Factors associated with fetal macrosomia

Perinatal factors and early neonatal outcomes of abnormal birthweight infants in Hangzhou, China, 2015-2021: a retrospective cohort study

BACKGROUND

This study aimed to investigate the perinatal factors and early neonatal outcomes of abnormal birth weight (ABW) in Hangzhou, China from 2015 to 2021.

METHODS

A retrospective cohort study was designed to analyse the data of 76 847 newborns, in which the case groups included 3042 cases of low birth weight (LBW) and 2941 cases of fetal macrosomia (MAC), and 70 864 cases of normal weight were as the reference group.

RESULTS

The incidence of LBW and MAC was 3.96% and 3.83% in Hangzhou, China from 2015 to 2021. Prematurity (<37 weeks), multiple births, hospitalisation >7 days, fetal anomalies, caesarean section, pregnancy complications, maternal coinfection with pathogens and summer births would be correlated with the incidence of LBW (ORs=43.50, 7.60, 2.09, 1.89, 1.57, 1.28, 1.19 and 1.18, all p<0.05). Factors such as post-term pregnancy (>41 weeks), scarred uterus, anterior vaginal incision and gravidity ≥2 were correlated with decreased incidence of LBW, with ORs of 0.05, 0.54, 0.65 and 0.80. Moreover, caesarean delivery, post-term pregnancy (> 41 weeks), parity ≥1, lateral vaginal incision, gravidity ≥2, hospitalisation >7 days, winter births and pregnancy complications also have association with the incidence of MAC (ORs=3.92, 2.73, 2.19, 1.87, 1.22, 1.20, 1.17 and 1.13, all p<0.05) while prematurity (<37 weeks), scarred uterus and anterior vaginal incision have close association with decreased incidence of MAC, with ORs of 0.07, 0.21 and 0.74 (all p<0.05).

CONCLUSION

There was a trend of yearly increase in ABW in Hangzhou, China from 2015 to 2021. Several neonatal and maternal-related variables such as caesarean section, pregnancy complications and hospitalisation >7 days are associated with the odds of LBW and MAC, however, factors such as pregnancy with scarred uterus relate to the decrease of ABW. Close monitoring and intervention during pregnancy are essential to reduce the occurrence of ABW.

Comparisons of the Rates of Large-for-Gestational-Age Newborns between Women with Diet-Controlled Gestational Diabetes Mellitus and Those with Non-Gestational Diabetes Mellitus

(1) Objectives: The primary objective is to compare the rate of large-for-gestational-age (LGA) between women with diet-controlled gestational diabetes mellitus (GDM) and those with non-GDM, and to assess whether or not diet-controlled GDM is an independent factor of LGA fetuses. The secondary objectives are to compare the rates of other common adverse pregnancy outcomes, such as preeclampsia, cesarean section rate, preterm birth, and low Apgar score, between pregnancies with diet-controlled GDM and non-GDM pregnancies. (2) Methods: A retrospective cohort study was conducted on singleton pregnancies, diagnosed with GDM and non-GDM between 24 and 28 weeks of gestation, based on a two-step screening test. The prospective database of the obstetric department was accessed to retrieve the records meeting the inclusion criteria, and full medical records were comprehensively reviewed. The patients were categorized into two groups, GDM (study group) and non-GDM (control group). The main outcome was the rate of LGA newborns, and the secondary outcomes included pregnancy-induced hypertension, preterm birth, cesarean rate, low Apgar scores, etc. (3) Results: Of 1364 recruited women, 1342 met the inclusion criteria, including 1177 cases in the non-GDM group and 165 (12.3%) in the GDM group. Maternal age and pre-pregnancy BMI were significantly higher in the GDM group. The rates of LGA newborns, PIH, and cesarean section were significantly higher in the GDM group (15.1% vs. 7.1%, p-value < 0.001; 7.8% vs. 2.6%, p-value = 0.004; and 54.5% vs. 41.5%, p-value = 0.002; respectively). On logistic regression analysis, GDM was not significantly associated with LGA (odds ratio 1.64, 95% CI: 0.97-2.77), while BMI and gender were still significantly associated with LGA. Likewise, GDM was not significantly associated with the rate of PIH (odds ratio: 1.7, 95% CI: 0.825-3.504), while BMI and maternal age were significantly associated with PIH, after controlling confounding factors. (4) Conclusions: The rates of LGA newborns, PIH, and cesarean section are significantly higher in women with diet-controlled GDM than those with non-GDM. Nevertheless, the rates of LGA newborns and PIH are not directly caused by GDM but mainly caused high pre-pregnancy BMI and advanced maternal age, which are more commonly encountered among women with GDM.

