We sought to determine risk factors associated with fetal macrosomia and to explore the long-term consequence of infant macrosomia at the age of 7 years.A prospective population based cohort study was designed to exam...We sought to determine risk factors associated with fetal macrosomia and to explore the long-term consequence of infant macrosomia at the age of 7 years.A prospective population based cohort study was designed to examine the associations between maternal and perinatal characteristics and the risk of macrosomia.A nested case-control study was conducted to explore the long-term health consequence of infant macrosomia.The mean maternal age of the macrosomia group was 24.74±3.32 years,which is slightly older than that in the control group（24.35±3.14 years,P = 0.000）.The mean maternal body mass index（BMI） at early pregnancy was 22.75±2.81 kg/m 2,which was also higher than that in the control group（21.76±2.59 kg/m 2,P = 0.000）.About 64.6% of macrosomic neonates were males,compared with 51.0% in the control group（P = 0.000）.Compared with women with normal weight（BMI：18.5-23.9 kg/m 2）,women who were overweight（BMI：24-27.9 kg/m 2） or obese（BMI ≥ 28 kg/m 2）,respectively,had a 1.69-fold（P = 0.000） and a 1.49-fold（P = 0.000） increased risks of having a neonate with macrosomia,while light weight（BMI〈18.5 kg/m 2） women had an approximately 50% reduction of the risk.Furthermore,macrosomia infant had a 1.52-fold and 1.50-fold risk,respectively,of developing overweight or obesity at the age of 7 years（P = 0.001 and P = 0.000）.Older maternal age,higher maternal BMI at early pregnancy and male gender were independent risk factors of macrosomia.Macrosomic infant was associated with an increased predisposition to develop overweight or obesity at the beginning of their childhood.展开更多
Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregn...Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record.Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.Results:Ninety-one non-CDM mothers with macrosomia were studied and compared with 41normoglycemic subjects without macrosomia.Of the subjects with non-GDM macrosomia,45(49.4%)had normal SO g glucose challenge test(GCT)without further testing,another 8(8.8%)had abnormal GCT but normal 75 g oral glucose tolerance test(OGTT).A total of 4(4.4%)subjects had normal GCT and OGTT.Interestingly.14 out of 16(87.5%)subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies.Only 12 subjects had both GCT and OGTT,the rest of the cohort had either of the two tests.Subjects with non-CDM macrosomia had higher frequency of neonatal hypoglycaemia 34%as compared to 10%in nonmacrosomic babies(P=0.003).Other feto-maternal complications were similar in both groups.Conclussions:No significant pattern of glucose tolerance characteristics was identified in nonGDM mothers with macrosomic babies.In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies.Further prospective studies on a larger population are needed to verify our findings.展开更多
Introduction: Macrosomia is usually defined by the delivery of a child over 4000 g at term. Because of the margins of error, the obstetrician must take into account, in addition to ultrasound, the constitutional and a...Introduction: Macrosomia is usually defined by the delivery of a child over 4000 g at term. Because of the margins of error, the obstetrician must take into account, in addition to ultrasound, the constitutional and acquired factors of the mother in order to be able to prevent the complications expected during the delivery of a large fetus. Material and method: We carried out a cross-sectional, descriptive, 12-month study in a level 2 hospital in southern France (Montélimar). The aim of the study was to assess the prevalence of macrosomia, to identify the epidemiological characteristics of the patients, to specify the management of obstetrics and complications in this hospital. Results: We recorded 141 births with a weight greater than or equal to 4000 g. That is a rate of 7.95%. The average age of our patients is 30 years. Half of them had a BMI of less than 25 and were not diabetic. 75% of the patients gave birth by a low-dose route. The sex ratio of the children is male to female 2:1. The main maternal complications were the perineovaginal tears (39 cases) and the hemorrhages of the deliverance (6 cases). Conclusion: The delivery of macrosomia is not uncommon at the Hospital Center of Montélimar. It predominates among Caucasians. Usual risk factors have rarely been found. Overall management was without major complications for both the mother and the child.展开更多
Objective: To investigate the risk factors of macrosomia and to predict the risk of macrosomia so as to reduce the incidence of macrosomia. Methods: A total of 2063 pregnant women who met the inclusion criteria were s...Objective: To investigate the risk factors of macrosomia and to predict the risk of macrosomia so as to reduce the incidence of macrosomia. Methods: A total of 2063 pregnant women who met the inclusion criteria were selected as the subjects from February 2016 to April 2017 in Jiading District Maternal and Child Health Hospital of Shanghai and Pudong New Area Maternal and Child Health Hospital. According to the birth weight of the neonates, the neonates were divided into the macrosomia group (neonatal weight > 4000 g, n=125) and the normal infant group (2500 g < neonatal weight < 4000 g, n=1938).The general data of age, number of pregnant women, BMI before pregnancy, gestational