Maternal and Neonatal Morbidity Associated With Early Term Delivery of Large-for-Gestational-Age But Nonmacrosomic Neonates

Abstract

To evaluate whether, at 37-39 weeks of gestation, delivery of a neonate with a birth weight that is 90% or greater for gestational age but less than 4,000 g is associated with increased composite maternal and neonatal morbidity. METHODS:This retrospective cohort study used U.S. Vital Statistics datasets for the years 2011-2013. Inclusion criteria were singleton pregnancies delivered at 37-39 weeks of gestation after labor in which the neonates were nonanomalous, and either appropriate for gestational age or large for gestational age (LGA) neonates with birth weights of less than 4,000 g (our threshold for macrosomia). The coprimary outcomes were composite maternal morbidity (any of the following: maternal transfusion, ruptured uterus, unplanned hysterectomy, admission to intensive care unit, or unplanned procedure) and composite neonatal morbidity (any of the following: Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure or serious neurologic dysfunction, significant birth injury or neonatal mortality). Multivariable Poisson regression models were used to calculate adjusted relative risk (aRR) and 95% CI.RESULTS: Among the 3.9 million women who met inclusion criteria, 1.3% delivered neonates who were LGA but nonmacrosomic. The rate of composite maternal morbidity was 53% higher women who delivered nonmacrosomic LGA neonate (6.27 vs 4.09/1,000 live births; aRR 1.40, 95% CI 1.25-1.56). This increased risk of composite maternal morbidity persisted in analyses stratified by diabetes. The rate of composite neonatal morbidity was 83% higher for nonmacrosomic LGA neonates (11.09 vs 6.07/1,000 live births; aRR 1.47, 95% CI 1.35-1.60) and persisted in analyses stratified by diabetes.CONCLUSION: At 37-39 weeks of gestation, delivery of a neonate with a birth weight that is 90% or greater for gestational age but less than 4,000 g is associated with increased composite maternal and neonatal morbidity.

First Trimester Microelements and Their Relationships with Pregnancy Outcomes and Complications

“…Epidemiological data indicate that adverse pregnancy outcomes and pregnancy complications, including preterm births, preeclampsia (PE), gestational diabetes, and fetal growth restriction (IUGR), occur in total in up to 25% of first pregnancies [1] and these pregnancy results are an important element of public health. They are associated with an increase in maternal and fetal morbidity and/or mortality [2][3][4][5][6][7][8][9][10] and they may lead to long-term diseases of both the mother and the child, increasing the risk of cardiovascular diseases, obesity, diabetes, and even some cancers, as well as neurodevelopmental disorders in the offspring [7][8][9][10][11]. Early identification of women at risk may be of great importance for improving pregnancy outcomes.…”

The freeze-all strategy after IVF: which indications?

“…In particular, data comparing the cumulative live birth rates and the time to obtain a live child between the fresh and the freeze-all strategy are lacking. Furthermore, although the current literature supports the notion that freeze-all strategy is safe, particularly in light of the decreased risks of SGA and LBW, the data reveal higher rates of LGA/HBW and HDP, which are a reason for concern as these complications are associated with increased risks of adverse neonatal outcomes (Doty et al, 2019;Khambalia et al, 2017). There is also a paucity of information regarding rare obstetric/perinatal outcomes and childhood outcomes.…”

Fetal Growth Acceleration – Current Approach to the Big Baby Issue

“…Of 3 917 831 births, only 50 630 (1,3 %) was non-macrosomic LGA. Authors concluded that non-macrosomic LGA had a greater risk of combined neonatal (aOR 1,47) and maternal (aOR 1,40) morbidity including a higher risk of maternal transfusion, maternal unplanned operating room procedures, need of assisted ventilation of neonate, fetal significant birth injury, or Apgar score <5 at 5 minutes [45].…”