewer birth fractures and shoulder dystocia. The observation of increased use of phototherapy in the largest trial, should also be kept in mind. Findings from trials included in the review suggest that to prevent one fracture it would be necessary to induce labour in 60 women. Since induction of labour does not appear to alter the rate of caesarean delivery or instrumental delivery, it is likely to be popular with many women. In settings where obstetricians can be reasonably confident about their scan assessment of fetal weight, the advantages and disadvantages of induction at or near term for fetuses suspected of being macrosomic should be discussed with parents. Although some parents and doctors may feel the evidence already justifies induction, others may justifiably disagree. Further trials of induction shortly before term for suspected fetal macrosomia are needed. Such trials should concentrate on refining the optimum gestation of induction, and improving the accuracy of the diagnosis of macrosomia.

Age-specific effects on adverse pregnancy outcomes vary by maternal characteristics: a population-based retrospective study in Xiamen, China

BACKGROUND

Advanced maternal age (AMA; ≥35 years) is considered to be a major risk factor for adverse pregnancy outcomes. Along with the global trend of delayed childbearing, and in particular, the implementation of China's second and third-child policy leading to a dramatic increase of AMA in recent years, the association between maternal age and pregnancy outcomes requires more investigation.

METHODS

A population-based retrospective study was performed. Data were derived from the Medical Birth Registry of Xiamen from 2011 to 2018. Univariate and multivariate logistic regression was used to evaluate the effects of maternal age on pregnancy outcomes.

RESULTS

A total of 63,137 women categorized into different age groups (< 25 years, 25-29 years, 30-34 years, and ≥ 35 years) were included in this study. Compared with the mothers aged 25-29 years, the univariate regression analysis showed that mothers aged < 25 years had lower risks of gestational diabetes mellitus (GDM) and cesarean. AMA was associated with higher risks of GDM, hypertension, cesarean, preterm birth, low-birth weight (LBW), large-for-gestational-age (LGA), macrosomia, and stillbirth (all P < 0.01). After adjustment for potential confounding factors, increased risks of GDM, hypertension, cesarean, preterm birth, and LBW remained significantly associated with AMA (all P < 0.05), whereas AMA mothers showed a lower risk of macrosomia than their younger counterparts. Additionally, no significant differences were detected in terms of Apgar score < 7.

CONCLUSION

AMA was associated with adverse pregnancy outcomes including increased risks of GDM, hypertension, cesarean, preterm birth, and LBW. This study confirmed the relationship between AMA and certain adverse maternal and fetal outcomes and emphasizes the necessity for women to be cautious about the age at which they become pregnant.

Additional single third trimester ultrasound scan in detection of large for gestational age fetuses

PURPOSE OF REVIEW

To evaluate the accuracy of growth scans in the third trimester. To evaluate the accuracy of universal third trimester ultrasound scans in the detection of large for gestational age (LGA) fetuses. To investigate how universal ultrasound scans affect the delivery and outcomes.

RECENT FINDINGS

Universal third trimester screening for LGA recorded a 22% positive predictive value (PPV), and 96% negative predicted value (NPV). The sensitivity in most studies reaches around 70% or more, of all the LGA fetuses delivered, there are different studies for and against universal ultrasonic screening of LGA. Estimated fetal weight (>4 kg/90th centile) and abdominal circumference are the best predictors of LGA with nearly 70% sensitivity. One study reported that an antenatal ultrasonic diagnosis of LGA in a low risk population has a weak association with the incidence of shoulder dystocia or poor neonatal outcomes. Universal screening in the third trimester for LGAs is not cost effective.

SUMMARY

Low risk pregnancies constitute the majority of the pregnancy population. All low risk pregnancy women will only receive two routine scans throughout the whole pregnancy. There is no evidence at present that conclusively demonstrates that an additional scan at 36 weeks improves maternal and neonatal outcomes and is cost effective.

Perinatal maternal characteristics predict a high risk of neonatal asphyxia: A multi-center retrospective cohort study in China

Objective

This study aimed to identify various perinatal maternal characteristics that contributed to neonatal asphyxia (NA) in term and late-preterm newborns based on the data obtained from a Chinese birth registry cohort and to establish an effective model for predicting a high risk of asphyxia.

Method

We retrospectively reviewed and analyzed the birth database from July 1, 2016, to June 30, 2017, in the main economically developed regions of China. Asphyxia was defined as an Apgar score <7 at 5 min post-delivery with umbilical cord arterial blood pH < 7.2 in the infant born after 34weeks. We compared the perinatal maternal characteristics of the newborns who developed asphyxia (NA group, n = 1,152) and those who did not (no NA group, n = 86,393). Candidate predictors of NA were analyzed using multivariable logistic regression. Subsequently, a prediction model was developed and validated by an independent test group.

Result

Of the maternal characteristics, duration of PROM ≥ 48 h, a gestational week at birth <37, prolonged duration of labor, hypertensive disorder, nuchal cord, and birth weight <2,500 or ≥4,000 g, abnormal fetal heart rate, meconium-stained amniotic fluid, and placenta previa were included in the predicting model, which presented a good performance in external validation (c-statistic of 0.731).

Conclusion

Our model relied heavily on clinical predictors that may be determined before or during birth, and pregnant women at high risk of NA might be recognized earlier in pregnancy and childbirth using this methodology, allowing them to avoid being neglected and delayed. Future studies should be conducted to assess its usefulness.

Human shoulder development is adapted to obstetrical constraints

SignificanceDuring human birth, the risk of complications is relatively high because of the comparatively large dimensions of the fetal head and shoulders relative to the maternal birth canal. Here we show that humans exhibit a developmental mode of the shoulders that likely contributes to mitigating obstetrical problems. Human shoulder growth is decelerated before birth but accelerated after birth, which stands in contrast to the more uniform shoulder growth trajectories of chimpanzees and macaques. This indicates that fetal developmental modifications were required during human evolution not only in the head but also in the shoulders to compensate obstetrical constraints.

Short- and Long-Term Outcomes Associated with Large for Gestational Age Birth Weight

Large for gestational age birth weight is associated with adverse short- and long-term outcomes. Infants born with large for gestational age birth weight are at increased risk for neonatal intensive care unit admission, respiratory distress, neonatal metabolic abnormalities including hypoglycemia, birth trauma, and even stillbirth or neonatal death. The risk for many of these complications increases with higher birth weights. Individuals with large for gestational age birth weight also appear to be at subsequent increased risk for overweight/obesity, diabetes, cardiovascular disease, and even some childhood cancers. These data highlight the need for effective interventions to decrease risk across the lifespan.

Abnormal Fetal Growth: Small for Gestational Age, Fetal Growth Restriction, Large for Gestational Age: Definitions and Epidemiology

Abnormal fetal growth (growth restriction and overgrowth) is associated with perinatal morbidity, mortality, and lifelong risks to health. To describe abnormal growth, "small for gestational age" and "large for gestational age" are commonly used terms. However, both are statistical definitions of fetal size below or above a certain threshold related to a reference population, rather than referring to an abnormal condition. Fetuses can be constitutionally small or large and thus healthy, whereas fetuses with seemingly normal size can be growth restricted or overgrown. Although golden standards to detect abnormal growth are lacking, understanding of both pathologic conditions has improved significantly.

