Birth weight, neonatal care, and infant mortality: Evidence from macrosomic babies.

This study demonstrates that rule-of-thumb health treatment decision-making exists when assigning medical care to macrosomic newborns with an extremely high birth weight and estimates the short-run health return to neonatal care for infants at the high end of the birth weight distribution. Using a regression discontinuity design, we find that infants born with a birth weight above 5000 grams have a 2 percentage-point higher probability of admission to a neonatal intensive care unit and a 1 percentage-point higher probability of antibiotics receipt, compared to infants with a birth weight below 5000 grams. We also find that being born above the 5000-gram cutoff has a mortality-reducing effect: infants with a birth weight larger than 5000 grams face a 0.15 percentage-point lower risk of mortality in the first week and a 0.20 percentage-point lower risk of mortality in the first month, compared to their counterparts with a birth weight below 5000 grams. We do not find any evidence of changes in health treatments and mortality at macrosomic cutoffs lower than 5000 grams, which is consistent with the idea that such treatment decisions are guided by the higher expected morbidity and mortality risk associated with infants weighing more than 5000 grams.

Performance of different fetal growth charts in prediction of large-for-gestational age and associated neonatal morbidity in multiethnic obese population.

OBJECTIVES: To examine the performance of different fetal growth charts in the prediction of large-for-gestational age (LGA) and associated neonatal morbidity at term in a multiethnic, obese population. METHODS: This was a retrospective cohort study of 253 non-anomalous, singleton, term pregnancies that underwent serial third-trimester ultrasound scans due to maternal body mass index ≥ 35 kg/m2 . We compared the performance of the Hadlock, Gestation Related Optimal Weight (GROW), INTERGROWTH-21st (IG-21), World Health Organization (WHO) and Fetal Medicine Foundation (FMF) fetal growth reference charts in the prediction of LGA at birth, defined as birth weight > 90th percentile, and neonatal morbidity, defined as a composite of neonatal intensive care unit admission or 5-min Apgar score < 7. RESULTS: In the study population, 53 (20.9%) infants were born LGA, 27 (10.7%) experienced neonatal morbidity and nine (3.6%) were LGA with associated neonatal morbidity. The Hadlock and GROW charts showed similar performance in predicting LGA, with sensitivity of 66.0% for both and specificity of 82.5% and 83.5%, respectively. The positive likelihood ratios (LR+) were 3.77 (95% CI, 2.64-5.40) and 4.00 (95% CI, 2.77-5.78), respectively. The IG-21, WHO and FMF charts performed similarly and had higher sensitivity of about 85%, with specificity between 66% and 72%. LR+ was 2.74 (95% CI, 2.16-3.47), 2.50 (95% CI, 2.00-3.12) and 3.03 (95% CI, 2.36-3.89), respectively. All charts had high sensitivity for predicting neonatal morbidity associated with LGA, with LR+ ranging between 2.35 and 3.61. CONCLUSIONS: In our multiethnic, obese population, all fetal growth charts performed well in predicting LGA and associated neonatal morbidity. However, the choice of fetal reference chart is likely to affect intervention rates. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Large-for-gestational age and stillbirth: is there a role for antenatal testing?

OBJECTIVE: To investigate the association between large-for-gestational-age (LGA) pregnancy and stillbirth to determine if the LGA fetus may benefit from antenatal testing with non-stress test or biophysical profile. METHODS: This was a retrospective cohort study of singleton pregnancies that were ongoing at 24 weeks' gestation and that had undergone routine second-trimester anatomy ultrasound examination, during the period 1990 to 2009. Pregnancies complicated by fetal anomaly or aneuploidy, those with missing birth weight information and those that were small-for-gestational age were excluded. Appropriate-for-gestational age (AGA) and LGA were defined as birth weight between the 10th and 90th percentiles and > 90th percentile, respectively, according to the Alexander growth standard. The incidence of stillbirth was calculated as the number of stillbirths per 10 000 ongoing pregnancies. Adjusted odds ratios (aOR) with 95% CI for stillbirth in LGA compared with AGA pregnancies were estimated using logistic regression analysis, controlling for pre-existing and gestational diabetes. The incidence and aOR for stillbirth were estimated at 4-week intervals from ≥ 24 to ≥ 40 weeks' gestation. RESULTS: Of 52 749 pregnancies ongoing at 24 weeks, 46 205 (87.6%) were AGA and 6544 (12.4%) were LGA at delivery. The incidence of stillbirth in LGA pregnancies was significantly higher than that in AGA pregnancies from 36 weeks' gestation (26/10 000 vs 7/10 000; aOR, 3.10; 95% CI, 1.68-5.70). When women with diabetes were excluded in stratified analysis, pregnancies complicated by LGA continued to be at increased risk for stillbirth ≥ 36 weeks (18/10 000 vs 7/10 000; OR, 2.63; 95% CI, 1.27-5.43). CONCLUSION: Pregnancies complicated by LGA are at significantly increased risk for stillbirth at or beyond 36 weeks, independent of maternal diabetes status, and may benefit from antenatal testing. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Universal vs selective ultrasonography to screen for large-for-gestational-age infants and associated morbidity.

