High birthweight births at University Hospital Olomouc (1993–2010)

Czech version

Authors: M. Větr
Authors‘ workplace: Gynekologicko-porodnická klinika FN, Olomouc, přednosta doc. MUDr. R. Pilka, Ph. D.
Published in: Ceska Gynekol 2012; 77(6): 579-588

Overview

Objective:
Evaluation of risk factors of fetal macrosomia and assess possible consequences of high birth weight at parturition and the newborn state.

Design:
A retrospective epidemiological cohort study.

Setting:
Department of Gynaecology and Obstetrics, Faculty of Medicine and University Hospital Olomouc.

Methods:
Evaluation of 26 789 maternal and newborn records of the singleton pregnancy with birth weight of 2500 g and above in the time interval from 1. 1. 1993 to 12. 31. 2010 at University Hospital in Olomouc. The study was excluded multiple pregnancies and low birth weight children.

Compare the neonate weighing 4000 g or more with a control group of infants 2500–3999 g.

Results:
The prevalence of macrosomia in the selected set of 26 789 pregnant women was 10.3%(2747 newborns). Significant and multivariate analysis identified the independent risk of: 1. gestational age over 40 weeks 18.3% vs. 8.3% (RR = 1.26, 95% CI 1.22 to 1.29, P = 0.00000000), 2. male sex 13.5% vs. 6.8% (RR = 1.98, 95% CI 1.84 to 2.14, P = 0.00000000), 3. diabetes mellitus, 16.7% vs. 10.1% (RR = 1.65, 95% CI 1.38 to 1.98, P = 0.00000000), 4. weight gain over 19 kg (x + SD) 19.2% vs. 9.3% (RR = 2.05, 95% CI 1.87 to 2.24, P = 0.00000000), 5. multiparity 12.5% vs. 7.9% (RR = 1.59, 95% CI 1.47 to 1.71,P = 0.00000000), 6. BMI over 22.4 (cutoff) 14.6% vs. 7.2% (RR = 2.04, 95% CI 1.88 to 2.20,P = 0.00000000), 7. obesity (BMI over 30 kg/m²) 19.5% vs. 9.8% (RR = 1.91, 95% CI 1.70 to 2.15,P = 0.00000000), 8. weight gain over 14 kg (cutoff) 14.3% vs. 8.3% (RR = 1.78, 95% CI 1.65 to 1.93, P = 0.00000000), 9. marital status – married 10.8% vs. 8.8% (RR = 1.22, 95% CI 1.12 to 1.33,P = 0.00000271). Independent protective factor in relation to macrosomia was low maternal education (basic school) 7.0% vs. 10.5% (RR = 0.66, 95% CI 0.57 to 0.77, P = 0.00000010). Maternal age or other factors evaluated showed not to be independent risk factors. Operative delivery of a large babies were significantly more common compared with the control group, 27.3% vs. 22.1% (RR 1.24, 95% CI 1.16 to 1.32, P = 0.00000000). Caesarean section 20.8% vs. 16.6% (RR 1.25, 95% CI 1.16 to 1.36,P = 0.00000003), vacuum extraction 4.4% vs. 3.4% (RR = 1.30; 95% CI 1.08 to 1.57, P = 0.00622233).The frequency of forceps deliveries in both groups compared was the same, 2.1% (RR = 1.00, 95% CI 0.75 to 1.33, P = 0.95676855). Fetal macrosomia was not a major cause of rising invasive methods in obstetrics, which occurred in recent years. Evaluation of the newborn health status in both weight classes had not significant differences.

Conclusion:
There was no significant change in the prevalence of births of large babies over the study period. Gestational age over 40 weeks, male sex, parity, physique, higher maternal weight gain and diabetes mellitus are independent risk factors of high birthweight births. The increase in operative births in recent years is comparable in both groups.

Key words:
pregnancy, macrosomia, BMI, weight gain, risks, complications.

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