Associations of ultrasound estimated early mid pregnancy visceral and subcutaneous fat depths and early pregnancy BMI with adverse neonatal outcomes

This study investigated whether maternal central adiposity and body mass index (BMI) were associated with neonatal hypoglycemia and adverse neonatal outcomes. A cohort study was performed at Uppsala University Hospital, Sweden, between 2015 and 2018. Visceral and subcutaneous fat depths were measured by ultrasound at the early second-trimester anomaly scan in 2771 women giving birth to singleton infants. Body mass index was assessed in early pregnancy. Logistic regression models were performed. Adjustments were made for age, BMI (not in model with BMI as exposure), smoking, maternal country of birth, and parity. Outcomes were neonatal hypoglycemia (blood glucose concentration < 2.6 mmol/l), a composite of adverse neonatal outcomes (Apgar < 7 at 5 min of age, or umbilical artery pH ≤ 7.0, or admission to neonatal intensive care unit), and the components of the composite outcome. Visceral and subcutaneous fat depths measured by ultrasound in early mid pregnancy were not associated with any of the outcomes in adjusted analyses. For every unit increase in BMI, the likelihood of neonatal hypoglycemia increased by 5% (aOR 1.05, 95% CI 1.01–1.10), the composite outcome by 5% (aOR 1.05, 95% CI 1.01–1.08), and admission to neonatal intensive care unit by 6% (aOR 1.06, 95% CI 1.02–1.10).

Maternal physical, socioeconomic, and demographic characteristics and childbirth complications in rural lowland Nepal: Applying an evolutionary framework to understand the role of phenotypic plasticity

OBJECTIVES

Evolutionary perspectives on human childbirth have primarily focused on characteristics of our species in general, rather than variability within and between contemporary populations. We use an evolutionary framework to explore how physical and demographic characteristics of mothers shape the risks of childbirth complications in rural lowland Nepal, where childbearing typically commences in adolescence and chronic undernutrition is widespread, though maternal overweight is increasing in association with nutrition transition.

METHODS

We conducted secondary analyses of data from a cluster-randomized trial. Women aged 14-35 years were categorized by age, number of previous pregnancies, height, body mass index (BMI), husband's education, and household wealth. Multivariable logistic regression models tested whether these characteristics independently predicted risks of episiotomy and cesarean section (CS, n = 14 261), and obstructed labor (OL, n = 5185).

RESULTS

Risks were greatest among first-time adolescent mothers, though associations with age varied by outcome. Independent of age and parity, short stature and high BMI increased risks of CS and OL, whereas associations were weaker for episiotomy. Male offspring had increased risk of CS and OL but not episiotomy. Wealth was not associated with OL, but lower wealth and lower husband's education were associated with lower likelihood of episiotomy and CS.

CONCLUSIONS

At the individual level, the risk childbirth complications is shaped by trade-offs between fertility, growth, and survival. Some biological markers of disadvantage (early childbearing, short stature) increased the risk, whereas low socio-economic status was associated with lower risk, indicating reduced access to relevant facilities. Independent of these associations, maternal age showed complex effects.

Interactions between Prepregnancy Overweight and Passive Smoking for Macrosomia and Large for Gestational Age in Chinese Pregnant Women

INTRODUCTION

Previous analysis showed that passive smoking and overweight were associated with an increased risk of gestational diabetes mellitus (GDM) in a synergistic manner, while GDM increased the risk of macrosomia/large for gestational age (LGA). This study aimed to examine any interactive effects between passive smoking and overweight/obesity on risk of macrosomia/LGA.

METHODS

From 2010 to 2012, 22,302 pregnant women registered for pregnancy at a primary hospital in Tianjin, China. Data were collected longitudinally; that is, from their first antenatal care visit, at the glucose challenge test (GCT) time (24-28 weeks of gestation) and at delivery. Passive smoking was self-reported. Macrosomia was defined as birth weight ≥4,000 g. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction was used to test the synergistic effect.

RESULTS

Passive smokers accounted for 57.4% of women (n = 8,230). Using nonpassive smoking and prepregnancy body mass index (BMI) <24.0 kg/m2 as the reference, the adjusted ORs of overweight alone and passive smoking alone for macrosomia were 2.39 (95% CI: 2.11-2.71) and 1.17 (95% CI: 1.04-1.32). Copresence of passive smoking and prepregnancy BMI ≥24.0 kg/m2 increased the OR to 2.70 (95% CI: 2.28-3.20), with a significant additive interaction. After further adjustment for GDM or GCT, the OR of copresence of both risk factors was slightly attenuated to 2.52 (2.13-3.00) and 2.51 (2.11-2.98), with significant additive interaction. However, the additive interaction between prepregnancy overweight/obesity and passive smoking for LGA was nonsignificant.

CONCLUSIONS

Prepregnancy overweight/obesity was associated with an increased risk of macrosomia in Chinese women synergistically with passive smoking during pregnancy, and most of the association was not modified by hyperglycemia during pregnancy.

Association of Antidepressant Continuation in Pregnancy and Infant Birth Weight

PURPOSE

The aim of the study was to evaluate the association of antidepressant continuation in pregnancy with infant birth weight among women using antidepressants before pregnancy.

METHODS

This retrospective cohort study used electronic health data linked with state birth records. We identified singleton live births (2001-2014) to enrolled women with 1 or more antidepressant prescriptions filled 6 months or less before pregnancy, including "continuers" (≥1 antidepressant fills during pregnancy, n = 1775) and "discontinuers" (no fill during pregnancy, n = 1249). We compared birth weight, small or large for gestational age (SGA or LGA), low birth weight (LBW; <2500 g), and macrosomia (>4500 g) between the 2 groups, using inverse probability of treatment weighting to account for pre-pregnancy characteristics, including mental health conditions.

RESULTS

After weighting, infants born to antidepressant continuers weighed 71.9 g less than discontinuers' infants (95% confidence interval [CI], -115.5 to -28.3 g), with a larger difference for female infants (-106.4 g; 95% CI, -164.6 to -48.1) than male infants (-48.5 g; 95% CI, -107.2 to 10.3). For female infants, SGA risk was greater in continuers than discontinuers (relative risk [RR],1.54; 95% CI, 1.02 to 2.32). Low birth weight risk was greater in continuers with 50% or more of days covered (RR, 1.69; 95% CI, 1.11 to 2.58) and exposure in the second trimester (RR, 1.53; 95% CI, 1.02 to 2.29), as compared with discontinuers.

CONCLUSIONS

Depending on infant sex, as well as duration and timing of use, continuation of antidepressant use during pregnancy may be associated with lower infant birth weight, with corresponding increases in LBW and SGA.

Association of maternal central adiposity measured by ultrasound in early mid pregnancy with infant birth size

We sought to investigate whether early mid pregnancy visceral and subcutaneous fat depths measured by ultrasound were associated with infant birth size, independent of early pregnancy BMI. A cohort study was performed at Uppsala University Hospital, Sweden, between 2015–2018. Visceral and subcutaneous fat depths were measured at the early second-trimester anomaly scan in 2498 women, giving birth to singleton, term infants. Primary outcomes were birthweight and LGA (birthweight standard deviation score > 90th percentile in the cohort). Linear and logistic regression models were used, adjusted for BMI, age, smoking, parity, maternal country of birth, gestational age and infant sex. A 5-mm increase in visceral fat depth was associated with an increase in birthweight of 8.3 g [95% confidence interval (CI) 2.5 − 14.1 g], after adjustments, and a 6% increase in the adjusted odds of having an infant born LGA (OR 1.06, CI 1.02–1.11). There was no association between subcutaneous fat depth and birthweight or LGA after covariate adjustments. Hence, visceral fat depth measured by ultrasound in early mid pregnancy was associated with excessive fetal growth, independent of early pregnancy BMI, and may be useful in models for predicting LGA infants.