Fetal weight estimation based on deep neural network: a retrospective observational study

BACKGROUND

Improving the accuracy of estimated fetal weight (EFW) calculation can contribute to decision-making for obstetricians and decrease perinatal complications. This study aimed to develop a deep neural network (DNN) model for EFW based on obstetric electronic health records.

METHODS

This study retrospectively analyzed the electronic health records of pregnant women with live births delivery at the obstetrics department of International Peace Maternity & Child Health Hospital between January 2016 and December 2018. The DNN model was evaluated using Hadlock's formula and multiple linear regression.

RESULTS

A total of 34824 live births (23922 primiparas) from 49896 pregnant women were analyzed. The root-mean-square error of DNN model was 189.64 g (95% CI 187.95 g-191.16 g), and the mean absolute percentage error was 5.79% (95%CI: 5.70%-5.81%), significantly lower compared to Hadlock's formula (240.36 g and 6.46%, respectively). By combining with previously unreported factors, such as birth weight of prior pregnancies, a concise and effective DNN model was built based on only 10 parameters. Accuracy rate of a new model increased from 76.08% to 83.87%, with root-mean-square error of only 243.80 g.

CONCLUSIONS

Proposed DNN model for EFW calculation is more accurate than previous approaches in this area and be adopted for better decision making related to fetal monitoring.

The Effect of Maternal Race, Ethnicity, and Nativity on Macrosomia Among Infants Born in the United States

OBJECTIVES

 This study aims to elucidate the influence of race, ethnicity, and nativity on macrosomia rates, hypothesizing that higher rates are observed among White non-Latina mothers and United States (US)-born mothers.

STUDY DESIGN

 We analyzed data from 1,791,718 US births sourced from the National Center for Health Statistics of the Centers for Disease Control and Prevention. Logistic regression analyses were conducted to examine the associations between macrosomia rates and maternal race, ethnicity, and nativity.

RESULTS

 After excluding non-singleton, preterm, post-term births, and those with missing data, six maternal cohorts were identified: White non-Latina US-born (1,147,096) and foreign-born (75,542), Black non-Latina US-born (174,540) and foreign-born (32,200), and Latina US-born (223,968) and foreign-born (137,515). White non-Latina US-born mothers had the highest rates of excessive gestational weight gain (58.9%). Black non-Latina US-born mothers exhibited the highest rates of pre-pregnancy diabetes (0.7%) and obesity (29.5%). Macrosomia rates were highest among White non-Latina US-born mothers (10.7%) compared to other cohorts. After adjusting for socioeconomic and health-related factors, this group maintained the highest odds of macrosomia (OR: 1.876; 95%CI 1.832-1.922, P<0.001).

CONCLUSION

Our findings reveal that White non-Latina US-born mothers experience the highest macrosomia rates, which persist after adjusting for known confounders. These results have significant implications for the development of gestational surveillance tools and targeted public health interventions aimed at improving pregnancy outcomes among high-risk cohorts.

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

AIM: This study aims to identify possible risk factors and concurrently investigates how macrosomia impacts mothers and neonates. STUDY DESIGN: The study is a retrospective cohort of data obtained in a large tertiary obstetrics and neonatal unit over 1 year, from anuary 1, 2019 to December 31, 2019. Data of all deliveries conducted at the institution were accessed. In addition, singleton and term pregnancies were included for further analysis. Multiple pregnancies, premature births, stillbirths, non-vertex presentations, and being lost to follow-up served as exclusion criteria. A database of the cases was constructed and data regarding maternal constitutional parameters, mode of delivery, shoulder dystocia, perineal trauma, and postpartum hemorrhage were collected. Further on, pregnancies were divided accordingly into two groups: Macrosomic fetuses (>4000 g) and non-macrosomic fetuses (<4000 g). The two groups were compared to assess possible macrosomia risk factors and maternal-neonatal outcomes. Statistical analysis is done using the Mann–Whitney-U and Chi-square tests. Significance was set as p < 0.05. RESULTS: A total of 3408 deliveries met the inclusion criteria of the study. The macrosomia rate is 10.3%. The mean age (30.1 ± 5.17 years vs. 28.9 ± 8.4 years, p < 0.05) and, body mass index (29.2 ± 3.54 vs. 26.1 ± 2.78, p < 0.05) was significantly higher in the macrosomia group. Women that gained more than 12.5 kg have nearly twice the odds of delivering a big baby (odds ratio [OR] 1.86, confidence interval [CI] 1.47–2.36, p < 0.001). No statistically significant differences were noted regarding cases of gestational diabetes (p = 0.56). Cesarean sections were preferred to vaginal deliveries in the macrosomic group (39.3% vs. 29.7%, OR 1.53, CI 1.2–1.9, p = 0.001). The risk of undergoing an emergency procedure is 6-fold higher in pregnancies with macrosomic newborns (20.5% vs. 13.6%, OR 6.1, CI 4.45–8.36, p < 0.001). Both episiotomy rate (40.45% vs. 31.9%, OR 1.44, CI 1.15–1.81, p = 0.001) and lacerations (3.13 % vs. 1.44%, OR 2.21, CI 1.13–4.33, p = 0.02) were higher in the macrosomic group. CONCLUSION: The study concludes that macrosomia is associated with an increase in maternal and neonatal adverse outcomes.

