High birthweight births at University Hospital Olomouc (1993–2010)

Česká verzia

Authors: M. Větr
Authors place of work: Gynekologicko-porodnická klinika FN, Olomouc, přednosta doc. MUDr. R. Pilka, Ph. D.
Published in the journal: Ceska Gynekol 2012; 77(6): 579-588

Summary

Objective:
Evaluation of risk factors of fetal macrosomia and assess possible consequences of high birth weight at parturition and the newborn state.

Design:
A retrospective epidemiological cohort study.

Setting:
Department of Gynaecology and Obstetrics, Faculty of Medicine and University Hospital Olomouc.

Methods:
Evaluation of 26 789 maternal and newborn records of the singleton pregnancy with birth weight of 2500 g and above in the time interval from 1. 1. 1993 to 12. 31. 2010 at University Hospital in Olomouc. The study was excluded multiple pregnancies and low birth weight children.

Compare the neonate weighing 4000 g or more with a control group of infants 2500–3999 g.

Results:
The prevalence of macrosomia in the selected set of 26 789 pregnant women was 10.3%(2747 newborns). Significant and multivariate analysis identified the independent risk of: 1. gestational age over 40 weeks 18.3% vs. 8.3% (RR = 1.26, 95% CI 1.22 to 1.29, P = 0.00000000), 2. male sex 13.5% vs. 6.8% (RR = 1.98, 95% CI 1.84 to 2.14, P = 0.00000000), 3. diabetes mellitus, 16.7% vs. 10.1% (RR = 1.65, 95% CI 1.38 to 1.98, P = 0.00000000), 4. weight gain over 19 kg (x + SD) 19.2% vs. 9.3% (RR = 2.05, 95% CI 1.87 to 2.24, P = 0.00000000), 5. multiparity 12.5% vs. 7.9% (RR = 1.59, 95% CI 1.47 to 1.71,P = 0.00000000), 6. BMI over 22.4 (cutoff) 14.6% vs. 7.2% (RR = 2.04, 95% CI 1.88 to 2.20,P = 0.00000000), 7. obesity (BMI over 30 kg/m²) 19.5% vs. 9.8% (RR = 1.91, 95% CI 1.70 to 2.15,P = 0.00000000), 8. weight gain over 14 kg (cutoff) 14.3% vs. 8.3% (RR = 1.78, 95% CI 1.65 to 1.93, P = 0.00000000), 9. marital status – married 10.8% vs. 8.8% (RR = 1.22, 95% CI 1.12 to 1.33,P = 0.00000271). Independent protective factor in relation to macrosomia was low maternal education (basic school) 7.0% vs. 10.5% (RR = 0.66, 95% CI 0.57 to 0.77, P = 0.00000010). Maternal age or other factors evaluated showed not to be independent risk factors. Operative delivery of a large babies were significantly more common compared with the control group, 27.3% vs. 22.1% (RR 1.24, 95% CI 1.16 to 1.32, P = 0.00000000). Caesarean section 20.8% vs. 16.6% (RR 1.25, 95% CI 1.16 to 1.36,P = 0.00000003), vacuum extraction 4.4% vs. 3.4% (RR = 1.30; 95% CI 1.08 to 1.57, P = 0.00622233).The frequency of forceps deliveries in both groups compared was the same, 2.1% (RR = 1.00, 95% CI 0.75 to 1.33, P = 0.95676855). Fetal macrosomia was not a major cause of rising invasive methods in obstetrics, which occurred in recent years. Evaluation of the newborn health status in both weight classes had not significant differences.

Conclusion:
There was no significant change in the prevalence of births of large babies over the study period. Gestational age over 40 weeks, male sex, parity, physique, higher maternal weight gain and diabetes mellitus are independent risk factors of high birthweight births. The increase in operative births in recent years is comparable in both groups.

Key words:
pregnancy, macrosomia, BMI, weight gain, risks, complications.

Zdroje

1. Ahlsson, F., Diderholm, B., Jonsson, B., et al. Insulin resistance, a link between maternal overweight and fetal macrosomia in nondiabetic pregnancies. Horm Res Paediatr, 2010, 74, 4, p. 267–274.

2. Akin, MA., Cobanm D., Doganay, S., et al. Intrahepatic and adrenal hemorrhage as a rare cause of neonatal anemia. J Perinat Med, 2011, 39, 3, p. 353–354.

3. Alanis, MC., Goodnight, WH., Hill, EG., et al. Maternal super-obesity (body mass index > or = 50) and adverse pregnancy outcomes. Acta Obstet Gynecol Scand, 2010, 89, 7, 924–930.

4. Barber, EL., Lundsberg, LS., Belanger, K., et al. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol, 2011, 118, 1, p. 29–38.

5. Bjørstad, AR., Irgens-Hansen, K., Daltveit, AK., Irgens, LM. Macrosomia: mode of delivery and pregnancy outcome. Acta Obstet Gynecol Scand, 2010, 89, 5, p. 664–669.

6. Bozkurt, N., Başgül Yigiter, A., Gokaslan, H., Kavak, ZN. Correlations of fetal-maternal outcomes and first trimester 3-D placental volume/3-D power Doppler calculations. Clin Exp Obstet Gynecol, 2010, 37, 1, p. 26–28.

7. Catalano, PM., Hauguel-De Mouzon, S. Is it time to revisit the Pedersen hypothesis in the face of the obesity epidemic? Am J Obstet Gynecol, 2011, 204, 6, p. 479–487.

8. Denguezli, W., Faleh, R., Fessi, A., et al. Risk factors of fetal macrosomia: role of maternal nutrition. Tunis Med, 2009, 87, 9, p. 564–568.