The Role of Early Programming and Early Nutrition on the Development and Progression of Celiac Disease: A Review

Experimental and epidemiological evidence has shown that modifications of the intrauterine environment can have deleterious consequences for individuals, expressed as an increased risk of suffering non-communicable pathologies in adult life, which is known as the hypothesis of the early origin of diseases or fetal programming. On the other hand, changes in gene expression patterns through epigenetic modifications can be the basis for long-term maintenance of the effects of fetal programming. In this sense, epigenetics comprises the study of intrauterine disturbances, which develop diseases in the adult, including celiac disease (CD). In addition, early feeding practices could influence the risk of CD development, such as breastfeeding timing and duration and age of gluten introduction in the diet. Gluten acts as a trigger for CD in genetically predisposed subjects, although approximately 30% of the world population has HLA DQ2 or DQ8, the prevalence of the disease is only 1–3%. It is not known what factors act to modify the risk of disease in genetically at-risk subjects. Taking into account all these considerations, the aim of the current review is to elucidate the role of early programming and the effect of early nutrition on the development and progression of CD. It is logical that attention has been paid to gluten as a key element in preventing the disease. However, there is no strong evidence in favor of the protective factor of breastfeeding, timing of introduction of gluten during lactation, and the development of CD. Diet, genetic risk, microbiota, and environmental interaction are possible triggers of the change in tolerance to an immune response to gluten, but large-scale cohort studies are needed. Emerging scientific concepts, such as epigenetics, may help us establish the role of these factors.

Pre-pregnancy maternal obesity, macrosomia, and risk of stillbirth: A population-based study

OBJECTIVE

An examination of the synergistic effects of maternal obesity and macrosomia on the risk of stillbirth is lacking. The purpose of this study was to determine the association between fetal macrosomia, maternal obesity, and the risk of stillbirth.

METHODS

This retrospective cross-sectional study used the CDC's Birth Data and Fetal Death Data files for 2014-2017 [n = 10,043,398‬ total births; including 48,799 stillbirths]. The exposure was fetal macrosomia stratified by obesity subtypes (I-III). The outcome was the risk of stillbirth. We also controlled for potential and known confounding factors in adjusted models. Adjusted Relative Risks (ARR) were estimated with log-binomial regression models.

RESULTS

The rate of stillbirth was higher among macrosomic infants born to mothers with obesity compared to those without (6.55 vs. 0.54 per 1000 total births). After controlling for confounding, women with obesity types II and III were at increased risk for stillbirth [Obesity II ARR = 2.37 (2.07-2.72); Obesity III ARR = 9.06 (7.61-10.78)].

CONCLUSIONS FOR PRACTICE

Obesity-related fetal overgrowth is a significant risk factor for stillbirth, especially among women with type II and type III obesity. This finding highlights the need for more effective clinical and public health strategies to address pre-pregnancy obesity and to optimize gestational weight gain.

Induction of labor versus expectant management among women with macrosomic neonates: a retrospective study

Background: The macrosomic fetus predisposes a variety of adverse maternal and perinatal outcomes. Although older studies have shown no benefit in inducing women of suspected macrosomic fetuses, more updated studies show different information.Objectives: The aim of our study was to compare induction of labor versus expectant management among women with macrosomic neonates weighing more than 4000 g at term (between 37°/7 and 416/7 weeks' gestation).Study design: This was a retrospective cohort study of all live-born singleton pregnancies with macrosomic newborns who were delivered at our institution between 1 January 2000 and 1 June 2015. We compared the outcomes of induction of labor, at each gestational age (GA), between 37 and 41 weeks (study group) with ongoing pregnancy. The primary outcome was cesarean section (CS) rate. Secondary outcomes were composite maternal and neonatal outcome and birth injuries.Results: Overall, out of 3095 patients with macrosomic newborns who were included in the study, 795 women (25.7%) underwent induction of labor. The cesarean section rate was not found to be significantly different between the groups at all gestational ages, nor was the vaginal delivery rate. After adjusting for confounders, induction of labor at 40 and 41 weeks' gestation was associated with composite maternal outcome (adjusted odds ratio (aOR) 1.6, 95% confidence interval (CI): 1.3-2.1; aOR 1.7, 95% CI: 1.3-2.2, respectively) and composite neonatal outcome (aOR 1.6, 95% CI: 1.1-2.4; aOR 1.8, 95% CI: 1.1-2.9). Induction of labor at 40 weeks' gestation was also associated with increased risk of birth injuries (aOR 2.9, 95% CI: 1.4-6).Conclusions: Compared with ongoing pregnancy, induction of labor of women with macrosomic neonates between 37 and 41 weeks of gestation does not reduce the CS rate, nor does it increase the vaginal delivery rate. Moreover, induction of labor of those women beyond 39 weeks' gestation is associated with composite adverse maternal/neonatal outcome, specifically birth injuries.

Early-life determinants of excess weight in children born heavy

Infants born heavy are vulnerable to later obesity, but it is unknown whether obesity-related risk factors present between conception and delivery predict their postnatal weight trajectory. We modelled the weight trajectories of infants born high birth weight (HBW, greater than or equal to 4000 g) and/or large for gestational age (LGA, greater than 90th percentile) using data from the Infant Feeding Practices Study II (N = 371). A high percentage of infants were both HBW and LGA, but the trajectories were modelled separately. Weight of infants born heavy begins high, gradually decreases, and then levels off by 12 months. Delivery method was the only predictor of weight. Caesarean-delivered HBW infants were heavier than vaginally-delivered HBW infants although this effect disappeared by 12 months. Findings indicate that early-life influences are not necessarily deterministic of the postnatal weight trajectory of infants born heavy. Future research is needed to examine postnatal behaviours that may be implicated in the relationship between large size at birth and later obesity.

The test accuracy of antenatal ultrasound definitions of fetal macrosomia to predict birth injury: A systematic review

OBJECTIVES

To determine which ultrasound measurement for predicted fetal macrosomia most accurately predicts adverse delivery and neonatal outcomes.

STUDY DESIGN

Four biomedical databases searched for studies published after 1966. Randomised trials or observational studies of women with singleton pregnancies, resulting in a term birth who have undergone an index test of interest measured and recorded as predicted fetal macrosomia ≥28 weeks. Adverse outcomes of interest included shoulder dystocia, brachial plexus injury (BPI) and Caesarean section.

RESULTS

Twenty-five observational studies (13,285 participants) were included. For BPI, the only significant positive association was found for Abdominal Circumference (AC) to Head Circumference (HC) difference > 50 mm (OR 7.2, 95 % CI 1.8-29). Shoulder dystocia was significantly associated with abdominal diameter (AD) minus biparietal diameter (BPD) ≥ 2.6 cm (OR 4.2, 95 % CI 2.3-7.5, PPV 11 %) and AC > 90th centile (OR 2.3, 95 % CI 1.3-4.0, PPV 8.6 %) and an estimated fetal weight (EFW) > 4000 g (OR 2.1 95 %CI 1.0-4.1, PPV 7.2 %).

CONCLUSIONS

Estimated fetal weight is the most widely used ultrasound marker to predict fetal macrosomia in the UK. This study suggests other markers have a higher positive predictive value for adverse outcomes associated with fetal macrosomia.

Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay

OBJECTIVE

To evaluate the risk of macrosomia in newborns from women with gestational diabetes, pregestational diabetes, overweight, and obesity in Uruguay in 2012, as well as its association with prolonged pregnancy, maternal age, multiparity, and excessive gestational weight gain (EGWG).

METHODS

We performed a cross-sectional study of 42,663 pregnant women. The risk of macrosomia was studied using logistic regression.