Gestational diabetes mellitus according to different diagnostic criteria: Prevalence and related factors

OBJECTIVE

Gestational diabetes mellitus (GDM) has an impact on maternal health; however, there is no consensus about the diagnostic criterion and frequency of disease. The objective of this study was to estimate the prevalence of GDM and to evaluate the clinical characteristics of normoglycemic pregnant women and of those diagnosed with gestational diabetes mellitus, based on each criterion.

METHODS

Prospective cohort study. Third-trimester pregnant women participated, with the occurrence of GDM being verified, according to two different diagnostic criteria. Prevalence was estimated in each category, and the prevalence ratios (PR) and 95% confidence intervals were adjusted using Poisson Regression.

RESULTS

A total of 8.7% of women were diagnosed with GDM (glycemia ≥95) and 8% had glycemic levels ≥92mg/dL according to IADPSG diagnosis. Factors related to the disease were the same, although the magnitude of the associations differed according to the diagnosis criteria. Pre-gestational obesity (PR 3.59 CI 1.28-10,07), previous diseases (PR 3.03 CI 1.15-7.94), and excessive weight gain (PR 4.71 CI 1.80-12.33) were factors related to total GDM, plus low nutritional knowledge (PR 3.17 CI 1.10-9.11). Regardless of the diagnostic criterion, women with GDM were at higher risk of intercurrences during pregnancy.

CONCLUSION

Nutritional knowledge and status were associated with GDM occurrence, independently of the diagnosis criteria. The adoption of the glycemic cutoff point of ≥ 92mg/dL indicated an important portion of the population without a diagnosis, suggesting that this cutoff point, more sensitive, should be used in order to guide women and minimize untoward outcomes.

Extreme fetal macrosomia at 42 gestational weeks: a case report and literature review

Objectives

Fetal macrosomia is a term to describe excessive fetal birth weight. Fetal macrosomia is strongly associated with adverse obstetrical outcome.

Case presentation

We report a rare case of excessive neonatal weight in a medically unsupervised pregnancy and give a literature review on this significant subject. A 38 year-old woman (Gravida 8 Para 7) presented herself at 42 2/7 weeks of gestation at the labor ward. The pregnancy had not been supervised medically. Labor induction was initiated. Due to failure to progress and suspicion of a disproportion of the fetal head and maternal pelvis an urgent caesarean section was performed. A morbidly macrosomic male infant was delivered (birth weight: 6,760 g [>99. percentile], length: 60 cm [>99. percentile]).

Conclusions

The morbidity for infants and women increases with a birth weight exceeding 4,500 g. Gestational diabetes mellitus, a high pre-pregnancy body mass index and excessive gestational weight gain have been independently associated as risk factors. The increase in pregnancies complicated by maternal obesity and gestational diabetes emphasizes the necessity of evidence-based clinical interventions to prevent or reduce these diseases. If prenatal care is not frequented by mothers-to-be there are no options open for obstetricians to detect fetal macrosomia and to intervene.

Protective Effect of Maternal First-Trimester Low Body Mass Index Against Macrosomia: A 10-Year Cross-Sectional Study

OBJECTIVE

We aimed to assess whether maternal first-trimester low body mass index (BMI) has a protective effect against macrosomia.