OBJECTIVES: To compare the diagnostic effectiveness of selective vs universal ultrasonography as a screening test for large-for-gestational-age (LGA) infants, and to determine whether previously described ultrasound markers of excessive fetal growth could identify suspected LGA fetuses that are at increased risk of adverse neonatal outcome. METHODS: Data from the Pregnancy Outcome Prediction study, a prospective cohort study of nulliparous women with a viable singleton pregnancy at the time of the dating ultrasound scan, were analyzed. Women were selected for clinically indicated ultrasound assessment in the third trimester as per routine clinical care, and the results of these scans were reported ('selective ultrasonography'). In addition, all participants underwent research ultrasound scans, including estimated fetal weight (EFW) assessment, at around 36 weeks' gestation, in which both the women and their clinicians were blinded to the results ('universal ultrasonography'). Participants who attended the 36-week research scan and had a live birth at the Rosie Hospital were included in the study. Screen positive for LGA was defined as EFW > 90th percentile at ≥ 34 weeks. RESULTS: The current analysis included 3866 eligible women, of whom 1354 (35%) had a clinically indicated ultrasound scan at or after 34 weeks' gestation. A total of 177 (4.6%) infants had a birth weight > 90th percentile. The sensitivity for detection of LGA infants was 27% for selective ultrasonography and 38% for universal ultrasonography. The specificity of both approaches was high (99% and 97%, respectively). Using universal ultrasonography, neonatal outcome differed (P for interaction) by abdominal circumference growth velocity (ACGV) for both any neonatal morbidity (P = 0.08) and severe adverse neonatal outcome (P = 0.03). LGA fetuses with increased ACGV had a relative risk of any neonatal morbidity of 2.0 (95% CI, 1.1-3.6; P = 0.04) and of severe adverse neonatal outcome of 6.5 (95% CI, 2.0-21.1; P = 0.01), whereas LGA fetuses with normal ACGV were not at increased risk. CONCLUSIONS: Third-trimester screening of nulliparous women by universal ultrasound fetal biometry increases the detection rate of LGA infants and, combined with ACGV, identifies those at increased risk of adverse neonatal outcome. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Neonatal Morbidity of Small- and Large-for-Gestational-Age Neonates Born at Term in Uncomplicated Pregnancies.