RESULTS

Mean maternal age was 26.7 ± 6.8 years. Pregestational overweight and obesity was present in 20.9% and 10.7% of women, respectively. There were 28.1% and 19.8% of women overweight and obese at the end of the pregnancy, respectively. Furthermore, 0.5% had pregestational diabetes and 8.5% were multiparous. Twenty two percent developed gestational diabetes and 44.9% had EGWG. The prevalence of macrosomia was 7.9%, significantly more prevalent in males (10.0% vs. 5.5%, p<0.005). Univariate analysis showed that obesity and overweight pre-pregnancy, obesity and overweight at the end of pregnancy, EGWG, pregestational diabetes, gestational diabetes, multiparity, prolonged pregnancy, and male newborn were strongly associated with macrosomia (p<0.0001). Maternal age >35 years did not increase the risk of macrosomia. After multiple logistic regression macrosomia was more likely in pre-gestational obese women (OR 1.24; CI 1.07-1.44), overweight women at the end of pregnancy (OR 1.66; CI 1.46-1.87), obese women at the end of pregnancy (OR 2.21; CI 1.90-2.58), women with EGWG (OR 1.78; CI 1.59-1.98), pregestational diabetes (OR 1.75; CI 1.15-2.69), gestational diabetes (OR 1.39; CI 1.25-1.53), prolonged pregnancy (OR 2.67; CI 2.28-3.12), multiparity (OR 1.24; CI 1.04-1.48), and male newborn (OR 1.89; CI 1.72-2.08).

CONCLUSION

Maternal overweight, obesity, EGWG, and gestational diabetes are prevalent in Uruguay, increasing the risk of macrosomia. Efforts to implement strategies to decrease the prevalence of overweight and obesity among women of reproductive age are essential to improve maternal and neonatal outcomes.

Spatial quantile regression with application to high and low child birth weight in Malawi

BACKGROUND

Child low and high birth weight are important public health problems. Many studies have looked at factors of low and high birth weight using mean regression. This study aimed at using quantile regression to find out determinants of low and high birth weight.

METHODS

Spatial quantile regression models at 0.05 and 0.95 percentiles of birth weight were fitted to 13,087 children birth weight in kilograms using Malawi demographic health survey data of 2010 study. Full Bayesian method by integrated nested Laplace approximations (INLA) was used to estimate the model. Second order random walk priors were assigned for mother age and antenatal visits for pregnancy while Gaussian markov random field prior was used for district of the child.

RESULTS

Residual spatial patterns reveal areas in the southern region promoting high birth weight while areas in the central and northern region promote low birth weight. Most fixed effects findings are consistent with the literature. Richest family, normal mother body mass index (BMI), mother over weight (BMI > 25 kg/m2), birth order 2-3, mother secondary education and height (≥150 cm) negate low birth weight while weight 45-70 kg promote low birth weight. Birth order category 6+, mother height (≥150 cm) and poor wealth quintile, promote high birth weight, while richer and richest wealth quintiles and education categories: primary, secondary, and higher, and mother overweight (BMI > 25 kg/m2) reduce high birth weight. Antenatal visits for pregnancy reduce both low and high birth weight.

CONCLUSION

Strategies to reduce low and high birth weight should simultaneously address mother education, weight gain during pregnancy and poverty while targeting areas increasing low and high birth weight.

Family socioeconomic position and abnormal birth weight: evidence from a Chinese birth cohort

BACKGROUND

Birth weight is a strong determinant of infant short- and long-term health outcomes. Family socioeconomic position (SEP) is usually positively associated with birth weight. Whether this association extends to abnormal birth weight or there exists potential mediator is unclear.

METHODS

We analyzed data from 14,984 mother-infant dyads from the Born in Guangzhou Cohort Study. We used multivariable logistic regression to assess the associations of a composite family SEP score quartile with macrosomia and low birth weight (LBW), and examined the potential mediation effect of maternal pre-pregnancy body mass index (BMI) using causal mediation analysis.

RESULTS

The prevalence of macrosomia and LBW was 2.62% (n = 392) and 4.26% (n = 638). Higher family SEP was associated with a higher risk of macrosomia (OR 1.30, 95% CI 0.93-1.82; OR 1.53, 95% CI 1.11-2.11; and OR 1.59, 95% CI 1.15-2.20 for the 2nd, 3rd, and 4th SEP quartile respectively) and a lower risk of LBW (OR 0.69, 95% CI 0.55-0.86; OR 0.76, 95% CI 0.61-0.94; and OR 0.61, 95% CI 0.48-0.77 for the 2nd, 3rd, and 4th SEP quartile respectively), compared to the 1st SEP quartile. We found that pre-pregnancy BMI did not mediate the associations of SEP with macrosomia and LBW.

CONCLUSIONS

Socioeconomic disparities in fetal macrosomia and LBW exist in Southern China. Whether the results can be applied to other populations should be further investigated.

Does prenatal identification of fetal macrosomia change management and outcome?

PURPOSE

To assess whether there is an association between predicted fetal macrosomia and adverse outcomes in macrosomic newborns (> 4000 g), based on a sonographic evaluation up to 2 weeks prior to delivery.

METHODS

A retrospective cohort study of 3098 mothers of macrosomic babies who were delivered at our institution (2000-2015). We compared the management and outcomes of women with predicted fetal macrosomia with that of women with unknown fetal macrosomia. The primary outcomes were cesarean section (CS) rate and postpartum hemorrhage. Secondary outcomes were composite maternal and neonatal outcomes and birth injuries.

RESULTS

In 601 (19.4%) women fetal macrosomia was predicted, and in 2497 (80.6%) women, fetal macrosomia was unknown. CS rate was more than 3.5 times higher in the group of predicted macrosomia (47.2% vs. 12.7%, P < 0.001) than those with unpredicted macrosomia; not only due to non-progressive labor, but for non-reassuring heart rate as well. However, predicted fetal macrosomia reduced the risk of postpartum hemorrhage (aOR 0.5, 95% CI 0.2-1.0), maternal (aOR 0.3, 95% CI 0.2-0.5) and neonatal composite adverse outcomes (aOR 0.7 95% CI 0.6-0.9). It was also associated with increased risk for induction of labor, episiotomy, 3rd- or 4th-degree tears and a longer maternal hospitalization. Birth injuries and shoulder dystocia were not different between the groups.

CONCLUSIONS

Antepartum CS was found to be associated with predicted fetal macrosomia. Moreover, a planned CS due to macrosomia was associated with reduced risk for postpartum hemorrhage, maternal and neonatal outcome, even for babies with a mean birth weight < 4500 g.

Birth-weight centiles and the risk of serious adverse neonatal outcomes at term

BACKGROUND

Birth-weight is an important determinant of perinatal outcome with low birth-weight being a particular risk factor for adverse consequences.

AIM

To investigate the impact of neonatal sex, mode of birth and gestational age at birth according to birth-weight centile on serious adverse neonatal outcomes in singleton term pregnancies.

MATERIALS AND METHODS

This was a retrospective cohort study of singleton term births at the Mater Mother's Hospital, Brisbane, Australia. Serious adverse neonatal outcome was defined as a composite of severe acidosis at birth (pH ≤7.0 and/or lactate ≥6 mmol/L and/or base excess ≤-12 mmol/L), Apgar <3 at 5 min, neonatal intensive-care unit admission and antepartum or neonatal death. The main exposure variable was birth-weight centile.

RESULTS

Of the 69,210 babies in our study, the overall proportion of serious adverse neonatal outcomes was 9.1% (6327/69,210). Overall, neonates in the <3rd birth-weight centile category had the highest adjusted odds ratio (OR) for serious adverse neonatal outcomes [OR 3.53, 95% confidence interval (CI) 3.06-4.07], whilst those in the ≥97th centile group also had elevated odds (OR 1.51, 95% CI 1.30-1.75). Regardless of birth modality, smaller babies in the <3rd centile group had the highest adjusted OR and predicted probability for serious adverse neonatal outcomes. When stratified by sex, male babies consistently demonstrated a higher predicted probability of serious adverse neonatal outcomes across all birth-weight centiles. The adjusted odds, when stratified by gestational age at birth, were the highest from 37+0 to 38+6 weeks in the <3rd centile group (OR 5.97, 95% CI 4.60-7.75).

