Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 08 Oct 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Risk factors for macrosomia and its clinical consequences: a study of 350,311 pregnancies. Eur J Obstet Gynecol Reprod Biol. 2003 Nov 10;111(1):9-14.

Author(s) :

Jolly MC, Sebire NJ, Harris JP, Regan L, Robinson S.

Year of publication :

2003

URL(s) :

http://www.sciencedirect.com/science?_ob=ArticleUR…

Résumé (français)  :

Abstract (English)  :

OBJECTIVES: To identify demographic risk factors for either birthweight >4kg or over the 90th centile and to quantify the obstetric risks.

STUDY DESIGN: Data from 350,311 completed singleton pregnancies in the North West Thames Region between 1988 and 1997 were analysed using logistic regression. Predisposing factors and pregnancy outcome were compared by birthweight 2.5-4kg (n=259,902) and >4kg (n=36,462) and 10th-90th centile (n=279,780) and >90th centile (n=34,937).

RESULTS: Macrosomia defined as birthweight >90th centile was more likely in women whose BMI >30 (kg/m(2)) (odds ratio (OR) 2.08; confidence intervals (CI) 1.99, 2.17), parity >4 (OR 2.20; CI 2.02, 2.40), age >40 (OR 1.22; CI 1.11, 1.35) and in women with pre-existing diabetes (OR 6.97; CI 5.36, 8.16) or who developed gestational diabetes (OR 2.77; CI 2.51, 3.07). Macrosomia defined by birthweight >4kg was better than birthweight >90th centile at predicting morbidity and was associated with a prolonged first and second stage of labour (OR 1.57; CI 1.51, 1.63) and (OR 2.03; CI 1.88, 2.19), respectively, an increased risk of instrumental vaginal delivery (OR 1.76; CI 1.68, 1.85), third degree perineal trauma (OR 2.73; CI 2.30, 3.23), emergency caesarean section (OR 1.84; CI 1.75, 1.93), postpartum haemorrhage (OR 2.01; CI 1.93, 2.10), Apgar score <4 (OR 1.35; CI 1.03, 1.76), and admission to the special care baby unit (OR 1.51; CI 21.38, 1.68).

CONCLUSION: Macrosomia is more common in mothers who are obese, older or diabetic and is associated with significant obstetric morbidity.

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Keywords :

➡ c-section/caesarean ; evidence-based medicine/midwifery ; perineal/vaginal tears ; gestational diabetes ; postpartum hemorrhage ; fetal distress ; morbidity ; instrumental delivery

Author of this record :

Cécile Loup — 08 Oct 2004