diabetes mellitus, glucose tolerance, weight gain during pregnancy, birth weight and gestational week were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors of macrosomia. Results: ①There were significant differences in BMI, glucose tolerance, fasting blood sugar, weight gain in the second trimester, weight gain in the third trimester, birth weight and gestational week between the two groups (P<0.05). ②Single factor analysis showed that pre-pregnancy BMI, gestational week at first diagnosis, fasting blood glucose tolerance, weight gain in the second trimester, weight gain in the third trimester, gestational week and birth weight were the influencing factors of macrosomia (P<0.05). ③Multi-factor analysis showed that gestational weeks, gestational diabetes, fasting glucose tolerance and weight growth in the second trimester were the main factors affecting the production of macrosomia, among which gestational diabetes was the protective factor, while gestational weeks, fasting glucose tolerance and weight growth in the second trimester were the risk factors. Conclusion: The high risk factors for macrosomia are gestational weeks, glucose tolerance, fasting blood sugar and weight gain in the second trimester of pregnancy.We should strengthen regular obstetric examination, health care during pregnancy, reasonable diet and proper exercise, and strictly control the weight gain during the second trimester of pregnancy. At the same time, we should monitor blood sugar in time so as to reduce the incidence of macrosomia.展开更多
Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and...Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.展开更多
Introduction: Fetal macrosomia is a birth weight greater than or equal to 4000 grams. The aim of this study is to determine the frequency of macrosomia, to identify the risk factors, and to evaluate the maternal and p...Introduction: Fetal macrosomia is a birth weight greater than or equal to 4000 grams. The aim of this study is to determine the frequency of macrosomia, to identify the risk factors, and to evaluate the maternal and perinatal prognosis in the obstetrics and gynaecology department of the Community University Hospital Centre (CHUC). Methodology: This was a retrospective case-control study over a period of 24 months in the maternity ward of the CHUC. Results: The frequency of delivery of macrosomic fetuses was 4.1%, and the average age of women with large fetuses was 29.5 years. In 65.7% of cases, they were not engaged in any income-generating activity. Most of them had at least secondary education (65.7%) and were mainly multiparous (78.8%). The risk factors found were maternal age greater than or equal to 35 years, multiparity, previous large fœtus, gestational diabetes, obesity and male sex. Maternal complications were dominated by uterine atony (52.2%), perineal tear (31.9%), and cervical tear (15.9%). In our series, macrosomic newborns were three times more likely to present with a neonatal complication than normal-weight newborns. Neonatal mortality was 2.1%. Conclusion: Reducing macrosomia requires a better understanding of the risk factors, early detection, correct management during vaginal delivery and close monitoring of labour with good control of obstetric manoeuvres.展开更多
Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a maj...Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a major health concern. Objectives: To determine the frequency of neonatal macrosomia, describe risk factors and neonatal and maternal complications. Materials and methods: This was a cross-sectional study carried out between January and December 2022, involving newborns whose birth weight was greater than or equal to 4000 grams admitted to the neonatology unit of the Labe regional hospital. Results: 591 deliveries were recorded, 15 of which were macrosomic, representing a frequency of 2.54%. The average age of the women was 30.26 years. History of fetal macrosomia and diabetes was 93.33 and 71.43% respectively. The mean gestational age was 38.71 ± 0.75 SA, the mean antenatal consultation was 3 ± 0.8 and the mode of delivery was caesarean section (66.67%). Third-trimester ultrasound was performed in 53.33% of cases. Macrosomic newborns were male in 80% of cases. Neonatal complications were asphyxia (60%), hypoglycemia (20%) and hypocalcemia (13.33%). Factors associated with neonatal macrosomia were diabetes (P < 0.001), history of macrosomia (P Conclusion: this study shows that the frequency of neonatal macrosomia is 2.54% with high neonatal morbidity among newborns hospitalized in the neonatology unit of the Labé regional hospital. Screening for macrosomia risk factors during pregnancy is essential to prevent perinatal complications.展开更多