CONCLUSIONS

Low and high birth-weights are risk factors for serious adverse neonatal outcomes. The adjusted OR appears to be greatest for babies in the <3rd birth-weight centile group, although an elevated risk was also found in babies within the ≥97th centile category.

Early elevated alkaline phosphatase increases the risk of large-for-gestational-age birth weight in pregnant women with normal glucose tolerance

AIMS

The aim of this study was to assess the association between levels of alkaline phosphatase (ALP) in early pregnancy and the incidence of large-for-gestational-age (LGA) neonates in pregnant women without gestational diabetes mellitus.

METHODS

A prospective cohort was carried out in 544 women and their biochemical parameters including serum ALP and demographic characteristics were collected in 13-16th gestational week. At 24-28th weeks of gestation, 50 g oral glucose challenge test and oral 75 g glucose tolerance test was performed. LGA was defined as birth weight ≥ 90th percentile for completed week of gestational age based on the sex-specific growth curves. Logistic regression and receiver operating characteristic analysis were utilized to identify independent risk factors and odds ratio among ALP quartiles for incidence of LGA.

RESULTS

Women diagnosed as LGA held higher level of ALP than women in non-LGA group (P = 0.008). Moreover, ALP (odds ratio (OR) 1.05 [95% confidence interval (CI): 1.00, 1.10]) was the independent risk factors associated with LGA. Compared with ALP quartile 1, women in quartile 4 had more than 2.5-fold increased odds of LGA (OR 3.78, 95% CI: 1.10, 13.02), and the risk reached 4 times after adjusting several covariates (OR 4.15, 95% CI: 1.14,15.13).

CONCLUSIONS

A significantly increased risk of LGA was associated with higher serum concentrations of ALP in pregnant women with NGT, even it is in normal reference range.

Use of the 50-g glucose challenge test to predict excess delivery weight

OBJECTIVE

To identify a cut-off value for the 50-g glucose challenge test (GCT) that predicts excess delivery weight.

METHODS

A retrospective study was conducted among pregnant women who undertook a 50-g GCT at Hacettepe University Hospital, Ankara, Turkey, between January 1, 2000, and December 31, 2016. Patients with singleton pregnancies who delivered live neonates after 28 weeks of pregnancy were included. Patients were classified according to their 50-g GCT values into group 1 (<7.770 mmol/L); group 2 (7.770 to <8.880 mmol/L, group 3 (8.880-9.990 mmol/L); or group 4 (>9.990 mmol/L). Classification and regression tree data mining was performed to identify the 50-g GCT cut-off value corresponding to a substantial increase in delivery weight.

, RESULTS

Median delivery weight were 3100 g in group 1 (n=352), 3200 g in group 2 (n=165), 3720 g in group 3 (n=47), and 3865 g in group 4 (n=20). Gravidity, 50-g GCT value, and pregnancy duration at delivery explained 30.6% of the observed variance in delivery weight. The cut-off required for maternal blood glucose level to predict excessive delivery weight was 8.741 mmol/L.

CONCLUSION

The 50-g GCT can be used to identify women at risk of delivering offspring with excessive delivery weight.

Evaluating The Impact of Risk Factors on Birth Weight and Gestational Age: A Multilevel Joint Modeling Approach

Background

Abnormalities in birth weight and gestational age cause several adverse maternal and infant out- comes. Our study aims to determine the potential factors that affect birth weight and gestational age, and their association.

Materials and Methods

We conducted this cross-sectional study of 4415 pregnant women in Tehran, Iran, from July 6-21, 2015. Joint multilevel multiple logistic regression was used in the analysis with demographic and obstetrical variables at the first level, and the hospitals at the second level.

Results

We observed the following prevalence rates: preterm (5.5%), term (94%), and postterm (0.5%). Low birth weight (LBW) had a prevalence rate of 4.8%, whereas the prevalence rate for normal weight was 92.4, and 2.8% for macrosomia. Compared to term, older mother’s age [odds ratio (OR)=1.04, 95% confidence interval (CI): 1.02-1.07], preeclampsia (OR=4.14, 95% CI: 2.71-6.31), multiple pregnancy (OR=18.04, 95% CI: 9.75- 33.38), and use of assisted reproductive technology (ART) (OR=2.47, 95% CI: 1.64-33.73) were associated with preterm birth. Better socioeconomic status (SES) was responsible for decreased odds for postterm birth com- pared to term birth (OR=0.53, 95% CI: 0.37-0.74). Cases with higher maternal body mass index (BMI) were 1.02 times more likely for macrosomia (95% CI: 1.01-1.04), and male infant sex (OR=1.78, 95% CI: 1.21-2.60). LBW was related to multiparity (OR=0.59, 95% CI: 0.42-0.82), multiple pregnancy (OR=17.35, 95% CI: 9.73-30.94), and preeclampsia (OR=3.36, 95% CI: 2.15-5.24).

Conclusion

Maternal age, SES, preeclampsia, multiple pregnancy, ART, higher maternal BMI, parity, and male infant sex were determined to be predictive variables for birth weight and gestational age after taking into consideration their association by using a joint multilevel multiple logistic regression model

Planned birth at or near term for improving health outcomes for pregnant women with pre-existing diabetes and their infants

BACKGROUND

Pregnant women with pre-existing diabetes (Type 1 or Type 2) have increased rates of adverse maternal and neonatal outcomes. Current clinical guidelines support elective birth, at or near term, because of increased perinatal mortality during the third trimester of pregnancy.This review replaces a review previously published in 2001 that included "diabetic pregnant women", which has now been split into two reviews. This current review focuses on pregnant women with pre-existing diabetes (Type 1 or Type 2) and a sister review focuses on women with gestational diabetes.

OBJECTIVES

To assess the effect of planned birth (either by induction of labour or caesarean birth) at or near term gestation (37 to 40 weeks' gestation) compared with an expectant approach, for improving health outcomes for pregnant women with pre-existing diabetes and their infants. The primary outcomes relate to maternal and perinatal mortality and morbidity.

SEARCH METHODS

We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (15 August 2017), and reference lists of retrieved studies.

SELECTION CRITERIA

We planned to include randomised trials (including those using a cluster-randomised design) and non-randomised trials (e.g. quasi-randomised trials using alternate allocation) which compared planned birth, at or near term, with an expectant approach for pregnant women with pre-existing diabetes.

DATA COLLECTION AND ANALYSIS

Two of the review authors independently assessed study eligibility. In future updates of this review, at least two of the review authors will extract data and assess the risk of bias in included studies. We will also assess the quality of the evidence using the GRADE approach.

MAIN RESULTS

We identified no eligible published trials for inclusion in this review.We did identify one randomised trial which examined whether expectant management reduced the incidence of caesarean birth in uncomplicated pregnancies of women with gestational diabetes (requiring insulin) and with pre-existing diabetes. However, published data from this trial does not differentiate between pre-existing and gestational diabetes, and therefore we excluded this trial.

AUTHORS' CONCLUSIONS

In the absence of evidence, we are unable to reach any conclusions about the health outcomes associated with planned birth, at or near term, compared with an expectant approach for pregnant women with pre-existing diabetes.This review demonstrates the urgent need for high-quality trials evaluating the effectiveness of planned birth at or near term gestation for pregnant women with pre-existing (Type 1 or Type 2) diabetes compared with an expectant approach.

