Download PDF
Am J Perinatol 2017; 34(07): 655-662
DOI: 10.1055/s-0036-1597325
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Large for Gestational Age Infants and Adverse Outcomes among Uncomplicated Pregnancies at Term

Hector Mendez-Figueroa
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
,
Van Thi Thanh Truong
2   Center for Clinical Research & Evidence-Based Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
,
Claudia Pedroza
2   Center for Clinical Research & Evidence-Based Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
,
Suneet P. Chauhan
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
› Author Affiliations
Further Information

Publication History

06 September 2016

03 November 2016

Publication Date:
07 December 2016 (online)

    Permissions and Reprints

Abstract

Background While traumatic delivery with large for gestational age (LGA; birth weight above 90%) is acknowledged, there is paucity of data regarding other morbidity and mortality associated with LGA. Our hypothesis was that compared with appropriate for gestational age (AGA), LGA have a significantly higher rate of composite neonatal morbidity (CNM).

Objective Our objective was to compare the CNM among uncomplicated LGA versus AGA at term (37 weeks or more) among all available Maternal-Fetal Medicine Units (MFMU) databases. We excluded women who delivered before 37 weeks, those with hypertension or diabetes, multiple gestations, and known anomalies, and those with birth weight less than 10% for GA. Using multivariable analysis, we compared the CNM between LGA and AGA. Random-effect logistic regressions were used to account for study heterogeneity, with adjustment for potential confounders. We calculated adjusted odds ratio (aOR) and 95% confidence intervals (CI).

Results Approximately 60% (n = 50,734) of all participants met inclusion criteria. Among uncomplicated pregnancies, the rate of LGA was 12.1%. The rate of CNM was 15% in LGA and 10% in AGA (aOR: 1.58; 95% CI: 1.46–1.70). The likelihood of stillbirth and neonatal mortality was similar among both groups. Subgroup analysis revealed that CNM was increased among both birth weight > 95% and birth weight 90 to 95% and at different GA at delivery.

Conclusion Among uncomplicated pregnancies at term, LGA newborns, compared with AGA, have a significantly higher likelihood of CNM but similar stillbirth and neonatal death risk. Trials are warranted to determine appropriate management of LGA to decrease these risks.