Fetal macrosomia is associated with maternal and newborn complications due to incorrect fetal weight estimation or inappropriate choice of delivery models.The early screening and evaluation of macrosomia in the third ...Fetal macrosomia is associated with maternal and newborn complications due to incorrect fetal weight estimation or inappropriate choice of delivery models.The early screening and evaluation of macrosomia in the third trimester can improve delivery outcomes and reduce complications.However,traditional clinical and ultrasound examinations face difficulties in obtaining accurate fetal measurements during the third trimester of pregnancy.This study aims to develop a comprehensive predictive model for detecting macrosomia using machine learning(ML)algorithms.The accuracy of macrosomia prediction using logistic regression,k-nearest neighbors,support vector machine,random forest(RF),XGBoost,and LightGBM algorithms was explored.Each approach was trained and validated using data from 3244 pregnant women at a hospital in southern China.The information gain method was employed to identify deterministic features associated with the occurrence of macrosomia.The performance of six ML algorithms based on the recall and area under the curve evaluation metrics were compared.To develop an efficient prediction model,two sets of experiments based on ultrasound examination records within 1-7 days and 8-14 days prior to delivery were conducted.The ensemble model,comprising the RF,XGBoost,and LightGBM algorithms,showed encouraging results.For each experimental group,the proposed ensemble model outperformed other ML approaches and the tra-ditional Hadlock formula.The experimental results indicate that,with the most risk-relevant features,the ML algo-rithms presented in this study can predict macrosomia and assist obstetricians in selecting more appropriate delivery models.展开更多
Context. The prevalence of macrosomia varies through the world according to racial and ethnic factors, life style and importance of non communicable diseases (maternal obesity, diabetes-gestational and type 2), post-t...Context. The prevalence of macrosomia varies through the world according to racial and ethnic factors, life style and importance of non communicable diseases (maternal obesity, diabetes-gestational and type 2), post-term gestation and multiparity. At the University Clinics of Kinshasa (UCK), 30 years ago, the frequency of macrosomia was 2.4%. Objectives. To update data on the frequency of macrosomia at UCK, regarding variations in maternal anthropometrics (obesity) and socio-demographic factors. Methods. A cross-sectional study was conducted at UCK from 1 January 2007 to 31 December 2016. Mothers who delivered babies weighing at least 4000 g were included in this study. Results. The frequency of macrosomia was 3.7%. Trend shows a variation of this frequency over time with lowest frequency (2.1%) in 2012 and highest (5.3%) in 2009. The mother average age and parity were 32.3 ± 5.4 years and 3 ± 2, respectively. Pregnancies were complicated by polyhydramnios (48%) and gestational diabetes (19.7%). Caesarean section was performed in 60.5% cases, mainly for macrosomia (47.8%) and 81.6% of newborns had constitutional macrosomia. Adverse obstetrical outcomes of macrosomia were dominated by caesarean section (28.9%), lacerations of birth canal (23%) and neonatal distress (9.2%). Conclusion. Macrosomia remains a constant finding at UCK, and is associated with maternal, fetal and neonatal adverse outcomes. Trend shows a variation of the frequency over time between 2.1% and 5.3%.展开更多
Background Fetal macrosomia,defined as birth weight equal or over 4000 g,is a major concern for both neonatal and maternal health.A rapid increasing trend in fetal macrosomia is observed in different regions of China....Background Fetal macrosomia,defined as birth weight equal or over 4000 g,is a major concern for both neonatal and maternal health.A rapid increasing trend in fetal macrosomia is observed in different regions of China.We aimed to examine the association between fetal macrosomia and risk of childhood obesity in Western China.Methods All macrosomic live singletons (≥ 4000 g),and a random sample of singletons with normal birth weight (2500-3999 g) born in four districts of Chengdu,Western China,in 2011 were included in the cohort study.Maternal demographics,obstetric factors,labor and delivery summary at baseline were extracted from the Chengdu Maternal and Child Health Management System.Anthropometric measurements before 3 years and infant feeding information at around 6 months were also collected.Childhood obesity under 3 years was primarily defined as a weight-for-length/height z score ≥ 1.645 using the WHO growth reference.Secondary definitions were based on weight-for-age and body mass index (BMI)-for-age over the same cut-offs.Results A total of 1767 infants were included in the analyses,of whom 714 were macrosomic.After controlling for maternal age,parity,gestational age and anemia at the first antenatal visit,pre-pregnancy BMI,gestational weight gain,gestational age at birth,baby age and sex,and breastfeeding practices at 6 months,the risk of childhood obesity defined according to weight-for-length/height among macrosomic babies was 1.90 (95% confidence interval 1.04-3.49) times that of babies with normal birth weight.The risk of childhood obesity for macrosomic babies was 3.74 (1.96-7.14) and 1.64 (0.89-3.00) times higher based on weight-for-age and BMI-for-age,respectively.Conclusion Fetal macrosomia is associated with increased risk of obesity in children under 3 years in Western China.展开更多