Planned birth at or near term for improving health outcomes for pregnant women with gestational diabetes and their infants

BACKGROUND

Gestational diabetes is a type of diabetes that occurs during pregnancy. Women with gestational diabetes are more likely to experience adverse health outcomes such as pre-eclampsia or polyhydramnios (excess amniotic fluid). Their babies are also more likely to have health complications such as macrosomia (birthweight > 4000 g) and being large-for-gestational age (birthweight above the 90th percentile for gestational age). Current clinical guidelines support elective birth, at or near term in women with gestational diabetes to minimise perinatal complications, especially those related to macrosomia.This review replaces a review previously published in 2001 that included "diabetic pregnant women", which has now been split into two reviews. This current review focuses on pregnant women with gestational diabetes and a sister review focuses on women with pre-existing diabetes (Type 1 or Type 2).

OBJECTIVES

To assess the effect of planned birth (either by induction of labour or caesarean birth), at or near term (37 to 40 weeks' gestation) compared with an expectant approach for improving health outcomes for women with gestational diabetes and their infants. The primary outcomes relate to maternal and perinatal mortality and morbidity.

SEARCH METHODS

We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (15 August 2017), and reference lists of retrieved studies.

SELECTION CRITERIA

We included randomised trials comparing planned birth, at or near term (37 to 40 weeks' gestation), with an expectant approach, for women with gestational diabetes. Cluster-randomised and non-randomised trials (e.g. quasi-randomised trials using alternate allocation) were also eligible for inclusion but none were identified.

DATA COLLECTION AND ANALYSIS

Two of the review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included study. The quality of the evidence was assessed using the GRADE approach.

MAIN RESULTS

The findings of this review are based on a single trial involving 425 women with gestational diabetes. The trial compared induction of labour with expectant management (waiting for the spontaneous onset of labour in the absence of any maternal or fetal issues that may necessitate birth) in pregnant women with gestational diabetes at term. We assessed the overall risk of bias as being low for most domains, apart from performance, detection and attrition bias (for outcome perineum intact), which we assessed as being at high risk. It was an open-label trial, and women and healthcare professionals were not blinded.There were no clear differences between women randomised to induction of labour and women randomised to expectant management for maternal mortality or serious maternal morbidity (risk ratio (RR) 1.48, 95% confidence interval (CI) 0.25 to 8.76, one trial, 425 women); caesarean section (RR 1.06, 95% CI 0.64 to 1.77, one trial, 425 women); or instrumental vaginal birth (RR 0.81, 95% CI 0.45 to 1.46, one trial, 425 women). For the primary outcome of maternal mortality or serious maternal morbidity, there were no deaths in either group and serious maternal morbidity related to admissions to intensive care unit. The quality of the evidence contributing to these outcomes was assessed as very low, mainly due to the study having high risk of bias for some domains and because of the imprecision of effect estimates.In relation to primary neonatal outcomes, there were no perinatal deaths in either group. The quality of evidence for this outcome was judged as very low, mainly due to high risk of bias and imprecision of effect estimates. There were no clear differences in infant outcomes between women randomised to induction of labour and women randomised to expectant management: shoulder dystocia (RR 2.96, 95% CI 0.31 to 28.21, one trial, 425 infants, very low-quality evidence); large-for-gestational age (RR 0.53, 95% CI 0.28 to 1.02, one trial, 425 infants, low-quality evidence).There were no clear differences between women randomised to induction of labour and women randomised to expectant management for postpartum haemorrhage (RR 1.17, 95% CI 0.53 to 2.54, one trial, 425 women); admission to intensive care unit (RR 1.48, 95% CI 0.25 to 8.76, one trial, 425 women); and intact perineum (RR 1.02, 95% CI 0.73 to 1.43, one trial, 425 women). No infant experienced a birth trauma, therefore, we could not draw conclusions about the effect of the intervention on the outcomes of brachial plexus injury and bone fracture at birth. Infants of women in the induction-of-labour group had higher incidences of neonatal hyperbilirubinaemia (jaundice) when compared to infants of women in the expectant-management group (RR 2.46, 95% CI 1.11 to 5.46, one trial, 425 women).We found no data on the following prespecified outcomes of this review: postnatal depression, maternal satisfaction, length of postnatal stay (mother), acidaemia, intracranial haemorrhage, hypoxia ischaemic encephalopathy, small-for-gestational age, length of postnatal stay (baby) and cost.The authors of this trial acknowledge that it is underpowered for their primary outcome of caesarean section. The authors of the trial and of this review note that the CIs demonstrate a wide range, therefore making it inappropriate to draw definite conclusions.

AUTHORS' CONCLUSIONS

There is limited evidence to inform implications for practice. The available data are not of high quality and lack power to detect possible important differences in either benefit or harm. There is an urgent need for high-quality trials evaluating the effectiveness of planned birth at or near term gestation for women with gestational diabetes compared with an expectant approach.

High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil

The association between the quality of maternal dietary fat intake during pregnancy and the infant's birthweight (BW) remains controversial. Our goal was to investigate the association between maternal dietary fat intake during pregnancy and the rate of large for gestational age (LGA) newborns. This study employed a cross-sectional analysis of 297 pairs of mothers/children attending a public maternity at Rio de Janeiro, Brazil. BW for gestational age according to the Intergrowth 21st was defined as follows: adequate for gestational age (AGA ≤ 90th percentile) and LGA (>90th percentile). The statistical analysis was a Poisson regression with robust estimations of the standard errors. Maternal dietary fat intake variables comprised lipids (% total energy); saturated (mg/1000 kcal), monounsaturated (mg/1000 kcal) and polyunsaturated (mg/1000 kcal) fats; and cholesterol (mg/1000 kcal), all of which were obtained with a Food Frequency Questionnaire. The mean BW was 3338 g (SD = 446.9), and the rate of LGA newborns was 13.1%. The mean maternal total energy intake was 2880 kcal (SD = 1074), cholesterol was 154.3 mg/1000 kcal (SD = 68.1) and monounsaturated fat was 6.9 mg/1000 kcal (SD = 2). Mothers of LGA newborns reported higher cholesterol dietary intake (195.8 vs. 148 mg/1000 kcal; P < 0.001), pre-pregnancy body mass index (25.1 vs. 23.5 kg/m2 ; P = 0.026) when compared with mothers of AGA newborns. Women with cholesterol intake within the fourth quartile were 2.48 (95% confidence interval: 1.31-4.66) times more likely to have an LGA infant compared with those in the 1-3 quartiles. Dietary intake of cholesterol during pregnancy influences LGA even after adjusting for other confounders.

Accuracy of clinical fetal weight estimation by Midwives

BACKGROUND

Clinical fetal weight estimation is a common practice in obstetrics. This study aims to evaluate the accuracy of fetal weight estimation by midwives, and to identify factors that may lead to overestimation or underestimation of fetal weight.

METHODS

A cohort prospective study in a Lebanese university hospital, included weight estimation of singleton pregnancies above 35 weeks. Multiple pregnancies, unclear dating, growth retardation, malformations and stillbirths cases are excluded. The estimated fetal weight is recorded by midwives in a sealed envelope and compared to true weight later. The effects of BMI, weight gain, parity, diabetes, hypertension, neonate's sex and weight, uterine contractions, rupture of membranes and daytime or nighttime shift on these estimations were assessed.

RESULTS

One hundred and sixty-six patients were included. Mean birth weight was 3246 ± 362 g. Mean absolute percentage error of weight estimation was 8.5 ± 6.7% (0-30.9%). Estimation was within the correct range of ±10% in 63% of cases. Maternal and fetal factors did not significantly change weight estimation. Fetuses with birth weights more than 4000 tended to be underestimated by midwives. Estimation improved over time (nonsignificant).

CONCLUSIONS

Maternal and fetal factors, except for macrosomia, have limited impact on estimation of fetal birth weight. Macrosomia is challenging because of a consistent tendency of underestimation by midwives.