OBJECTIVE: To compare morbidity among small-for-gestational-age (SGA; birth weight less than the 10th percentile for gestational age), appropriate-for-gestational-age (AGA; birth weight 10th to 90th percentile; reference group), and large-for-gestational-age (LGA; birth weight greater than the 90th percentile) neonates in apparently uncomplicated pregnancies at term (37 weeks of gestation or greater). METHODS: This secondary analysis, derived from an observational obstetric cohort of 115,502 deliveries, included women with apparently uncomplicated pregnancies of nonanomalous singletons who had confirmatory ultrasound dating no later than the second trimester and who delivered between 37 0/7 and 42 6/7 weeks of gestation. We used two different composite neonatal morbidity outcomes: hypoxic composite neonatal morbidity for SGA and traumatic composite neonatal morbidity for LGA neonates. Log Poisson relative risks (RRs) with 95% CIs adjusted for potential confounding factors (nulliparity, body mass index, insurance status, and neonatal sex) were calculated. RESULTS: Among the 63,436 women who met our inclusion criteria, SGA occurred in 7.9% (n=4,983) and LGA in 8.3% (n=5,253). Hypoxic composite neonatal morbidity was significantly higher in SGA (1.1%) compared with AGA (0.7%; adjusted RR 1.44, 95% CI 1.07-1.93) but similar between LGA (0.6%) and AGA (adjusted RR 0.84, 95% CI 0.58-1.22). Traumatic composite neonatal morbidity was significantly higher in LGA (1.9%) than AGA (1.0%; adjusted RR 1.88, 95% CI 1.51-2.34) but similar in SGA (1.3%) compared with AGA (adjusted RR 1.28, 95% CI 0.98-1.67). CONCLUSION: Among women with uncomplicated pregnancies, hypoxic composite neonatal morbidity is more common with SGA neonates and traumatic-composite neonatal morbidity is more common with LGA neonates.

Macrosomic births in abuja: A case-control study of predisposing factors and early neonatal outcome.

BACKGROUND: Although research has shown that having a macrosomic fetus could be predictive of a negative pregnancy outcome, the factors that control its incidence and the outcome of delivery management have been less well characterized in Africa. The aim of this study was to identify specific predispositions and the factors that influence the early neonatal outcome of macrosomic infants in Abuja. METHODS: Data from 120 mother and macrosomic (weighing ≥4000 g) newborn pairs, and an equal number of mother and normal weight (2500-3999 g) matched controls, delivered over a 5-month period at three large hospitals in Abuja, Nigeria, were analyzed. Chi-square and logistic regression analyses were performed for various predisposing factors and neonatal outcomes of macrosomic births. RESULTS: The incidence of macrosomia was 77 per 1000 births. Independent predictors of macrosomia were parental high social class (P = 0.000), gestational weight gain of ≥15 kg (P = 0.000), and previous history of macrosomia (P = 0.002). The most frequent route of delivery was emergency cesarean section accounting for 51 (42%) births. Macrosomia was significantly associated with higher rates of birth injuries (P = 0.030), perinatal asphyxia (P = 0.015), admissions into the special care newborn unit (P = 0.000), and hypoglycemia (P = 0.000). Although the difference in the early neonatal mortality rates between the macrosomic group (2.5%) and the control group (0.8%) was not statistically significant, nearly 70% of deaths in the macrosomic group were associated with severe perinatal asphyxia. CONCLUSION: Our findings highlight the need for improved anticipatory care of the macrosomic fetus at delivery, in Africa.

Temporary hindlimb paresis following dystocia due to foetal macrosomia in a Celebes crested macaque (Macaca nigra).

A multiparous Celebes crested macaque presented with dystocia due to foetal macrosomia, causing foetal mortality and hindlimb paresis. After emergency caesarean section, recovery of motor function took 1 month before hindlimbs were weight bearing and 2 months before re-integration with the troop.

Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010.

BACKGROUND: Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related. METHODS: This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340), other First Nations (n = 10,810) and non-Aboriginal (n = 229,960) communities in Quebec, 1996-2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality. RESULTS: Macrosomia (birth weight for gestational age >90th percentile) was substantially more frequent in Cree (38.0%) and other First Nations (21.9%) vs non-Aboriginal (9.4%) communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1.52 (95% confidence intervals 1.17, 1.98) and 1.34 (1.10, 1.64) times higher, and infant mortality rates 2.27 (1.71, 3.02) and 1.49 (1.16, 1.91) times higher, respectively. The risk elevations in perinatal and infant death in Cree communities attenuated after adjusting for maternal characteristics (age, education, marital status, parity), but became greater after further adjustment for birth weight (small, appropriate, or large for gestational age). CONCLUSIONS: Cree communities had greater risk elevations in perinatal and infant mortality than other First Nations relative to non-Aboriginal communities in Quebec. High prevalence of macrosomia did not explain the elevated risk of perinatal and infant mortality in Cree communities.

Predictive macrosomia birthweight thresholds for adverse maternal and neonatal outcomes.

