NEONATAL MACROSOMIA: RISK FACTORS AND POSTPARTUM COMPLICATIONS
Keywords:Macrosomia, birth weight, obstetric labor complications, neonatal complications
Introduction/Objectives: Neonatal macrosomia is used to describe newborns with a birth weight higher than certain limit, more frequently ≥4000 g. This has been associated to several complications during and postpartum, both for the mother and newborn. The aim of this study is to investigate which are the risk factors and complications most frequently associated to neonatal macrosomia in children born at the same period in two Portuguese hospitals: Senhora da Oliveira, Guimarães (HSOG) and Cova da Beira (CHCB).
Material and Methods: A case-control, observational and retrospective study was performed, including 860 newborns: 711 in the control group (birth weight between 2500 and 3999 g), 281 from CHCB and 430 from HSOG, and 149 in the macrosomic group (birth weight ≥4000 g), 30 from CHCB and 119 from HSOG. Risk factors for macrosomia and maternal and neonatal complications were compared with the control group, using the IBM SPSS Statistics 23.0® software.
Results: There is an association between male infant, higher weight before pregnancy and higher gestacional age and macrosomia in both hospitals. Furthermore, it was associated with multiparity, macrosomic sibling and weight gained during pregnancy in HSOG and with maternal diabetes in CHCB. The complications associated with macrosomia were cephalopelvic disproportion, higher proportion of caesarean and shoulder dystocia in HSOG and hypoglycemia in CHCB.
Conclusions: This study has shown an increase in maternal and neonatal complications with macrosomia. Eliminate modifiable risk factors is fundamental to decrease morbidity.
Henriksen T. The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand. 2008; 87: 134-45.
Linder N, Lahat Y, Kogan A, Fridman E, Kouadio F, Melamed N, et al. Macrosomic newborns of non-diabetic mothers: anthropometric measurements and neonatal complications. Arch Dis childhood Fetal Neonatal Ed. 2014: 353-8.
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; 188:1372-8.
Sociedade Portuguesa de Endocrinologia Diabetes e Metabolismo, Sociedade Portuguesa de Diabetologia, Sociedade Portuguesa de Obstetricia e Medicina Materno-Fetal, Secção de Neonatologia da Sociedade Portuguesa de Pediatria. Relatório do Consenso sobre Diabetes e Gravidez. 2011.
Koyanagi A, Zhang J, Dagvadorj A, Hirayama F, Shibuya K, Souza JP, et al. Macrosomia in 23 developing countries: An analysis of a multicountry, facility-based, cross-sectional survey. Lancet. 2013; 381: 476-83.
Walsh JM, McAuliffe FM. Prediction and prevention of the macrosomic fetus. Eur J Obstet Gynecol Reprod Biol. 2012;162: 125-30.
Stotland NE, Caughey AB, Breed EM, Escobar GJ. Risk factors and obstetric complications associated with macrosomia. Int J Gynaecol Obstet. 2004: 220-6.
American College of Obstetricians and Gynecologists (ACOG). Fetal Macrosomia. American College of Obstetricians and Gynecologists (ACOG); Washington, DC: 2000 Nov. p.11(ACOG practice bulletin; no. 22).
Jolly MC, Sebire NJ, Harris JP, Regan L, Robinson S. Risk factors for macrosomia and its clinical consequences: A study of 350,311 pregnancies. Eur J Obstet Gynecol Reprod Biol. 2003; 111: 9-14.
Alberico S, Montico M, Barresi V, Monasta L, Businelli C, Soini V, et al. The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study. BMC Pregnancy Childbirth. 2014; 14: 23.
Xiong X, Demianczuk NN, Saunders LD, Wang FL, Fraser WD. Impact of preeclampsia and gestational hypertension on birth weight by gestational age. Am J Epidemiol. 2002; 155: 203-9.
Rasmussen S, Irgens L, Espinoza J. Maternal obesity and excess of fetal growth in pre-eclampsia. BJOG An Int J Obstet Gynaecol. 2014; 121: 1351-8.
Wollschlaeger K, Nieder J, Koppe I, Hartlein K. A study of fetal macrosomia. Arch Gynecol Obs. 1999; 263 :51-5.