Background Women who had delivered a macrosomic newborn will have a higher risk to deliver another macrosomia.We aimed to examine the recurrence risk of macrosomia in the subsequent pregnancy and the implications in l...Background Women who had delivered a macrosomic newborn will have a higher risk to deliver another macrosomia.We aimed to examine the recurrence risk of macrosomia in the subsequent pregnancy and the implications in long-term child health.Methods Data from the Collaborative Perinatal Project,a longitudinal birth cohort with 54,371 singleton births,were used.401 recurrent macrosomic infants (macro-macro) and 1327 normal weight babies with a macrosomia in the last pregnancy (macro-normal) were selected to explore risk factors for recurrent macrosomia.Furthermore,768 newly onset macrosomia with normal birthweight infant in previous pregnancies (normal-macro) were identified to examine long-term health effects of recurrent macrosomia.Results The recurrent rate of macrosomia was 23.2% [95% confidence interval (CI) 21.2%,25.2%].White race,higher pre-pregnant body mass index (BMI),more gestational weight gain,male infant and more prior macrosomic infants were significant risk factors for recurrent macrosomia.At 4 years of age,recurrent macrosomic infants had a higher BMI (16.7 vs.16.1 kg/m2,adjusted fβ:0.36,95% CI:0.12,0.60) and a higher risk of overweight and obesity (adjusted OR:1.56,95% CI:1.10,2.23) than infants with normal birthweight after a previous macrosomic sibling.There was no significant difference between recurrent macrosomia and newly onset macrosomia in child outcomes after adjustment for covariates.Conclusions Fetal macrosomia has a high recurrence rate in the following pregnancy.Higher maternal pre-pregnant BMI and gestational weight gain are still important risk factors for recurrence of macrosomia,which in turn increases the risk for childhood obesity.展开更多
Gestational diabetes mellitus(GDM)is a well-established risk factor for fetal macrosomia.A significant number of patients with GDM also suffer from obesity,a factor associated with fetal macrosomia.An important questi...Gestational diabetes mellitus(GDM)is a well-established risk factor for fetal macrosomia.A significant number of patients with GDM also suffer from obesity,a factor associated with fetal macrosomia.An important question is whether GDM is independently associated with fetal macrosomia,or whether this relationship is merely the result of maternal obesity acting as a confounder.In this review of the literature,we attempt to further elucidate the relationship between GDM,maternal obesity,and fetal macrosomia.展开更多
Objective:To investigate the morphological and ultrastructural alterations in placentas from pregnancies with gestational diabetes mellitus(GDM)–induced macrosomia,term nondiabetic macrosomia,and normal pregnancies.M...Objective:To investigate the morphological and ultrastructural alterations in placentas from pregnancies with gestational diabetes mellitus(GDM)–induced macrosomia,term nondiabetic macrosomia,and normal pregnancies.Methods:Sixty full-term placentaswere collected,and clinical data alongwith informed consent were obtained from pregnant womenwho underwent regular visit checks and delivered their newborns in Northwest Women’s and Children’s Hospital between May and December 2022.Placentas were divided into three equal groups:normal pregnancy(control group),nondiabetic macrosomia group,and macrosomia complicated with GDM(diabetic macrosomia)group.Gross morphological data of placentas were recorded,and placental samples were processed for examination of ultrastructural and stereological changes using transmission electron microscopy.Analysis of variance and chi-squared test were used to examine the differences among the three groups for continuous and categorical variables,respectively.Results:The baseline characteristics of mothers and neonates did not differ across the three groups,except for a significantly higher birth weight in the diabetic macrosomia group(4172.00±151.20 g vs.3192.00±328.70 g,P<0.001)and nondiabetic macrosomia group(4138.00±115.20 g vs.3192.00±328.70 g,P<0.001)comparedwith control group.Examination of the placentas revealed that placental weight was also highest in the diabeticmacrosomia group comparedwith control group(810.00±15.81 g vs.490.00±51.48 g,P<0.001)and nondiabetic macrosomia group(810.00±15.81 g vs.684.00±62.69 g,P<0.001),but the ratio of neonatal birth weight to placental weight(BW/PW)was significantly lower in the diabetic macrosomia group compared with that in the control group(5.15±0.19 vs.6.54±0.63,P<0.001)and nondiabetic macrosomia group(5.15±0.19 vs.6.09±0.52,P<0.001)group.In contrast,the BW/PW ratio in nondiabetic macrosomia did not differ significantly from that in the control group.Distinct ultrastructural changes in terminal villi and stereological alterations in microvilli were observed in the diabetic macrosomia group,including changes in the appearance of cytoplasmic organelles and the fetal capillary endothelium and thickness of the vasculo-syncytial membrane and basal membrane.Conclusion:Significant ultrastructural and stereological alterations were discovered in the placentas from pregnant women with macrosomia induced by GDM.These alterationsmay be the response of the placenta to the hyperglycemia condition encountered during pregnancies complicated with GDM.展开更多
