BACKGROUND: Large-for-gestational-age (LGA) or macrosomic infants are associated with adverse maternal and neonatal outcomes. It is unclear if these associations are stronger using customised birthweight centiles. We compared outcomes between term infants defined macrosomic by birthweight >4000 g (Macro(4000) ) or LGA by population centiles (LGA(pop) ) with those defined LGA by customised centiles (LGA(cust) ). METHODS: This is a prospective cohort study of 2668 term nulliparous women recruited into the Screening for Pregnancy Endpoints (SCOPE) study centres in Auckland, New Zealand and Adelaide, Australia. Maternal (caesarean delivery, postpartum haemorrhage) and infant (severe neonatal morbidity/mortality and admission to neonatal intensive care) outcomes in Macro(4000) and LGA groups were compared with appropriate-for-gestational-age infants by customised centiles using logistic regression. RESULTS: Customised centiles defined fewer infants as LGA (10.3% LGA(cust) , 14.8% Macro(4000) , 11.2% LGA(pop) ). However customised centiles showed stronger association with adverse outcomes. Pre-labour and intrapartum caesarean section were increased twofold in LGA(cust) pregnancies, including those that were not Macro(4000) or LGA(pop) . Postpartum haemorrhage was increased twofold in mothers of LGA(cust) infants only when infants were also LGA(pop) . Severe neonatal morbidity/mortality or admission to neonatal intensive care was increased twofold in LGA(cust) who were also either Macro(4000) or LGA(pop) . Importantly 52.3% of Macro(4000) and 25.5% of LGA(pop) infants were AGA(cust) and not at increased risk of most adverse maternal or neonatal outcomes. CONCLUSIONS: The use of customised centiles are more strongly associated with adverse birth outcomes and its use should be considered in the definition of LGA.
BACKGROUND: Large-for-gestational-age (LGA) or macrosomic infants are associated with adverse maternal and neonatal outcomes. It is unclear if these associations are stronger using customised birthweight centiles. We compared outcomes between term infants defined macrosomic by birthweight >4000 g (Macro(4000) ) or LGA by population centiles (LGA(pop) ) with those defined LGA by customised centiles (LGA(cust) ). METHODS: This is a prospective cohort study of 2668 term nulliparous women recruited into the Screening for Pregnancy Endpoints (SCOPE) study centres in Auckland, New Zealand and Adelaide, Australia. Maternal (caesarean delivery, postpartum haemorrhage) and infant (severe neonatal morbidity/mortality and admission to neonatal intensive care) outcomes in Macro(4000) and LGA groups were compared with appropriate-for-gestational-age infants by customised centiles using logistic regression. RESULTS: Customised centiles defined fewer infants as LGA (10.3% LGA(cust) , 14.8% Macro(4000) , 11.2% LGA(pop) ). However customised centiles showed stronger association with adverse outcomes. Pre-labour and intrapartum caesarean section were increased twofold in LGA(cust) pregnancies, including those that were not Macro(4000) or LGA(pop) . Postpartum haemorrhage was increased twofold in mothers of LGA(cust) infants only when infants were also LGA(pop) . Severe neonatal morbidity/mortality or admission to neonatal intensive care was increased twofold in LGA(cust) who were also either Macro(4000) or LGA(pop) . Importantly 52.3% of Macro(4000) and 25.5% of LGA(pop) infants were AGA(cust) and not at increased risk of most adverse maternal or neonatal outcomes. CONCLUSIONS: The use of customised centiles are more strongly associated with adverse birth outcomes and its use should be considered in the definition of LGA.
Authors: Kathryn V Dalrymple; John M D Thompson; Shahina Begum; Keith M Godfrey; Lucilla Poston; Paul T Seed; Lesley M E McCowan; Clare Wall; Andrew Shelling; Robyn North; Wayne S Cutfield; Edwin A Mitchell Journal: Pediatr Obes Date: 2019-06-24 Impact factor: 4.000
Authors: Robert D Cartwright; Ngaire H Anderson; Lynn C Sadler; Jane E Harding; Lesley M E McCowan; Christopher J D McKinlay Journal: J Perinatol Date: 2020-02-20 Impact factor: 2.521
Authors: Russell L Deter; Wesley Lee; Haleh Sangi-Haghpeykar; Adi L Tarca; Lami Yeo; Roberto Romero Journal: J Matern Fetal Neonatal Med Date: 2014-07-11
Authors: Lindsey A Sjaarda; Paul S Albert; Sunni L Mumford; Stefanie N Hinkle; Pauline Mendola; S Katherine Laughon Journal: Am J Obstet Gynecol Date: 2013-09-10 Impact factor: 8.661
Authors: Matias C Vieira; Lesley M E McCowan; Alexandra Gillett; Lucilla Poston; Elaine Fyfe; Gustaaf A Dekker; Philip N Baker; James J Walker; Louise C Kenny; Dharmintra Pasupathy Journal: PLoS One Date: 2017-06-01 Impact factor: 3.240