OBJECTIVE: We examined the predictive macrosomia birthweight thresholds for adverse maternal and neonatal outcomes. STUDY DESIGN: This was a multicenter, retrospective cohort study conducted in China. We selected 178 709 singletons weighing ≥2500 g with gestational age 37-44 weeks. We categorized macrosomia with two gradations (4000-4499 g and ≥4500 g) and compared them with a normosomic reference group of infants with birthweight 2500-3999 g. RESULTS: The risks of obstetric and neonatal complications increased when infants had a birthweight of ≥4000 g. The rates of infant mortality, Apgar score ≤3 at 5 min, respiratory and neurological disorders rose significantly among neonates weighing ≥4500 g. CONCLUSION: A definition of macrosomia as birthweight ≥4000 g could be beneficial as an indicator of obstetric and newborn complications, and birthweight ≥4500 g might be predictive of severe infant morbidity and mortality risk.

Morbilidad y mortalidad materna y perinatal en pacientes con macrosomía fetal / Maternal and perinatal morbidity and mortality in patients with foetal macrosomia

Introducción: la macrosomía fetal se ha encontrado asociada a una mayor morbilidad y mortalidad, tanto infantil como materna.Objetivo: identificar la morbilidad y mortalidad materna y perinatal presente en pacientes con macrosomía fetal.Métodos: se realizó un estudio transversal descriptivo para identificar la morbilidad y la mortalidad materna y perinatal presente en pacientes con macrosomía fetal en el Hospital Universitario Ginecobstétrico Mariana Grajales de Santa Clara, Villa Clara, enero de 2009 a diciembre del 2010, el universo de trabajo quedó conformado por todas las pacientes que tuvieron un parto de macrosómico 557, el cual coincidió con la muestra, las variables incluidas fueron: morbilidad y mortalidad materna y perinatal, momento del diagnóstico, tipo de parto, grado de la macrosomía y trauma al nacer. Se utilizó la estadística descriptiva e inferencial resumiéndose la información en forma de tablas.Resultados: la hemorragia obstétrica fue la principal morbilidad materna 80 casos (58,0 por ciento), el trauma al nacer fue la morbilidad perinatal más frecuente con 33 casos (41,8 por ciento) y no existió asociación estadística significativa entre el trauma al nacer y el grado de macrosomía con X2= 43.4 y p=0.120.Conclusiones: en el periodo de estudio se observó en las pacientes con macrosomía fetal: morbilidad materna, relacionada con hemorragia posparto y morbilidad perinatal, relacionada con trauma al nacer, el grado de la macrosomía y el trauma al nacer fueron variables independientes(AU)

Introduction: foetal macrosomia has been associated with higher morbidity and mortality rates, in both the infant and the mother.Objective: to identify maternal and perinatal morbidity and mortality in patients with foetal macrosomia.Methods: across-sectional descriptive study was performed to identify maternal and foetal morbidity and mortality in patients with foetal macrosomia, at Mariana Grajales Gynaecobstetric University Hospital of Santa Clara City, Villa Clara Province, from January 2009 to December 2010. The sample group was made up of all the patients who had macrosomic labor (557), which coincided with the sample. The variables included were maternal and perinatal morbidity and mortality, moment of the diagnosis, type of labor, degree of macrosomia and birth trauma. Descriptive and inferential statistics were used; and the information was summarized in charts.Results: obstetrical haemorrhage was the main cause of maternal morbidity (80 cases, 58.0 percent), birth trauma was the most frequent perinatal morbidity (33 cases, 42.8 percent) and there was not any significant statistical relationship between birth trauma and the degree of macrosomia (X2= 43.4 y p=0.120).Conclusions: in the period of study, the patients with foetal macrosomia presented, as it was observed: maternal morbidity, associated to postpartum haemorrhage; and perinatal morbidity, associated to birth trauma. The degree of macrosomia and birth trauma were independent variables(AU)

Macrosomic and low birth weight neonates in Pacific Islanders from Samoa: a case-control study.