9. El Fekih, C., Mourali, M., Ouerdiane, N., et al. Maternal and fetal outcomes of large fetus delivery: A comparative study. Br J Nutr, 2010, 104, 2, p. 153–159.

10. Gillman, MW., Oakey, H., Baghurst, PA., et al. Effect of treatment of gestational diabetes mellitus on obesity in the next generation. Diabet Care, 2010, 33, 5, p. 964–968.

11. Han, YS., Ha, EH., Park, HS., et al. Relationships between pregnancy outcomes, biochemical markers and pre-pregnancy body mass index. Int J Obes (Lond), 2011, 35, 4, p. 570–577.

12. Herrera, E., Ortega-Senovilla, H. Disturbances in lipid metabolism in diabetic pregnancy – Are these the cause of the problem? Best Pract Res Clin Endocrinol Metab, 2010, 24, 4, p. 515–525.

13. Hatfield, L., Schwoebel, A., Lynyak, C. Caring for the infant of a diabetic mother. MCN Am J Matern Child Nurs, 2011, 36, 1, p. 10–16.

14. Hinkle, SN., Sharma, AJ., Dietz, PM. Gestational weight gain in obese mothers and associations with fetal growth. Am J Clin Nutr, 2010, 92, 3, p. 644–651.

15. Hussain, AA., Yakoob, MY., Imdad, A., Bhutta, ZA. Elective induction for pregnancies at or beyond 41 weeks of gestation and its impact on stillbirths: a systematic review with meta-analysis. BMC Public Health, 2011, 11, Suppl. 3, p. S5.

16. Chaouachi, S., Ben Hamida, E., Belhaj, R., et al. Postpartum levels of glycosylated hemoglobin in mothers of large baby: a prospective study. Tunis Med, 2009, 87, 9, p. 589–592.

17. Kessler, J., Rasmussen, S., Godfrey, K., et al. Venous liver blood flow and regulation of human fetal growth: evidence from macrosomic fetuses. Am J Obstet Gynecol, 2011, 204, 5, p. 429.e1–7

18. Lapolla, A., Bonomo, M., Dalfrà, MG., et al. Prepregnancy BMI influences maternal and fetal outcomes in women with isolated gestational hyperglycaemia: a multicentre study. Diabetes Metab, 2010, 36, 4, p. 265–270.

19. Li, G., Fan, L., Zhang, L., et al. Metabolic parameters and perinatal outcomes of gestational diabetes mellitus in women with polycystic ovary syndrome. J Perinat Med, 2010, 38, 2, p. 141–146.

20. Lim, JH., Tan, BC., Jammal, AE., Symonds, EM. Delivery of macrosomic babies: management and outcomes of 330 cases. LJ Obstet Gynaecol, 2002, 22, 4, p. 370–374.

21. Ludwig, DS., Currie, J. The association between pregnancy weight gain and birthweight: a within-family comparison. Lancet, 2010, 376, 9745, p. 984–990.

22. Malý, Z., Grosmanová, A., Pulkrábková, S. Vliv porodní hmotnosti na morbiditu novorozence a matky u expektativniho pristupu k poterminove gravidite. Čes Gynek, 2002, 67, Suppl. 1, s. 20–22.

23. Mandal, D., Manda, S., Rakshi, A., et al. Maternal obesity and pregnancy outcome: a prospective analysis. J Assoc Physicians India, 2011, 59, p. 486–489.

24. Mantakas, A., Farrell, T. The influence of increasing BMI in nulliparous women on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol, 2010, 153, 1, p. 43–46.

25. McGowan, CA., McAuliffe, FM. The influence of maternal glycaemia and dietary glycaemic index on pregnancy outcome in healthy mothers. Br J Nutr, 2010, 104, 2, p. 153–159.

26. Mulder, EJ., Koopman, CM., Vermut, JK. Fetal growth trajectories in type-1 diabetic pregnancy. Ultrasound Obstet Gynecol, 2010, 36, 6, p. 735–742.

27. Pietro, L., Doher, S., Rudge, MV., et al. Vascular endothelial growth factor (VEGF) and VEGF-receptor expression in placenta of hyperglycemic pregnant women. Placenta, 2010, 31, 9, p. 770–780.

28. Poon, LC., Karagiannis, G., Stratieva, V., et al. First-trimester prediction of macrosomia. Fetal Diagn Ther, 2011, 29, 2, p. 139–147.

29. Ragnarsdottir, LH., Conroy, P. Development of macrosomia resulting from gestational diabetes mellitus: physiology and social determinants of health. Adv Neonatal Care, 2010, 10, 1, p. 7–12.

30. Vasudevan, C., Renfrew, M., McGuire, W. Fetal and perinatal consequences of maternal obesity. Arch Dis Child Fetal Neonatal Ed, 2011, 96, 5, p. 378–382.

31. Větr, M. Rizikové faktory porodů dětí nejvyšší hmotnostní kategorie. Čes Gynek, 2005, 70, 5, s. 347–354.

32. Větr, M. Laboratorní a klinické ukazatele stavu novorozence po porodu. Čes Gynek, 2010, 75, 5, s. 447–454.

33. Voigt, M., Rochow, N., Jährig, K., et al. Dependence of neonatal small and large for gestational age rates on maternal height and weight – an analysis of the German Perinatal Survey. Perinat Med, 2010, 38, 4, p. 425–430.

34. Wang, J., Wang, PH., Shang, LX., et al. Relationship of adiponectin and resistin levels in umbilical and maternal serum with fetal macrosomia. Obstet Gynaecol Res, 2010, 36, 3, p. 533–537.

35. Zhang, X., Joseph, KP., Kramer, MP. Decreased term and postterm birthweight in the United States: impact of labor induction. Am J Obstet Gynecol, 2010, 203, 2, p. 124.e1–7.