Three-Versus Two-Dimensional Sonographic Biometry for Predicting Birth Weight and Macrosomia in Diabetic Pregnancies

OBJECTIVES

The purpose of this study was to test the hypothesis that a formula incorporating 3-dimensional (3D) fractional thigh volume would be superior to the conventional 2-dimensional (2D) formula of Hadlock et al (Am J Obstet Gynecol 1985; 151:333-337) for predicting birth weight and macrosomia.

METHODS

We conducted a prospective cohort study of pregnancies complicated by pregestational or gestational diabetes and delivered after 38 weeks. Two-dimensional and 3D sonographic examinations were performed for fetal biometry and factional thigh volumes at 34 to 37 weeks. Fetal weight was estimated by Hadlock's 2D formula IV, which uses only 2D biometry, and formula 6 from Lee et al (Ultrasound Obstet Gynecol 2009; 34:556-565), which incorporates 3D fractional thigh volume and 2D biometry. The gestation-adjusted projection method was used to estimate predicted birth weights from 2D and 3D estimates. The primary outcome was fetal macrosomia, which was defined as birth weight of 4000 g or higher.

RESULTS

A total of 115 women with diabetes met inclusion criteria, and 17 (14.8%) delivered macrosomic neonates. The mean percentage error was significantly lower for the 2D than the 3D projected estimate (1.0% versus 12.0%; P < .01). The standard deviation of the mean percentage error was also significantly lower for the 2D projected estimate (10.2% versus 17.2%; P< .01). Two-dimensional biometry was overall superior to 3D biometry for predicting macrosomia (area under the receiver operating characteristic curve, 0.88 versus 0.75; P = .03). Specificity was significantly higher for 2D biometry (85% versus 66%; P < .01), whereas the difference in sensitivity was not statistically significant (59% versus 71%; P = .22).

CONCLUSIONS

In this study, the Hadlock 2D formula was superior to the 3D method for predicting birth weight and macrosomia in diabetic women when used approximately 2 weeks before delivery, based on the gestation-adjusted projection method.

Obesity epidemic: impact from preconception to postpartum

The obesity epidemic is on the rise throughout the USA and the world. Not only does it affect the general population but it also specifically poses unique threats to a woman’s life in the antepartum, peripartum and postpartum periods. An increased BMI is associated with worse perinatal outcomes, including higher rates of preeclampsia (and other hypertensive disorders), macrosomia, other neonatal morbidities and gestational diabetes. Isolated maternal obesity and additional maternal diabetes predispose the infant to potential adult disease through fetal programming. This review of the literature examines the effects of obesity on a woman’s life, outlining complications beginning with preconception through the postpartum period.

Lay abstract: The obesity epidemic poses unique threats during the whole cycle of pregnancy. This review examines the effects of obesity on a woman’s life, outlining complications from prior to conception through the postpartum period. In addition, the contributions to adult disease of fetal exposure to this maternal risk are discussed. Future advances in nanotechnology and better understanding of placental function might allow more options in preventative and therapeutic interventions, yet with minimal fetal risk.

Induction of labour at or near term for suspected fetal macrosomia

EDITORIAL NOTE

It has been brought to the authors' attention that there may be an error in the data (Analysis 1.9). This is currently under investigation, and a correction will be made if the data are found to be incorrect. Details can be found in the comments.

BACKGROUND

Women with a suspected large-for-dates fetus or a fetus with suspected macrosomia (birthweight greater than 4000 g) are at risk of operative birth or caesarean section. The baby is also at increased risk of shoulder dystocia and trauma, in particular fractures and brachial plexus injury. Induction of labour may reduce these risks by decreasing the birthweight, but may also lead to longer labours and an increased risk of caesarean section.

OBJECTIVES

To assess the effects of a policy of labour induction at or shortly before term (37 to 40 weeks) for suspected fetal macrosomia on the way of giving birth and maternal or perinatal morbidity.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), contacted trial authors and searched reference lists of retrieved studies.

SELECTION CRITERIA

Randomised trials of induction of labour for suspected fetal macrosomia.

DATA COLLECTION AND ANALYSIS

Review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We contacted study authors for additional information. For key outcomes the quality of the evidence was assessed using the GRADE approach.

MAIN RESULTS

We included four trials, involving 1190 women. It was not possible to blind women and staff to the intervention, but for other 'Risk of bias' domains these studies were assessed as being at low or unclear risk of bias.Compared to expectant management, there was no clear effect of induction of labour for suspected macrosomia on the risk of caesarean section (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.76 to 1.09; 1190 women; four trials, moderate-quality evidence) or instrumental delivery (RR 0.86, 95% CI 0.65 to 1.13; 1190 women; four trials, low-quality evidence). Shoulder dystocia (RR 0.60, 95% CI 0.37 to 0.98; 1190 women; four trials, moderate-quality evidence), and fracture (any) (RR 0.20, 95% CI 0.05 to 0.79; 1190 women; four studies, high-quality evidence) were reduced in the induction of labour group. There were no clear differences between groups for brachial plexus injury (two events were reported in the control group in one trial, low-quality evidence). There was no strong evidence of any difference between groups for measures of neonatal asphyxia; low five-minute infant Apgar scores (less than seven) or low arterial cord blood pH (RR 1.51, 95% CI 0.25 to 9.02; 858 infants; two trials, low-quality evidence; and, RR 1.01, 95% CI 0.46 to 2.22; 818 infants; one trial, moderate-quality evidence, respectively). Mean birthweight was lower in the induction group, but there was considerable heterogeneity between studies for this outcome (mean difference (MD) -178.03 g, 95% CI -315.26 to -40.81; 1190 infants; four studies; I(2) = 89%). In one study with data for 818 women, third- and fourth-degree perineal tears were increased in the induction group (RR 3.70, 95% CI 1.04 to 13.17).For outcomes assessed using GRADE, we based our downgrading decisions on high risk of bias from lack of blinding and imprecision of effect estimates.

AUTHORS' CONCLUSIONS

Induction of labour for suspected fetal macrosomia has not been shown to alter the risk of brachial plexus injury, but the power of the included studies to show a difference for such a rare event is limited. Also antenatal estimates of fetal weight are often inaccurate so many women may be worried unnecessarily, and many inductions may not be needed. Nevertheless, induction of labour for suspected fetal macrosomia results in a lower mean birthweight, and fewer birth fractures and shoulder dystocia. The unexpected observation in the induction group of increased perineal damage, and the plausible, but of uncertain significance, observation of increased use of phototherapy, both in the largest trial, should also be kept in mind.Findings from trials included in the review suggest that to prevent one fracture it would be necessary to induce labour in 60 women. Since induction of labour does not appear to alter the rate of caesarean delivery or instrumental delivery, it is likely to be popular with many women. In settings where obstetricians can be reasonably confident about their scan assessment of fetal weight, the advantages and disadvantages of induction at or near term for fetuses suspected of being macrosomic should be discussed with parents.Although some parents and doctors may feel the evidence already justifies induction, others may justifiably disagree. Further trials of induction shortly before term for suspected fetal macrosomia are needed. Such trials should concentrate on refining the optimum gestation of induction, and improving the accuracy of the diagnosis of macrosomia.