BACKGROUND: To assess the perinatal morbidity and mortality of macrosomic (>4500 g) and low birth weight (LBW) (<2500 g) neonates in a Pacific Islander population (PIP) from Samoa compared to a Caucasian population (CP). METHODS: Case-control study. Clinical data were extracted by chart review. RESULTS: In 3166 (PIP) and 2101 (CP) deliveries, macrosomia was more prevalent and LBW less prevalent in the PIP [76/3166 (2.4 %) vs. 21/2101 (0.9 %); p < 0.0001 and 149/3166 (4.7 %) vs. 163/2101 (7.7 %); p < 0.0001, respectively]. Among macrosomic neonates, perinatal mortality and composite severe neonatal morbidity (CNM) were higher in the PIP compared to the CP [2/76 (3 %) vs. 0/21 (0 %) and 6/76 (7 %) vs. 1/21 (4 %), respectively]. Among LBW neonates, mortality, but not CNM, was significantly higher in the PIP [16/149 (7 %) vs. 2/163 (1 %), p < 0.0001 and 10/149 (6 %) vs. 5/163 (3 %), p = 0.2, respectively]. The proportion of macrosomic neonates transferred to the Neonatal Intensive Care Unit was significantly higher in the PIP [50/76 (65 %) vs. 0/21 (0 %), p < 0.0001]. Age, body mass index, and delivery mode did not independently predict CNM. CONCLUSION: Samoan women have higher rates of macrosomia and lower rates of LBW compared to Caucasians, suggesting an anthropomorphic basis of this phenomenon.

Searching for the definition of macrosomia through an outcome-based approach.

BACKGROUND: Macrosomia has been defined in various ways by obstetricians and researchers. The purpose of the present study was to search for a definition of macrosomia through an outcome-based approach. METHODS: In a study of 30,831,694 singleton term live births and 38,053 stillbirths in the U.S. Linked Birth-Infant Death Cohort datasets (1995-2004), we compared the occurrence of stillbirth, neonatal death, and 5-min Apgar score less than four in subgroups of birthweight (4000-4099 g, 4100-4199 g, 4200-4299 g, 4300-4399 g, 4400-4499 g, 4500-4999 g vs. reference group 3500-4000 g) and birthweight percentile for gestational age (90th-94th percentile, 95th-96th, and ≥ 97th percentile, vs. reference group 75th-90th percentile). RESULTS: There was no significant increase in adverse perinatal outcomes until birthweight exceeded the 97th percentile. Weight-specific odds ratios (ORs) elevated substantially to 2 when birthweight exceeded 4500 g in Whites. In Blacks and Hispanics, the aORs exceeded 2 for 5-min Apgar less than four when birthweight exceeded 4300 g. For vaginal deliveries, the aORs of perinatal morbidity and mortality were larger for most of the subgroups, but the patterns remained the same. CONCLUSIONS: A birthweight greater than 4500 g in Whites, or 4300 g in Blacks and Hispanics regardless of gestational age is the optimal threshold to define macrosomia. A birthweight greater than the 97th percentile for a given gestational age, irrespective of race is also reasonable to define macrosomia. The former may be more clinically useful and simpler to apply.

Caracterización de la morbi-mortalidad de los neonatos cuyo peso oscila entre 4000-4500 gr. según el tipo de parto en el Hospital Nacional Daniel Alcides Carrión entre Enero a Diciembre del 2012 / Characterization of the morbidity and mortality of newborn whose weight ranges between 4000-4500 g depending on the type of labor in the National Hospital Daniel Alcides Carrion between January to December 2012