Objective:Interventions currently recommended to control and prevent obesity have not been successful.Recent research has shifted toward the transgenerational cycle of obesity.We assessed the association between fetal...Objective:Interventions currently recommended to control and prevent obesity have not been successful.Recent research has shifted toward the transgenerational cycle of obesity.We assessed the association between fetal macrosomia and early childhood body weight.Methods:We conducted a follow-back study to link birth certificate data to the Third National Health and Nutrition Examination Survey(1988–1994)of 2621 United States-born singletons aged 2–6 years.Birth weight and gestational age data were collected from birth certificates.Fetal macrosomia was defined as≥90th percentile of gestational age-race-sex-parity specific body weight distribution in 1989 vital statistics.Results:With 12.7%(standard error=0.85%)of participants born macrosomic,the prevalence of obesity and overweight(BMI percentiles≥85th in the CDC growth chart)among children was 17.8%(1.17%).When the body weight was measured against age-sex-specific height(BMI percentiles),macrosomia was significantly associated with overweight and obesity(odds ratio[OR]=1.64,95%confidence interval=1.07–2.50)adjusted for family income,maternal age and marital status,race,maternal smoking during pregnancy,and breastfeeding.The association became insignificant after adjusting for postnatal lifestyle and parental body mass index(OR=1.38[0.84-2.26]].When body weight was measured against age,children who were too heavy for their age were more likely to be born macrosomically(OR=2.64[1.66-4.22])than their peers with healthy age-specific body weight.Conclusion:Fetal macrosomia was significantly associated with a doubled risk of heavy body weight in children aged 2–6 years.展开更多
基金supported by grants from the Jiangsu Birth Defects Intervention Program(No.JS200302)the Natural Science Foundation of Jiangsu Province(No.BK2008501)
文摘We sought to determine risk factors associated with fetal macrosomia and to explore the long-term consequence of infant macrosomia at the age of 7 years.A prospective population based cohort study was designed to examine the associations between maternal and perinatal characteristics and the risk of macrosomia.A nested case-control study was conducted to explore the long-term health consequence of infant macrosomia.The mean maternal age of the macrosomia group was 24.74±3.32 years,which is slightly older than that in the control group（24.35±3.14 years,P = 0.000）.The mean maternal body mass index（BMI） at early pregnancy was 22.75±2.81 kg/m 2,which was also higher than that in the control group（21.76±2.59 kg/m 2,P = 0.000）.About 64.6% of macrosomic neonates were males,compared with 51.0% in the control group（P = 0.000）.Compared with women with normal weight（BMI：18.5-23.9 kg/m 2）,women who were overweight（BMI：24-27.9 kg/m 2） or obese（BMI ≥ 28 kg/m 2）,respectively,had a 1.69-fold（P = 0.000） and a 1.49-fold（P = 0.000） increased risks of having a neonate with macrosomia,while light weight（BMI〈18.5 kg/m 2） women had an approximately 50% reduction of the risk.Furthermore,macrosomia infant had a 1.52-fold and 1.50-fold risk,respectively,of developing overweight or obesity at the age of 7 years（P = 0.001 and P = 0.000）.Older maternal age,higher maternal BMI at early pregnancy and male gender were independent risk factors of macrosomia.Macrosomic infant was associated with an increased predisposition to develop overweight or obesity at the beginning of their childhood.
基金Supported in part by funds from Australia's James Cook University research infrastructure block grant(Grant No.RIBG 09-2009)
文摘Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record.Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.Results:Ninety-one non-CDM mothers with macrosomia were studied and compared with 41normoglycemic subjects without macrosomia.Of the subjects with non-GDM macrosomia,45(49.4%)had normal SO g glucose challenge test(GCT)without further testing,another 8(8.8%)had abnormal GCT but normal 75 g oral glucose tolerance test(OGTT).A total of 4(4.4%)subjects had normal GCT and OGTT.Interestingly.14 out of 16(87.5%)subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies.Only 12 subjects had both GCT and OGTT,the rest of the cohort had either of the two tests.Subjects with non-CDM macrosomia had higher frequency of neonatal hypoglycaemia 34%as compared to 10%in nonmacrosomic babies(P=0.003).Other feto-maternal complications were similar in both groups.Conclussions:No significant pattern of glucose tolerance characteristics was identified in nonGDM mothers with macrosomic babies.In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies.Further prospective studies on a larger population are needed to verify our findings.
文摘Introduction: Macrosomia is usually defined by the delivery of a child over 4000 g at term. Because of the margins of error, the obstetrician must take into account, in addition to ultrasound, the constitutional and acquired factors of the mother in order to be able to prevent the complications expected during the delivery of a large fetus. Material and method: We carried out a cross-sectional, descriptive, 12-month study in a level 2 hospital in southern France (Montélimar). The aim of the study was to assess the prevalence of macrosomia, to identify the epidemiological characteristics of the patients, to specify the management of obstetrics and complications in this hospital. Results: We recorded 141 births with a weight greater than or equal to 4000 g. That is a rate of 7.95%. The average age of our patients is 30 years. Half of them had a BMI of less than 25 and were not diabetic. 75% of the patients gave birth by a low-dose route. The sex ratio of the children is male to female 2:1. The main maternal complications were the perineovaginal tears (39 cases) and the hemorrhages of the deliverance (6 cases). Conclusion: The delivery of macrosomia is not uncommon at the Hospital Center of Montélimar. It predominates among Caucasians. Usual risk factors have rarely been found. Overall management was without major complications for both the mother and the child.
