Maternal and neonatal complications of fetal macrosomia: cohort study

ABSTRACT Objective To estimate the risks of maternal and neonatal complications in pregnancies with macrosomia. Methods This was a retrospective cohort study conducted at a large maternity unit in the UK between January 2009 and December 2016. The incidence of maternal and neonatal complications in...

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Bibliographic Details
Published in:Ultrasound in obstetrics & gynecology 2019-09, Vol.54 (3), p.319-325
Main Authors: Beta, J., Khan, N., Fiolna, M., Khalil, A., Ramadan, G., Akolekar, R.
Format: Article
Language:English
Subjects:
Adult
Birth injuries
Birth weight
brachial plexus injury
Brain damage
Cesarean section
Cesarean Section - statistics & numerical data
Cohort analysis
Complications
Dystocia - etiology
Encephalopathy
Female
Fetal Macrosomia - physiopathology
Fetuses
Fractures
Health risk assessment
Hemorrhage
Humans
Hypoxia
Ischemia
Joint and ligament injuries
large‐for‐gestational age
macrosomia
Neonates
Newborn babies
Obstetric Labor Complications
obstetric sphincter injury
Obstetrics
Population studies
Postpartum
Postpartum Hemorrhage - etiology
Practice Guidelines as Topic
Pregnancy
Pregnancy Complications
Regression analysis
Retrospective Studies
Risk Assessment
Risk management
Shoulder
shoulder dystocia
Sphincter
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Summary:ABSTRACT Objective To estimate the risks of maternal and neonatal complications in pregnancies with macrosomia. Methods This was a retrospective cohort study conducted at a large maternity unit in the UK between January 2009 and December 2016. The incidence of maternal and neonatal complications in pregnancies with macrosomia, defined as birth weight (BW) > 4000 g, and in those with severe macrosomia, defined as BW > 4500 g, was compared with that in pregnancies with normal BW (2500–4000 g). Regression analysis was performed to determine odds ratios (ORs) for complications in macrosomic pregnancies compared to those with normal BW. Results The study population of 35 548 pregnancies included 4522 (12.7%) with macrosomia, of which 643 (1.8%) had severe macrosomia, and 31 026 (87.3%) with normal BW. In the macrosomia group, the adjusted OR was 3.1 (95% CI, 2.6–3.6) for Cesarean section for failure to progress, 2.4 (95% CI, 2.0–3.0) for severe postpartum hemorrhage, 2.3 (95% CI, 1.9–2.8) for obstetric anal sphincter injury, 10.4 (95% CI, 8.6–12.6) for shoulder dystocia, 28.5 (95% CI, 8.9–90.7) for obstetric brachial plexus injury, 32.3 (95% CI, 3.8–278.2) for birth fractures and 4.4 (95% CI, 2.2–8.8) for hypoxic‐ischemic encephalopathy. The respective values in pregnancies with severe macrosomia were 4.3 (95% CI, 3.1–6.1), 2.9 (95% CI, 1.9–4.4), 3.1 (95% CI, 1.9–5.1), 28.7 (95% CI, 20.8–39.8), 73.9 (95% CI, 15.1–363.2), 87.2 (95% CI, 7.7–985.0) and 13.8 (95% CI, 5.2–36.8). Conclusion Macrosomia is associated with serious adverse perinatal outcomes. This study provides accurate estimates of risks to aid in pregnancy management. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. RESUMEN Complicaciones maternas y neonatales de la macrosomía fetal: estudio de cohorte Objetivo Estimar los riesgos de complicaciones maternas y neonatales en embarazos con macrosomía. Methods Este fue un estudio de cohorte retrospectivo realizado en una unidad de maternidad de gran tamaño en el Reino Unido entre enero de 2009 y diciembre de 2016. La incidencia de complicaciones maternas y neonatales en los embarazos con macrosomía, definida como peso al nacer (PN) >4000 g, y en los embarazos con macrosomía grave, definida como PN >4500 g, se comparó con la de los embarazos con PN normal (2500‐4000 g). Se realizó un análisis de regresión para determinar las razones de momios (RM) para las complicaciones en los embarazos macrosómicos en comparación con los que tenían un PN norma
ISSN:0960-7692
1469-0705
DOI:10.1002/uog.20278