Objetivo: Caracterizar la morbi-mortalidad de los neonatos cuyo peso oscila entre 4000-4500 gr. según el tipo parto en el Hospital Nacional Daniel Alcides Carrión entre enero y diciembre del 2012. Métodos: Estudio de tipo observacional, descriptivo, transversal y retrospectivo. Se incluyó a todas las madres cuyo parto fue atendido entre enero y diciembre del 2012 y cuyos productos hayan pesado entre 4000 y 4500 gramos en el servicio de Ginecología y Obstetricia del Hospital Nacional Daniel A. Carrión. Se revisó las historias clínicas de las madres y los neonatos y se analizaron las variables según la vía de parto (vaginal o cesárea). La investigación fue aprobada por el Comité Ético y Metodológico del HNDAC. Resultados: Se recolectaron los datos de 180 pares de madres y sus neonatos. La media de edad de las madres fue de 27.31 ± 6.7 años. El 33.6 por ciento de las madres tuvieron algún antecedente de aborto y 12.5 por ciento algún antecedente de macrosomia. La vía de parto más común fue la vía vaginal con un 73.4 por ciento, mientras que la vía vaginal representó un 26.6 por ciento de los partos. Con respecto a las complicaciones neonatales, existieron mayores complicaciones en la vía vaginal (6.67 por ciento) en comparación con los partos por cesárea (5.26 por ciento); sin embargo la diferencia encontrada no fue significativa. Al análisis bivariado se encontró diferencias significativas entre el número de gestaciones previas (p=0.004), la multiparidad (p=0.002), la obesidad materna (p=0.002), la talla al nacer (p=0.003); siendo estas mayores en los partos nacidos por vía vaginal; mientras que se encontró un mayor número de casos de sufrimiento fetal agudo (p=0.004) en los neonatos nacidos de cesárea. Conclusiones: Los partos de neonatos cuyo peso oscila entre 4000 y 4500 gr cursan con complicaciones tanto obstétricas como perinatales, sin embargo no se encontró diferencias según la vía de parto. Variables como el número de gestaciones previas, la...

Objective: To characterize the morbidity and mortality of neonates weighing between 4000-4500 g according to the type of delivery in Daniel Alcides Carrion National Hospital between January and December 2012. Methods: An observational, descriptive, cross-sectional and retrospective study. We included all mothers and neonates whose birth was attended between January and December 2012 and whose products have weighed between 4000 and 4500 grams in the service of Gynecology and Obstetrics Hospital National Daniel A. Carrion. Medical records of the mothers and infants were reviewed and variables were analyzed according to mode of delivery (vaginal or cesarean). The research was approved by the Ethical and Methodological Committee of HNDAC. Results: Data from 180 pairs of mothers and their infants were collected. The mean age of the mothers was 27.31 ± 6.7 years. 33.6 per cent of the mothers had a history of abortion and 12.5 per cent a history of macrosomia. The most common route of delivery was vaginal with 73.4 per cent, while the vaginal represented 26.6 per cent of births. Regarding neonatal complications, no major complications were found in vaginal (6.67 per cent) compared with cesarean deliveries (5.26 per cent), been the difference not significant. In bivariate analysis, significant differences between the number of previous pregnancies (p=0.004), multiparity (p=0.002), maternal obesity (p=0.002), birth length (p=0.003) was found, being higher in these births born vaginally, while a greater number of cases of acute fetal distress (p=0.004) in infants born cesarean was found. Conclusions: The births of infants weighing between 4000 and 4500 g present with both obstetric and perinatal complications, however no differences were found according to the route of delivery. Variables such as the number of previous pregnancies, multiparity and maternal obesity are related to the completion of vaginal delivery. An association between acute fetal distress and birth...

Is prenatal identification of fetal macrosomia useful?

OBJECTIVES: To determine whether prenatal identification of macrosomia (≥4000g) reduces neonatal complications and maternal perineal lesions during delivery. STUDY DESIGN: This historical cohort study (n=14,684 from the National perinatal database of the Audipog Association, France) included women with cephalic singleton term pregnancies. Among the babies born with macrosomia, we compared those who had been identified as such in utero (n=1211) with those who were not (n=13,473). The principal outcome was a composite variable defined as resuscitation in the delivery room, death in the delivery room or the immediate postpartum period, or transfer to a neonatal intensive care unit (NICU). The secondary outcome measures were neonatal trauma, 5-min Apgar score (≤4 and <7), and maternal perineal lesions. Results are expressed as crude relative risks and adjusted odds ratios. RESULTS: The mean birthweight in the cohort was 4229g±219. The adjusted OR for the principal outcome defined above was 1.15 (95% CI: 0.89-1.50) in the group identified prenatally as macrosomic compared with the others (10.8% vs. 8.5%). The risk of neonatal trauma was higher in prenatally identified babies (adjusted OR: 1.80; 95% CI: 1.34-2.42). The 5-min Apgar score and the perineal lesion rate did not differ significantly between the groups. The a posteriori study power according to our results with α=0.05 was 84% (one-sided test). CONCLUSIONS: Among babies born with macrosomia, in utero identification did not improve neonatal or maternal outcomes.