METHODS

This was a cross-sectional study from January 1, 2011, to June 30, 2021, and 84,900 participants were included. The predictive performance of maternal first-trimester and parental pre-pregnancy BMI for macrosomia was assessed using the area under the receiver-operating characteristics curve (AUC). Multivariate logistic regression analyses were performed to evaluate the independent effect of maternal first-trimester low BMI on macrosomia. Interactions were investigated to evaluate the potential variation of the effect of first-trimester low BMI across different groups. Furthermore, interactions were also examined across groups determined by multiple factors jointly: a) gestational diabetes mellitus (GDM)/GDM history status, parity, and maternal age; and b) GDM/GDM history status, fetal sex, and season of delivery.

RESULTS

The proportion of macrosomia was 6.14% (5,215 of 84,900). Maternal first-trimester BMI showed the best discrimination of macrosomia (all Delong tests: P < 0.001). The protective effect of maternal first-trimester low BMI against macrosomia remained significant after adjusting for all confounders of this study [adjusted odds ratios (aOR) = 0.37, 95% CI: 0.32-0.43]. Maternal first-trimester low BMI was inversely associated with macrosomia, irrespective of parity, fetal sex, season of delivery, maternal age, and GDM/GDM history status. The protective effect was most pronounced among pregnant women without GDM/GDM history aged 25 to 29 years old, irrespective of parity (multipara: aOR = 0.32, 95% CI: 0.22-0.47; nullipara: aOR = 0.32, 95% CI: 0.24-0.43). In multipara with GDM/GDM history, the protective effect of low BMI was only observed in the 30- to 34-year-old group (aOR = 0.12, 95% CI: 0.02-0.86). For pregnant women without GDM/GDM history, the protective effect of maternal first-trimester low BMI against macrosomia was the weakest in infants born in winter, irrespective of fetal sex (female: aOR = 0.45, 95% CI: 0.29-0.69; male: aOR = 0.39, 95% CI: 0.28-0.55).

CONCLUSION

Maternal first-trimester low BMI was inversely associated with macrosomia, and the protective effect was most pronounced among 25- to 29-year-old pregnant women without GDM/GDM history and was only found among 30- to 34-year-old multipara with GDM/GDM history. The protective effect of maternal first-trimester low BMI against macrosomia was the weakest in winter among mothers without GDM/GDM history.

Comportamiento frente a la alimentación en un grupo de gestantes con exceso de peso en dos poblaciones en Antioquia, Colombia: estudio cualitativo

Objetivo:

Describir el comportamiento, frente a la alimentación, de un grupo de gestantes con exceso de peso.

Materiales y métodos:

Estudio cualitativo, desde la perspectiva de etnografía enfocada. Se incluyeron mujeres gestantes mayores de 18 años con sobrepeso u obesidad, o ganancia excesiva de peso en el embarazo, y que asistieron al programa de control prenatal de dos instituciones públicas de salud pertenecientes al régimen subsidiado por el Estado en el Sistema General de Seguridad Social, en dos municipios del departamento de Antioquia (Colombia). Se realizaron 13 entrevistas semiestructuradas individuales y tres entrevistas grupales. Análisis por triangulación y codificación abierta y axial.

Resultados:

Participaron 22 mujeres gestantes. Se encontraron cinco factores que condicionan el comportamiento alimentario de esta población: el nivel socioeconómico bajo que limita el acceso a una alimentación variada, la red social de apoyo, el estado de salud en los embarazos previos o en la gestación actual, las recomendaciones genéricas brindadas por el personal de salud sobre alimentación y nutrición, y, por último, los conocimientos de las participantes sobre alimentación y las implicaciones del exceso de peso materno en la salud madre-hijo.

Conclusión:

Es imperante que la atención y educación alimentaria y nutricional sean brindadas desde las particularidades que inciden en la adopción de cambios del comportamiento alimentario de las mujeres embarazadas con exceso de peso; los profesionales del control prenatal deben contar con capacitación que promueva la unificación de criterios y una atención adaptada a la realidad social de la gestante.

Factors associated with small- and large-for-gestational-age in socioeconomically vulnerable individuals in the 100 Million Brazilian Cohort

BACKGROUND

Evidence points to diverse risk factors associated with small- (SGA) and large-for-gestational-age (LGA) births. A more comprehensive understanding of these factors is imperative, especially in vulnerable populations.

OBJECTIVES

To estimate the occurrence of and sociodemographic factors associated with SGA and LGA births in poor and extremely poor populations of Brazil.

METHODS

The study population consisted of women of reproductive age (14-49 y), whose last child was born between 2012 and 2015. INTERGROWTH 21st consortium criteria were used to classify weight for gestational age according to sex. Multinomial logistic regression modeling was performed to investigate associations of interest.