Keywords

macrosomia - LGA - morbidity - mortality
 

  • References

  • 1 Chatfield J ; American College of Obstetricians and Gynecologists. ACOG issues guidelines on fetal macrosomia. Am Fam Physician 2001; 64 (1) 169-170
    PubMedGoogle Scholar
  • 2 Chauhan SP, Grobman WA, Gherman RA , et al. Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol 2005; 193 (2) 332-346
    CrossrefPubMedGoogle Scholar
  • 3 Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the United States: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol 2003; 188 (5) 1372-1378
    Google Scholar
  • 4 Mendez-Figueroa H, Truong VT, Pedroza C, Khan AM, Chauhan SP. Small-for-gestational-age infants among uncomplicated pregnancies at term: a secondary analysis of 9 Maternal-Fetal Medicine Units Network studies. Am J Obstet Gynecol 2016; 215 (5) 628.e1-628 .e7
    CrossrefPubMedGoogle Scholar
  • 5 Chen HY, Chauhan SP, Ward TC, Mori N, Gass ET, Cisler RA. Aberrant fetal growth and early, late, and postneonatal mortality: an analysis of Milwaukee births, 1996-2007. Am J Obstet Gynecol 2011; 204 (3) 261.e1-261 .e10
    CrossrefPubMedGoogle Scholar
  • 6 ACOG Practice Bulletin No. ACOG practice bulletin no. 102: management of stillbirth. Obstet Gynecol 2009; 113 (3) 748-761
    CrossrefPubMedGoogle Scholar
  • 7 Bukowski R, Hansen NI, Willinger M , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network. Fetal growth and risk of stillbirth: a population-based case-control study. PLoS Med 2014; 11 (4) e1001633 . DOI: 10.1371/journal.pmed.1001633.
    CrossrefPubMedGoogle Scholar
  • 8 Hill AB. The environment and disease: association or causation?. Proc R Soc Med 1965; 58: 295-300
    PubMedGoogle Scholar
  • 9 Sibai BM, Caritis SN, Thom E , et al; The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. N Engl J Med 1993; 329 (17) 1213-1218
    CrossrefPubMedGoogle Scholar
  • 10 Goldenberg RL, Mercer BM, Meis PJ, Copper RL, Das A, McNellis D ; NICHD Maternal Fetal Medicine Units Network. The preterm prediction study: fetal fibronectin testing and spontaneous preterm birth. Obstet Gynecol 1996; 87 (5 Pt 1): 643-648
    CrossrefPubMedGoogle Scholar
  • 11 Caritis S, Sibai B, Hauth J , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Low-dose aspirin to prevent preeclampsia in women at high risk. N Engl J Med 1998; 338 (11) 701-705
    CrossrefPubMedGoogle Scholar
  • 12 Meis PJ, Klebanoff M, Thom E , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003; 348 (24) 2379-2385
    CrossrefPubMedGoogle Scholar
  • 13 Landon MB, Hauth JC, Leveno KJ , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004; 351 (25) 2581-2589
    CrossrefPubMedGoogle Scholar
  • 14 Rouse DJ, Hirtz DG, Thom E , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (9) 895-905
    CrossrefPubMedGoogle Scholar
  • 15 Wapner RJ, Sorokin Y, Thom EA , et al; National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network. Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. Am J Obstet Gynecol 2006; 195 (3) 633-642
    CrossrefPubMedGoogle Scholar
  • 16 Dizon-Townson D, Miller C, Sibai B , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The relationship of the factor V Leiden mutation and pregnancy outcomes for mother and fetus. Obstet Gynecol 2005; 106 (3) 517-524
    CrossrefPubMedGoogle Scholar
  • 17 Owen J, Yost N, Berghella V , et al; National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network. Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth. JAMA 2001; 286 (11) 1340-1348
    CrossrefPubMedGoogle Scholar
  • 18 Bottoms SF, Paul RH, Iams JD , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Obstetric determinants of neonatal survival: influence of willingness to perform cesarean delivery on survival of extremely low-birth-weight infants. Am J Obstet Gynecol 1997; 176 (5) 960-966
    CrossrefPubMedGoogle Scholar
  • 19 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87 (2) 163-168
    CrossrefPubMedGoogle Scholar
  • 20 Raghunathan TW, Lepkowksi JM, Van Hoewyk J, Solenbeger P. A multivariate technique for multiply imputing missing values using a sequence of regression models. Surv Methodol 2001; 27: 85-95
    PubMedGoogle Scholar
  • 21 Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med 1991; 10 (4) 585-598
    CrossrefPubMedGoogle Scholar
  • 22 Bailit JL, Gregory KD, Reddy UM , et al. Maternal and neonatal outcomes by labor onset type and gestational age. Am J Obstet Gynecol 2010; 202 (3) 245.e1-245.e12
    CrossrefPubMedGoogle Scholar
  • 23 Wortham JM, Hansen NI, Schrag SJ , et al; Eunice Kennedy Shriver NICHD Neonatal Research Network. Chorioamnionitis and culture-confirmed, early-onset neonatal infections. Pediatrics 2016; 137 (1) 1-11
    CrossrefPubMedGoogle Scholar
  • 24 Zhang J, Kim S, Grewal J, Albert PS. Predicting large fetuses at birth: do multiple ultrasound examinations and longitudinal statistical modelling improve prediction?. Paediatr Perinat Epidemiol 2012; 26 (3) 199-207
    CrossrefPubMedGoogle Scholar
  • 25 Ecker JL, Greenberg JA, Norwitz ER, Nadel AS, Repke JT. Birth weight as a predictor of brachial plexus injury. Obstet Gynecol 1997; 89 (5 Pt 1): 643-647
    CrossrefPubMedGoogle Scholar
  • 26 Gilbert WM, Nesbitt TS, Danielsen B. Associated factors in 1611 cases of brachial plexus injury. Obstet Gynecol 1999; 93 (4) 536-540
    CrossrefPubMedGoogle Scholar
  • 27 Turner MJ, Rasmussen MJ, Turner JE, Boylan PC, MacDonald D, Stronge JM. The influence of birth weight on labor in nulliparas. Obstet Gynecol 1990; 76 (2) 159-163
    PubMedGoogle Scholar
  • 28 Heywood RE, Magann EF, Rich DL, Chauhan SP. The detection of macrosomia at a teaching hospital. Am J Perinatol 2009; 26 (2) 165-168
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Sparks TN, Cheng YW, McLaughlin B, Esakoff TF, Caughey AB. Fundal height: a useful screening tool for fetal growth?. J Matern Fetal Neonatal Med 2011; 24 (5) 708-712
    CrossrefPubMedGoogle Scholar
  • 30 Belfort MA, Saade GR, Thom E , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. A randomized trial of intrapartum fetal ECG ST-segment analysis. N Engl J Med 2015; 373 (7) 632-641
    CrossrefPubMedGoogle Scholar