Waist-to-Hip Ratio versus Body Mass Index as Predictor of Obesity-Related Pregnancy Outcomes

Objective In nonpregnant populations the waist-to-hip ratio (WHR) is a better predictor of obesity-related outcomes than body mass index (BMI). Our objective was to determine, in pregnancy, the relationship between these measures of obesity, and large-for-gestational age (LGA) and cesarean delivery (CD). Methods This is a secondary analysis of data from the Combined Antioxidant and Preeclampsia Prediction Study. Women with a WHR of ≥ 0.85 and 0.80 to 0.84 at 9 to 16 weeks gestation were compared with those with a WHR < 0.80. Women with early pregnancy BMI ≥ 30.0 kg/m(2) (obese) and 25.0 to 29.9 kg/m(2) (overweight) were compared with those < 25.0 kg/m(2). LGA was defined as > 90% by Alexander nomogram. Univariable analysis, logistic regression, and receiver operating characteristic curves were used. Results Data from 2,276 women were analyzed. After correcting for potential confounders, only BMI ≥ 30 was significantly associated with LGA (adjusted odds ratio [aOR]: 2.07, 1.35-3.16) while BMI 25.0-29.9 (aOR: 1.5, 0.98-2.28), WHR 0.8-0.84 (aOR: 1.33, 0.83-2.13), and WHR ≥ 0.85 (aOR: 1.05, 0.67-1.65) were not. Risk for CD was increased for women with elevated WHR and with higher BMI compared with normal. Conclusion WHR is not associated with LGA. While BMI performed better than WHR, neither was a strong predictor of LGA or need for CD in low-risk nulliparous women.

Regimens of fetal surveillance of suspected large-for-gestational-age fetuses for improving health outcomes

BACKGROUND

Policies and protocols vary widely for fetal surveillance in a pregnancy where the fetus is suspected to be large-for-gestational-age (LGA). All ultimately culminate in decisions about the mode and timing of birth. LGA is known to be associated with increased risks to both the mother and baby. Interventions based on surveillance regimen findings may be associated with risks to the mother and baby.

OBJECTIVES

To assess the effectiveness or efficacy of different antenatal surveillance methods for the suspected LGA fetus on important health outcomes for the mother and baby.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 August 2015), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (21 August 2015).

SELECTION CRITERIA

Published and unpublished randomised, quasi-randomised and cluster-randomised trials comparing the effects of described antenatal fetal surveillance regimens for women with suspected LGA infants.

DATA COLLECTION AND ANALYSIS

We identified no studies that met the inclusion criteria for this review.

MAIN RESULTS

There are no included trials.

AUTHORS' CONCLUSIONS

We found no randomised controlled trials that assessed the effect of antenatal fetal surveillance regimens of a suspected LGA fetus on important health outcomes for the mother and baby.There has been a rise in the prevalence of LGA babies over the past few decades in many countries. Research is therefore required on regimens of antenatal surveillance of suspected LGA infants, in order to guide practice and improve the health outcomes for the mother and infant. In particular, randomised control trials to investigate whether serial antenatal clinic and ultrasound assessments of suspected LGA infants (including liquor volume and markers of fetal adiposity) would be useful, to assess whether surveillance methods improve health outcomes. In addition, as there are concerns that identifying suspected LGA fetuses may lead to unnecessary maternal anxiety, investigations and interventions, any such trial would need to assess the risks as well as benefits of regimens of fetal surveillance for suspected LGA fetuses.

Exploring the Role of Different Neonatal Nutrition Regimens during the First Week of Life by Urinary GC-MS Metabolomics

In this study, a gas-chromatography mass spectrometry (GC-MS) metabolomics study was applied to examine urine metabolite profiles of different classes of neonates under different nutrition regimens. The study population included 35 neonates, exclusively either breastfed or formula milk fed, in a seven-day timeframe. Urine samples were collected from intrauterine growth restriction (IUGR), large for gestational age (LGA), and appropriate gestational age (AGA) neonates. At birth, IUGR and LGA neonates showed similarities in their urine metabolite profiles that differed from AGA. When neonates started milk feeding, their metabolite excretion profile was strongly characterized by the different diet regimens. After three days of formula milk nutrition, urine had higher levels of glucose, galactose, glycine and myo-inositol, while up-regulated aconitic acid, aminomalonic acid and adipic acid were found in breast milk fed neonates. At seven days, neonates fed with formula milk shared higher levels of pseudouridine with IUGR and LGA at birth. Breastfed neonates shared up-regulated pyroglutamic acid, citric acid, and homoserine, with AGA at birth. The role of most important metabolites is herein discussed.

Investigating the metabolic fingerprint of term infants with normal and increased fetal growth

An NMR metabolomic approach was employed to highlight the metabolic changes underlying prenatal disorders and determine metabolites that could serve as potential markers in relation to large for gestational age (LGA) newborns.

Investigation of the ¹H-NMR based urine metabolomic profiles of IUGR, LGA and AGA newborns on the first day of life

(1)H-NMR spectroscopy coupled with multivariate statistical analysis was used for the first time to compare the urinary NMR metabolic profiles of neonates with intrauterine growth retardation (IUGR) and large for gestational age (LGA). For the sake of comparison, infants who were adequate for gestational age (AGA) were also analyzed. Pattern recognition methods, including Principal Component Analyses (PCA), Partial Least Squares Discriminant Analysis (PLS-DA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA), were used to analyze NMR data. Clear differences among the metabolic profiles of AGA, IUGR and LGA were observed. The main metabolites responsible for these differentiations were identified as myo-inositol, creatinine, creatine, citrate, urea and glycine. In particular, among these, myo-inositol may be a potential biomarker of an altered glucose metabolism during fetal development both in IUGR and LGA. This study highlights the applicability of NMR-based metabolomics for improving the understanding of the relations among nutrition, integrated metabolism and health in neonatology.

The biomarkers of fetal growth in intrauterine growth retardation and large for gestational age cases: from adipocytokines to a metabolomic all-in-one tool

Adipose tissue is no longer considered as inert; the literature describes the role it plays in the production of many substances, such as adiponectin, visfatin, ghrelin, S100B, apelin, TNF, IL-6 and leptin. These molecules have specific roles in humans and their potential as biomarkers useful for identifying alterations related to intrauterine growth retardation and large for gestational age neonates is emerging. Infants born in such conditions have undergone metabolic changes, such as fetal hypo- or hyperinsulinemia, which may lead to development of dysmetabolic syndrome and other chronic diseases in adulthood. In this review, these biomarkers are analyzed specifically and it is discussed how metabolomics may be an advantageous tool for detection, discrimination and prediction of metabolic alterations and diseases. Thus, a holistic approach, such as metabolomics, could help the prevention and early diagnosis of metabolic syndrome.

Comparison of neonatal outcomes in macrosomic infants of diabetic and non-diabetic mothers

OBJECTIVE

To compare the neonatal outcomes in macrosomic term infants of diabetic mothers and non-diabetic mothers.

METHODS

This is a retrospective survey of all live-born term singletons with a birth weight ≥4000 g, admitted at Tianjin Medical University General Hospital between 2010 and 2013. Data collected for the mothers included age, parity, gestational age, method of glycemic control and mode of delivery. Data for the infants included sex, birth weight, birth length, duration of hospital stay and laboratory tests. Outcomes were compared between infants of diabetic mothers (IDMs) and infants of non-diabetic mothers (Non-IDMs). All data were analyzed using Statistical Package for Social Sciences (SPSS) 17.0.

RESULTS

One hundred and eleven infant-mother pairs met the inclusion criteria. Fifty-seven were IDMs while 54 were non-IDMs. Seven (12.28%) of the IDMs were delivered vaginally while 50 (87.72%) were delivered via Caesarian section (CS). Seventeen (31.48%) of the non-IDMs were delivered vaginally while 37 (68.51%) were delivered by CS. Respiratory distress was the most common morbidity affecting 52.6% of the IDMs and 40.7% of the non-IDMs. Hyperbilirubinemia was observed in 49.1% of the IDMs and 14.8% of the non-IDMs. Hypoglycemia affected 38.6% of the IDMs and 7.4% of the non-IDMs. Cardiac enzymes were higher in IDMs than in non-IDMs. On average, IDMs had a longer duration of hospital stay.

CONCLUSION

Macrosomic IDMs in comparison to macrosomic non-IDMs are at an increased risk for adverse neonatal outcomes.