RESULTS

Of 5,521,517 live births analyzed, SGA and LGA corresponded to 7.8% and 17.1%, respectively. Multivariate analysis revealed greater odds of SGA in children born to women who self-reported as black (OR: 1.21; 95% CI: 1.19, 1.22), mixed-race (parda) (OR: 1.08; 95% CI: 1.07, 1.09), or indigenous (OR: 1.11; 95% CI: 1.06, 1.15), were unmarried (OR: 1.08; 95% CI: 1.07, 1.08), illiterate (OR: 1.47; 95% CI: 1.42, 1.52), did not receive prenatal care (OR: 1.57; 95% CI: 1.53, 1.60), or were aged 14-20 y (OR: 1.21; 95% CI: 1.20, 1.22) or 35-49 y (OR: 1.12; 95% CI: 1.10, 1.13). Considering LGA children, higher odds were found in infants born to women living in households with ≥3 inadequate housing conditions (OR: 1.11; 95% CI: 1.10, 1.12), in indigenous women (OR: 1.22; 95% CI: 1.19, 1.25), those who had 1-3 y of schooling (OR: 1.18; 95% CI: 1.17, 1.19), 1-3 prenatal visits (OR: 1.16; CI 95%: 1.14, 1.17), or were older (OR: 1.26; 95% CI: 1.25, 1.27).

CONCLUSIONS

In poorer Brazilian populations, socioeconomic, racial, and maternal characteristics are consistently associated with the occurrence of SGA births, but remain less clearly linked to the occurrence of LGA births.

The Role of Maternal Weight in the Hierarchy of Macrosomia Predictors; Overall Effect of Analysis of Three Prediction Indicators

So far it has not been established which maternal features play the most important role in newborn macrosomia. The aim of this study is to provide assessment of a hierarchy of twenty six (26) maternal characteristics in macrosomia prediction. A Polish prospective cohort of women with singleton pregnancy (N = 912) which was recruited in the years 2015–2016 has been studied. Two analyses were performed: for probability of macrosomia > 4000 g (n = 97) (vs. 755 newborns 2500–4000 g); and for birthweight > 90th percentile (n = 99) (vs. 741 newborns 10–90th percentile). A multiple logistic regression was used (with 95% confidence intervals (CI)). A hierarchy of significance of potential predictors was established after summing up of three prediction indicators (NRI, IDI and AUC) calculated for the basic prediction model (maternal age + parity) extended with one (test) predictor. ‘Net reclassification improvement’ (NRI) focuses on the reclassification table describing the number of women in whom an upward or downward shift in the disease probability value occurred after a new factor had been added, including the results for healthy and ill women. ‘Integrated discrimination improvement’ (IDI) shows the difference between the value of mean change in predicted probability between the group of ill and healthy women when a new factor is added to the model. The area under curve (AUC) is a commonly used indicator. Results. The macrosomia risk was the highest for prior macrosomia (AOR = 7.53, 95%CI: 3.15–18.00, p < 0.001). A few maternal characteristics were associated with more than three times higher macrosomia odds ratios, e.g., maternal obesity and gestational age ≥ 38 weeks. A different hierarchy was shown by the prediction study. Compared to the basic prediction model (AUC = 0.564 (0.501–0.627), p = 0.04), AUC increased most when pre-pregnancy weight (kg) was added to the base model (AUC = 0.706 (0.649–0.764), p < 0.001). The values of IDI and NRI were also the highest for the model with maternal weight (IDI = 0.061 (0.039–0.083), p < 0.001), and (NRI = 0.538 (0.33–0.746), p < 0.001). Adding another factor to the base model was connected with significantly weaker prediction, e.g., for gestational age ≥ 38 weeks (AUC = 0.602 (0.543–0.662), p = 0.001), (IDI = 0.009 (0.004; 0.013), p < 0.001), and (NRI = 0.155 (0.073; 0.237), p < 0.001). After summing up the effects of NRI, IDI and AUC, the probability of macrosomia was most strongly improved (in order) by: pre-pregnancy weight, body mass index (BMI), excessive gestational weight gain (GWG) and BMI ≥ 25 kg/m². Maternal height, prior macrosomia, fetal sex-son, and gestational diabetes mellitus (GDM) occupied an intermediate place in the hierarchy. The main conclusions: newer prediction indicators showed that (among 26 features) excessive pre-pregnancy weight/BMI and excessive GWG played a much more important role in macrosomia prediction than other maternal characteristics. These indicators more strongly highlighted the differences between predictors than the results of commonly used odds ratios.

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.