Ko T-J, Tsai L-Y, Chu L-C, Yeh S-J, Leung C, Chen C-Y, et al. Parental smoking during pregnancy and its association with low birth weight, small for gestational age, and preterm birth offspring: a birth cohort study. Pediatr Neonatol. 2014; 55: 20-7.
Wahabi HA, Mandil AA, Alzeidan RA, Bahnassy AA, Fayed AA. The independent effects of second hand smoke exposure and maternal body mass index on the anthropometric measurements of the newborn. BMC Public Health. 2013; 13 :1058.
Marques JB, Reynolds A. Shoulder dystocia: an obstetrical emergency. Acta Med Port. 2011; 24: 613-20.
Jevitt C. Shoulder Dystocia: Etiology, Common Risk Factors, and Management. J Midwifery Womens Health. 2005; 50: 485-97.
Akin Y, Cömert S, Turan C, Piçak A, Ağzikuru T, Telatar B. Macrosomic newborns: a 3-year review. Turk J Pediatr. 2010; 52: 378-83.
Gyurkovits Z, Kálló K, Bakki J, Katona M, Bitó T, Pál A, et al. Neonatal outcome of macrosomic infants: An analysis of a two-year period. Eur J Obstet Gynecol Reprod Biol. 2011;159:289-92.
ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod. 2000; 15: 1856-64.
Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010; 88: 31-8.
Sociedade Portuguesa de Pediatria. Secção de Neonatologia. Consenso Clínico Hipoglicemia Neonatal. 2013; 1-10.
Kramer MS, Morin I, Yang H, Platt RW, Usher R, McNamara H, et al. Why are babies getting bigger? Temporal trends in fetal growth and its determinants. J Pediatr. 2002; 141: 538-42.
Ørskou J, Kesmodel U, Henriksen TB, Secher NJ. An increasing proportion of infants weigh more than 4000 grams at birth. Acta Obstet Gynecol Scand. 2001; 80: 931-6.
Sibai BM. A Relative Rise in Blood Pressure From 18 to 30 Weeks Gestation Is Associated With Reduced Fetal Growth and Lower Gestational Age at Delivery. Hypertension. 2014 Jul; 64: 28-9.
Easterling TR, Benedetti TJ, Schmucker BC, Millard SP. Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study. Obstet Gynecol. 1990; 76: 1061–9.
Liu KC, Joseph JA., Nkole TB, Kaunda E, Stringer JSA, Chi BH, et al. Predictors and pregnancy outcomes associated with a newborn birth weight of 4000 g or more in Lusaka, Zambia. Int J Gynecol Obstet. 2013; 122: 150-5.
Braz L, Figueiredo L, Fonseca F. A influência da obesidade e ganho ponderal no peso do recém-nascido num grupo de grávidas com diabetes gestacional. Rev Port Endocrinol Diabetes e Metab. 2013; 8: 70-6.
IOM (Institute of Medicine), NRC (National Research Council). Weight Gain During Pregnancy. 2009; 121
Meshari AA, De Silva S, Rahman I. Fetal macrosomia-maternal risks and fetal outcome. Int J Gynaecol Obstet. 1990; 32: 215-22.
Baxley EG, Gobbo RW. Shoulder dystocia. Am Fam Physician. 2004; 69: 1707-14.
Baskett TF. Shoulder dystocia. Best Pr Res Clin Obs Gynaecol. 2002; 16: 57-68.
Horvath K, Koch K, Jeitler K, Matyas E, Bender R, Bastian H,et al. Effects of treatment in women with gestational diabetesmellitus: systematic review and meta-analysis. BMJ. 2010;340: 1395.
Mitanchez D, Yzydorczyk C, Siddeek B, Boubred F, Benahmed M, Simeoni U. The offspring of the diabetic mother - Short- and long-term implications. Best Pract Res Clin Obstet Gynaecol. 2014; 29: 1-14.
Gu S, An X, Fang L, Zhang X, Zhang C, Wang J, et al. Risk factors and long - term health consequences of macrosomia:a prospective study in Jiangsu Province, China. J Biomed Res. 2012; 26: 235-40.
Harder T, Rodekamp E, Schellong K, Dudenhausen JW. Meta-Analysis Birth Weight and Subsequent Risk of Type 2 Diabetes : A Meta-Analysis. Am J Epidemiol. 2007; 165: 849-57.
How to Cite
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.