Associated outcomes to fetal macrosomia: effect of maternal diabetes
Keywords:
Macrosomia, maternal diabetes, maternal outcomes, perinatal outcomesAbstract
Background: Fetal macrosomia is associated with an increased risk of adverse outcomes to both the mother and the infant.
Aim: To determine maternal and neonatal outcomes associated to fetal macrosomia in diabetic and non- diabetic mothers.
Methods: It is a descriptive retrospective study conducted in Tunisia. We included in this study all patients who delivered newborns having a
birth weight above 4kg during 2013. Multivariate analysis was performed using binary logistic regression to identify the complications associated
to macrosomic pregnancies with diabetes.
Results: Among the 10186 deliveries registered during the study period, 821 mothers gave birth to macrosomic newborns. The prevalence of
macrosomia was 8.1%, and macrosomic newborns who had a birth weight of 4500 g or greater were 1.06%. Macrosomia was significantly higher
in males (p <10-3). The rate of cesarean delivery was 47.9%. The most frequent adverse maternal and neonatal outcomes were perineal tears
(3.6%), post-partum hemorrhage (0.6%), shoulder dystocia (4.9%) and neonatal intensive care unit admission
(7.6%).The proportion of maternal diabetes was 9.3%. Macrosomic pregnancies with diabetes appear to be significantly associated with
cesarean delivery (OR=2.22), postpartum hemorrhage (OR=6.69) and neonatal intensive care unit admission (OR=4.18).
Conclusion: Macrosomia increases the risk of maternal and perinatal morbidity particularly when it was associated to maternal diabetes
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References
Najafian M, Cheraghi M. Occurrence of fetal macrosomia rate and its maternal and neonatal complications: a 5-year cohort study. Obstet Gynecol. 2012:353791
Henriksen T. The macrosomic fetus: a challenge in current obstetrics. ActaObstetGynecol Scand. 2008;87:134‑45.
Henriksen T. The macrosomic fetus: a challenge in current obstetrics. ActaObstetGynecol Scand. 2008;87:134‑45.
Campbell S. Fetal macrosomia: a problem in need of a policy. Ultrasound Obstet Gynecol.2014;43(1):3-10.
Heiskanen N, Raatikainen K, Heinonen S. Fetal Macrosomia - A Continuing Obstetric Challenge. Neonatology. 2006;90:98‑103.
Esakoff TF, Cheng YW, Sparks TN, Caughey AB. The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am J Obstet Gynecol. 2009;200:672.e1-4.
Fuchs F, Bouyer J, Rozenberg P, Senat MV. Adverse maternal outcomes associated with fetal macrosomia: what are the risk factors beyond birth weight? BMC Pregnancy Childbirth. 2013;13:90.
Koyanagi A, Zhang J, Dagvadorj A, Hirayama F, Shibuya K, Souza JP, Gülmezoglu AM. Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet. 2013;381:476- 83.
American Diabetes Association. Classification and Diagnosis of Diabetes. Diabetes Care 2015;38:S8-16.
Zupan J, Ã…hman E, Lander T. Neonatal and perinatal mortality: country, regional and global estimates. Geneva: World Health Organization; 2006. Available at: http://apps.who.int/iris/bitstream/10665/43444/1/9241563206_eng.pdf (Accessed April 16, 2016)
Adamkin DH, Polin R. Neonatal hypoglycemia: is 60 the new 40? The questions remain the same. J Perinatol 2016;36:10-2.
Likis FE, Sathe NA, Morgans AK, Hartmann KE, Young JL, Carlson-Bremer D, et al. Management of Postpartum Hemorrhage. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015.
Denguezli W, Faleh R, Hajjaji A, Saidani Z, Letaief M, Haddad A, et al. Maternal nutrition as a determinant of fetal weight: role of trace elements and vitamins. J GynécologieObstétriqueBiolReprod. 2007;36(5):473-8.
El Fkih C, Mourali, M, Ouerdiane, N, Oueslati, S, et al. Maternal and fetal outcomes of macrosomia delivery : a comparative study. Tunis Med. 2011;89:553‑6.
Saidi O, O'Flaherty M, Mansour NB, Aissi W, Lassoued O, Capewell S, Critchley JA, Malouche D, Romdhane HB; EC FP7 funded MEDCHAMPS project. Forecasting Tunisian type 2 diabetes prevalence to 2027: validation of a simple model. BMC Public Health. 2015;15:104.
Chauhan SP, Grobman WA, Gherman RA, Chauhan VB, Chang G, Magann EF, Hendrix NW. Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol. 2005;193(2):332-46.
Akin Y, Cömert S, Turan C, Piçak A, AÄŸzikuru T, Telatar B. Macrosomic newborns: a 3-year review. Turk J Pediatr. 2010;52:378-83.
Alsammani MA, Ahmed SR. Fetal and Maternal Outcomes in Pregnancies complicated with Fetal Macrosomia. North Am J Med Sci. 2012;4:283‑6.
Mai AH, Abbassia D. The Prevalence of Fetal Macrosomia at the Specialized Hospital of Gynecology and Obstetrics of SidiBel Abbes (West Of Algeria). Nutr Food Sci 2014,4:3.
Mardani M, Khalkhalirad A, Rossta S, Rezapour P. Macrosomia and its Maternal Risk Factors. Iran J Neonatol. 2014;5.
Wilkin TJ, Murphy MJ. The gender insulin hypothesis: why girls are born lighter than boys, and the implication for insulin resistance. Int J Obes. 2006;30:1056-61.
Aye SS, Miller V, Saxena S, Farhan DM. Management of large-forgestational- age pregnancy in non-diabetic women. ObstetGynaecol 2010;12:250-6.
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 ObstetGynecolReprod Biol. 2011;159(2):289‑92.
Unicef. Statistiques Tunisie. Available at: http://www.unicef.org/french/infobycountry/Tunisia_statistics.html (Accessed April 20, 2016)
Chatfield J. ACOG issues: Guidelines on fetal macrosomia. American College of Obstetricians and Gynecologists. Am Fam Physician. 2001;64:169-170.
Fathima N. A Quality improvement tool-driver diagram: a model of driver diagram to reduce primary caesarean section rates. Int J Res Med Sci.2016;4: 1339-1342.
