Inter-delivery birthweight difference greater than 1000 grams and its effects on maternal and neonatal outcomes

Abstract

To examine the association between actual birthweight difference of more than 1000 grams between the second and first delivery and short-term maternal and neonatal outcomes including mode of delivery. Retrospective cohort study using medical records of a single large academic center, between the years 2005 and 2019. The study population included all women who had their first and second live fetus singleton delivery in our center. Women who had cesarean delivery at first delivery were excluded. The primary outcome was the mode of delivery in the second delivery. Secondary outcomes were composite adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariate logistic regression. A total of 22,751 women were included. Of those, 316 (1.4%) gave birth to neonates with inter-delivery birthweight interval >1000 grams from their first delivery, Figure. Women in the study group were older, more likely to suffer from hypertensive disorders during both pregnancies with a lower mean BW in the first delivery. There was no significant difference between the two groups in diabetes rates (pre-gestational + gestational) or maternal age in either one of the pregnancies. Women in the study group had lower rates of preterm labor, but higher rates of Oxytocin augmentation of labor, longer first and second stages of labor, episiotomy, vacuum extraction, shoulder dystocia, 1-minute Apgar score < 7 and were large for gestational age (61.7% vs. 11.9%, p< 0.001) neonates, Table. Cesarean delivery was more prevalent among the study group (7.9% vs 3.2%, aOR 3.31 [1.78-6.17], p< 0.001(, including in-labor cesarean delivery (3.2% vs 1.5%, aOR 2.97 [1.46-6.06], p=0.01) as were the composite adverse maternal and neonatal outcomes – (12.7% vs 8.4%, aOR 1.69 [1.20-2.38], p< 0.01), and (15.5% vs 11,9% aOR 1.95 [1.40-2.72], p< 0.001), respectively. Birthweight interval >1,000 grams is associated with higher rates of CD, as well as an increase in maternal and neonatal adverse outcomes, making it worthwhile to screen women for significant birthweight differences.View Large Image Figure ViewerDownload Hi-res image Download (PPT)