基金Key Medical Speciality (Obstetrics) of Jiading District, Shanghai (JDYXZDZK-8)
文摘Objective: To investigate the risk factors of macrosomia and to predict the risk of macrosomia so as to reduce the incidence of macrosomia. Methods: A total of 2063 pregnant women who met the inclusion criteria were selected as the subjects from February 2016 to April 2017 in Jiading District Maternal and Child Health Hospital of Shanghai and Pudong New Area Maternal and Child Health Hospital. According to the birth weight of the neonates, the neonates were divided into the macrosomia group (neonatal weight > 4000 g, n=125) and the normal infant group (2500 g < neonatal weight < 4000 g, n=1938).The general data of age, number of pregnant women, BMI before pregnancy, gestational diabetes mellitus, glucose tolerance, weight gain during pregnancy, birth weight and gestational week were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors of macrosomia. Results: ①There were significant differences in BMI, glucose tolerance, fasting blood sugar, weight gain in the second trimester, weight gain in the third trimester, birth weight and gestational week between the two groups (P<0.05). ②Single factor analysis showed that pre-pregnancy BMI, gestational week at first diagnosis, fasting blood glucose tolerance, weight gain in the second trimester, weight gain in the third trimester, gestational week and birth weight were the influencing factors of macrosomia (P<0.05). ③Multi-factor analysis showed that gestational weeks, gestational diabetes, fasting glucose tolerance and weight growth in the second trimester were the main factors affecting the production of macrosomia, among which gestational diabetes was the protective factor, while gestational weeks, fasting glucose tolerance and weight growth in the second trimester were the risk factors. Conclusion: The high risk factors for macrosomia are gestational weeks, glucose tolerance, fasting blood sugar and weight gain in the second trimester of pregnancy.We should strengthen regular obstetric examination, health care during pregnancy, reasonable diet and proper exercise, and strictly control the weight gain during the second trimester of pregnancy. At the same time, we should monitor blood sugar in time so as to reduce the incidence of macrosomia.
文摘Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.
文摘Introduction: Fetal macrosomia is a birth weight greater than or equal to 4000 grams. The aim of this study is to determine the frequency of macrosomia, to identify the risk factors, and to evaluate the maternal and perinatal prognosis in the obstetrics and gynaecology department of the Community University Hospital Centre (CHUC). Methodology: This was a retrospective case-control study over a period of 24 months in the maternity ward of the CHUC. Results: The frequency of delivery of macrosomic fetuses was 4.1%, and the average age of women with large fetuses was 29.5 years. In 65.7% of cases, they were not engaged in any income-generating activity. Most of them had at least secondary education (65.7%) and were mainly multiparous (78.8%). The risk factors found were maternal age greater than or equal to 35 years, multiparity, previous large fœtus, gestational diabetes, obesity and male sex. Maternal complications were dominated by uterine atony (52.2%), perineal tear (31.9%), and cervical tear (15.9%). In our series, macrosomic newborns were three times more likely to present with a neonatal complication than normal-weight newborns. Neonatal mortality was 2.1%. Conclusion: Reducing macrosomia requires a better understanding of the risk factors, early detection, correct management during vaginal delivery and close monitoring of labour with good control of obstetric manoeuvres.
文摘Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a major health concern. Objectives: To determine the frequency of neonatal macrosomia, describe risk factors and neonatal and maternal complications. Materials and methods: This was a cross-sectional study carried out between January and December 2022, involving newborns whose birth weight was greater than or equal to 4000 grams admitted to the neonatology unit of the Labe regional hospital. Results: 591 deliveries were recorded, 15 of which were macrosomic, representing a frequency of 2.54%. The average age of the women was 30.26 years. History of fetal macrosomia and diabetes was 93.33 and 71.43% respectively. The mean gestational age was 38.71 ± 0.75 SA, the mean antenatal consultation was 3 ± 0.8 and the mode of delivery was caesarean section (66.67%). Third-trimester ultrasound was performed in 53.33% of cases. Macrosomic newborns were male in 80% of cases. Neonatal complications were asphyxia (60%), hypoglycemia (20%) and hypocalcemia (13.33%). Factors associated with neonatal macrosomia were diabetes (P < 0.001), history of macrosomia (P Conclusion: this study shows that the frequency of neonatal macrosomia is 2.54% with high neonatal morbidity among newborns hospitalized in the neonatology unit of the Labé regional hospital. Screening for macrosomia risk factors during pregnancy is essential to prevent perinatal complications.
基金supported by the High Level-Hospital Program,Health Commission of Guangdong Province,China,No.HKUSZH201901011the Shenzhen Science and Technology Program,No.JCYJ20220530142017038.