Aberrant fetal growth and early, late, and postneonatal mortality: an analysis of Milwaukee births, 1996-2007.

OBJECTIVE: The objective of the study was to ascertain the association between fetal growth (small- [SGA], appropriate- [AGA], and large-for-gestational-age [LGA]) and early, late, and postneonatal mortality. STUDY DESIGN: Birth certificate data for nonanomalous singletons, delivered from 1996 to 2007, were obtained for Milwaukee residents. Multivariate logistic regression analyses, adjusted for 19 covariates, determined the association between fetal growth and mortality. RESULTS: Among the 123,383 live births, SGA was 57% higher than LGA (11% vs 7%). The infant mortality rate for SGA was 11.0, AGA, 5.3, and LGA, 2.7/1000 live births. SGA was a significant risk factor for early (adjusted odds ratio, 2.66) and late (2.06) but not postneonatal mortality. The adjusted risk of mortality for LGA was not significantly different from AGA. Over 12 years, 3 types of mortality for aberrant fetal growth did not change significantly. CONCLUSION: In the city of Milwaukee, aberrant fetal growth was variably associated with early, late, and postneonatal mortality.

Fetal and maternal factors associated with infant mortality in vervet monkeys.

BACKGROUND: Causes of infant death remain unknown in significant proportions of human and non-human primate pregnancies. METHODS: A closed breeding colony with high rates of infant mortality had pregnancies assessed (n=153) by fetal measurements and maternal characteristics. Infant outcome was classified as neonatal death (stillborn or died <48 hours from birth), postnatal death (died 2-30 days) or surviving (alive after 30 days). RESULTS: Fetal size did not predict outcome. Poor maternal glycemic control and low social ranking increased odds for adverse outcome (OR=3.72, P=0.01 and 2.27, P=0.04, respectively). Male sex was over-represented in stillbirths (P=0.04), and many were macrosomic, but size did not associate with maternal glycemic control measured as glycated hemoglobin A1c. Postnatally dead infants were smaller (P<0.01), which associated with behavioral factors and glycemic control. CONCLUSIONS: Fetal growth estimates predicted gestational age but not fetal outcome. Maternal social status and metabolic health, particularly glycemic control, increased risks of adverse pregnancy outcome.

Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria.

BACKGROUND: Infants born to diabetic women have certain distinctive characteristics, including large size and high morbidity risks. The neonatal mortality rate is over five times that of infants of non diabetic mothers and is higher at all gestational ages and birth weight for gestational age (GA) categories.The study aimed to determine morbidity and mortality pattern amongst infants of diabetic mothers (IDMS) admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital. METHODS: This was a study of prevalence of morbidity and mortality among IDMs carried out prospectively over a two year period. All IDMs (pregestational and gestational) admitted into the Unit within the period were recruited into the study.Data on delivery mode, GA, birth weight, other associated morbidities, investigation results, treatment, duration of hospital stay and outcome were collated and compared with those of infants of non diabetic mothers matched for GA and birth weight admitted within the same period. Maternal data were reviewed retrospectively. Data were analyzed using SPSS 16.0. RESULTS: Sixty percent of the IDMs were born to mothers with gestational diabetes, while 40% were born to mothers with pregestational DM. 38 (74.3%) were born by Caesarian section (CS), of which 20 (52.6%) were by emergency CS. There was no significant difference in emergency CS rates, when compared with controls, but non-IDMs were more likely to be delivered vaginally. The mean GA of IDMs was 37.84 weeks ± 1.88. 29 (61.7%) of them were macrosomic. The commonest morbidities were Hypoglycemia (significantly higher in IDMs than non-IDMs) and hyperbilirubinaemia in 30 (63.8%) and 26 (57.4%) respectively.There was no difference in morbidity pattern between infants of pre- gestational and gestational diabetic mothers. Mortality rate was not significantly higher in IDMs CONCLUSIONS: The incidence of macrosomia in IDMs was high but high rates of emergency CS was not peculiar to them. Hypoglycaemia and hyperbilirubinaemia were the commonest morbidities in IDMs.Referring women with unstable metabolic control to specialized centers improves pre- and post- natal outcomes. Maternal-Infant centers for management of diabetes in pregnancy are advocated on a national scale to reduce associated morbidity and mortality.

Perinatal outcome of macrosomic births in Port Harcourt.

BACKGROUND: Macrosomic babies are at increased risk of adverse perinatal outcome and therefore constitute a high risk group of neonates and the incidence appears to be rising. The objective was to determine the incidence of fetal macrosomia, and the perinatal outcome of macrosomic babies, compare with matched term, appropriate weight neonates in the booked antenatal population of the UPTH. METHODS: It was a one year prospective study of the perinatal outcome of singleton babies whose birth weights were 4000 g and above (macrosomia) delivered to booked antenatal mothers in UPTH between 1st October 2003 and 30th September 2004, comparing them with term appropriate (2500-3999 g) weight babies. The birth weight, sex, perinatal and maternal complications documented from direct observations, questioning and other information extracted from patients' case notes, were entered into a personal computer, analysed and presented as frequency tables, percentages, Chi-square X2, calculated as appropriate using Epi info version 3.4.3 statistical software. P < 0.05 was considered statistically significant. RESULTS: Fetal macrosomia occurred in 354 out of 2417 singleton term deliveries, giving an incidence of 1 in 7 deliveries or 14.65%. The birth asphyxia (7.90% vs 2.60%, p = 0.011), Neonatal admission (29.54% vs 2.85%, p = 0.001) and perinatal mortality (48/1000 vs 23/1000 births, p = 0.001), caesarean delivery (55.70% vs 18.64%, p = 0.001) rates were significantly higher in the macrosomic than the control group. CONCLUSION: There is a high incidence of fetal macrosomia in Port Harcourt with associated relatively higher adverse perinatal outcome compared to singleton term normal weight babies.

Infants of diabetic mothers with abnormal fetal growth missed by standard growth charts.

Diabetic pregnancies may result in fetal macrosomia when glycaemia is poorly controlled, and when associated with diabetic vasculopathy, with small for gestational age (SGA) neonates. Both groups of infants have high neonatal morbidity. As fetal growth depends on maternal genetic influences, ethnic group or parity, relying exclusively on population-based growth charts may wrongly categorise the growth pattern of these infants. We compared neonatal morbidity and mortality of a cohort of 214 infants of diabetic mothers (IDM), identified either by population standards or by customised birth weight percentiles (adjusted for maternal height, booking weight, parity, ethnic origin, gestational age at delivery and sex). A total of 68 (31.8%) were diagnosed with macrosomia, 11 (16%) of whom were identified by the customised growth method alone, and 16 were diagnosed as SGA (7.5%), of whom the majority (13 or 81.2%) were identified by the customised growth method alone. None had increased mortality and morbidity.

Lack of prenatal care: an independent risk factor for perinatal mortality among macrosomic newborns.

OBJECTIVE: To examine the association between lack of prenatal care (LOPC) and perinatal complications among parturients carrying macrosomic fetuses. STUDY DESIGN: The study population consisted of consecutive women with singleton fetuses weighing 4 kg and above, delivered between the years 1988 and 2003. A comparison was performed between parturients lacking prenatal care (fewer than three visits at any prenatal care facility) and those with three and more prenatal care visits. A multiple logistic regression model was constructed in order to investigate the association between LOPC and perinatal mortality. RESULTS: During the study period, 7,332 women delivered macrosomic newborns in our institute. Of those, 8.0% (n = 590) lacked prenatal care. Patients lacking prenatal care were more likely to be Bedouins, of higher parity and older than the comparison group. Higher rates of perinatal mortality were noted among patients lacking prenatal care (OR = 5.4, 95%CI 2.8-10.5; P < 0.001). Using a multivariable analysis and controlling for macrosomia-related complications, it was found that the association between LOPC and perinatal mortality persisted (OR = 4.1, 95% CI 2.1-8.1; P < 0.001). CONCLUSION: Lack of prenatal care is an independent risk factor for perinatal mortality among macrosomic newborns.