文摘Fetal macrosomia is associated with maternal and newborn complications due to incorrect fetal weight estimation or inappropriate choice of delivery models.The early screening and evaluation of macrosomia in the third trimester can improve delivery outcomes and reduce complications.However,traditional clinical and ultrasound examinations face difficulties in obtaining accurate fetal measurements during the third trimester of pregnancy.This study aims to develop a comprehensive predictive model for detecting macrosomia using machine learning(ML)algorithms.The accuracy of macrosomia prediction using logistic regression,k-nearest neighbors,support vector machine,random forest(RF),XGBoost,and LightGBM algorithms was explored.Each approach was trained and validated using data from 3244 pregnant women at a hospital in southern China.The information gain method was employed to identify deterministic features associated with the occurrence of macrosomia.The performance of six ML algorithms based on the recall and area under the curve evaluation metrics were compared.To develop an efficient prediction model,two sets of experiments based on ultrasound examination records within 1-7 days and 8-14 days prior to delivery were conducted.The ensemble model,comprising the RF,XGBoost,and LightGBM algorithms,showed encouraging results.For each experimental group,the proposed ensemble model outperformed other ML approaches and the tra-ditional Hadlock formula.The experimental results indicate that,with the most risk-relevant features,the ML algo-rithms presented in this study can predict macrosomia and assist obstetricians in selecting more appropriate delivery models.
文摘Context. The prevalence of macrosomia varies through the world according to racial and ethnic factors, life style and importance of non communicable diseases (maternal obesity, diabetes-gestational and type 2), post-term gestation and multiparity. At the University Clinics of Kinshasa (UCK), 30 years ago, the frequency of macrosomia was 2.4%. Objectives. To update data on the frequency of macrosomia at UCK, regarding variations in maternal anthropometrics (obesity) and socio-demographic factors. Methods. A cross-sectional study was conducted at UCK from 1 January 2007 to 31 December 2016. Mothers who delivered babies weighing at least 4000 g were included in this study. Results. The frequency of macrosomia was 3.7%. Trend shows a variation of this frequency over time with lowest frequency (2.1%) in 2012 and highest (5.3%) in 2009. The mother average age and parity were 32.3 ± 5.4 years and 3 ± 2, respectively. Pregnancies were complicated by polyhydramnios (48%) and gestational diabetes (19.7%). Caesarean section was performed in 60.5% cases, mainly for macrosomia (47.8%) and 81.6% of newborns had constitutional macrosomia. Adverse obstetrical outcomes of macrosomia were dominated by caesarean section (28.9%), lacerations of birth canal (23%) and neonatal distress (9.2%). Conclusion. Macrosomia remains a constant finding at UCK, and is associated with maternal, fetal and neonatal adverse outcomes. Trend shows a variation of the frequency over time between 2.1% and 5.3%.
文摘Background Fetal macrosomia,defined as birth weight equal or over 4000 g,is a major concern for both neonatal and maternal health.A rapid increasing trend in fetal macrosomia is observed in different regions of China.We aimed to examine the association between fetal macrosomia and risk of childhood obesity in Western China.Methods All macrosomic live singletons (≥ 4000 g),and a random sample of singletons with normal birth weight (2500-3999 g) born in four districts of Chengdu,Western China,in 2011 were included in the cohort study.Maternal demographics,obstetric factors,labor and delivery summary at baseline were extracted from the Chengdu Maternal and Child Health Management System.Anthropometric measurements before 3 years and infant feeding information at around 6 months were also collected.Childhood obesity under 3 years was primarily defined as a weight-for-length/height z score ≥ 1.645 using the WHO growth reference.Secondary definitions were based on weight-for-age and body mass index (BMI)-for-age over the same cut-offs.Results A total of 1767 infants were included in the analyses,of whom 714 were macrosomic.After controlling for maternal age,parity,gestational age and anemia at the first antenatal visit,pre-pregnancy BMI,gestational weight gain,gestational age at birth,baby age and sex,and breastfeeding practices at 6 months,the risk of childhood obesity defined according to weight-for-length/height among macrosomic babies was 1.90 (95% confidence interval 1.04-3.49) times that of babies with normal birth weight.The risk of childhood obesity for macrosomic babies was 3.74 (1.96-7.14) and 1.64 (0.89-3.00) times higher based on weight-for-age and BMI-for-age,respectively.Conclusion Fetal macrosomia is associated with increased risk of obesity in children under 3 years in Western China.
文摘Background Women who had delivered a macrosomic newborn will have a higher risk to deliver another macrosomia.We aimed to examine the recurrence risk of macrosomia in the subsequent pregnancy and the implications in long-term child health.Methods Data from the Collaborative Perinatal Project,a longitudinal birth cohort with 54,371 singleton births,were used.401 recurrent macrosomic infants (macro-macro) and 1327 normal weight babies with a macrosomia in the last pregnancy (macro-normal) were selected to explore risk factors for recurrent macrosomia.Furthermore,768 newly onset macrosomia with normal birthweight infant in previous pregnancies (normal-macro) were identified to examine long-term health effects of recurrent macrosomia.Results The recurrent rate of macrosomia was 23.2% [95% confidence interval (CI) 21.2%,25.2%].White race,higher pre-pregnant body mass index (BMI),more gestational weight gain,male infant and more prior macrosomic infants were significant risk factors for recurrent macrosomia.At 4 years of age,recurrent macrosomic infants had a higher BMI (16.7 vs.16.1 kg/m2,adjusted fβ:0.36,95% CI:0.12,0.60) and a higher risk of overweight and obesity (adjusted OR:1.56,95% CI:1.10,2.23) than infants with normal birthweight after a previous macrosomic sibling.There was no significant difference between recurrent macrosomia and newly onset macrosomia in child outcomes after adjustment for covariates.Conclusions Fetal macrosomia has a high recurrence rate in the following pregnancy.Higher maternal pre-pregnant BMI and gestational weight gain are still important risk factors for recurrence of macrosomia,which in turn increases the risk for childhood obesity.
文摘Gestational diabetes mellitus(GDM)is a well-established risk factor for fetal macrosomia.A significant number of patients with GDM also suffer from obesity,a factor associated with fetal macrosomia.An important question is whether GDM is independently associated with fetal macrosomia,or whether this relationship is merely the result of maternal obesity acting as a confounder.In this review of the literature,we attempt to further elucidate the relationship between GDM,maternal obesity,and fetal macrosomia.
基金supported by the research grant from the Key Research and Development Program of Shaanxi Province(no.2022SF-125,2021ZDLSF02-14).
文摘Objective:To investigate the morphological and ultrastructural alterations in placentas from pregnancies with gestational diabetes mellitus(GDM)–induced macrosomia,term nondiabetic macrosomia,and normal pregnancies.Methods:Sixty full-term placentaswere collected,and clinical data alongwith informed consent were obtained from pregnant womenwho underwent regular visit checks and delivered their newborns in Northwest Women’s and Children’s Hospital between May and December 2022.Placentas were divided into three equal groups:normal pregnancy(control group),nondiabetic macrosomia group,and macrosomia complicated with GDM(diabetic macrosomia)group.Gross morphological data of placentas were recorded,and placental samples were processed for examination of ultrastructural and stereological changes using transmission electron microscopy.Analysis of variance and chi-squared test were used to examine the differences among the three groups for continuous and categorical variables,respectively.Results:The baseline characteristics of mothers and neonates did not differ across the three groups,except for a significantly higher birth weight in the diabetic macrosomia group(4172.00±151.20 g vs.3192.00±328.70 g,P<0.001)and nondiabetic macrosomia group(4138.00±115.20 g vs.3192.00±328.70 g,P<0.001)comparedwith control group.Examination of the placentas revealed that placental weight was also highest in the diabeticmacrosomia group comparedwith control group(810.00±15.81 g vs.490.00±51.48 g,P<0.001)and nondiabetic macrosomia group(810.00±15.81 g vs.684.00±62.69 g,P<0.001),but the ratio of neonatal birth weight to placental weight(BW/PW)was significantly lower in the diabetic macrosomia group compared with that in the control group(5.15±0.19 vs.6.54±0.63,P<0.001)and nondiabetic macrosomia group(5.15±0.19 vs.6.09±0.52,P<0.001)group.In contrast,the BW/PW ratio in nondiabetic macrosomia did not differ significantly from that in the control group.Distinct ultrastructural changes in terminal villi and stereological alterations in microvilli were observed in the diabetic macrosomia group,including changes in the appearance of cytoplasmic organelles and the fetal capillary endothelium and thickness of the vasculo-syncytial membrane and basal membrane.Conclusion:Significant ultrastructural and stereological alterations were discovered in the placentas from pregnant women with macrosomia induced by GDM.These alterationsmay be the response of the placenta to the hyperglycemia condition encountered during pregnancies complicated with GDM.
文摘Objective:Interventions currently recommended to control and prevent obesity have not been successful.Recent research has shifted toward the transgenerational cycle of obesity.We assessed the association between fetal macrosomia and early childhood body weight.Methods:We conducted a follow-back study to link birth certificate data to the Third National Health and Nutrition Examination Survey(1988–1994)of 2621 United States-born singletons aged 2–6 years.Birth weight and gestational age data were collected from birth certificates.Fetal macrosomia was defined as≥90th percentile of gestational age-race-sex-parity specific body weight distribution in 1989 vital statistics.Results:With 12.7%(standard error=0.85%)of participants born macrosomic,the prevalence of obesity and overweight(BMI percentiles≥85th in the CDC growth chart)among children was 17.8%(1.17%).When the body weight was measured against age-sex-specific height(BMI percentiles),macrosomia was significantly associated with overweight and obesity(odds ratio[OR]=1.64,95%confidence interval=1.07–2.50)adjusted for family income,maternal age and marital status,race,maternal smoking during pregnancy,and breastfeeding.The association became insignificant after adjusting for postnatal lifestyle and parental body mass index(OR=1.38[0.84-2.26]].When body weight was measured against age,children who were too heavy for their age were more likely to be born macrosomically(OR=2.64[1.66-4.22])than their peers with healthy age-specific body weight.Conclusion:Fetal macrosomia was significantly associated with a doubled risk of heavy body weight in children aged 2–6 years.
