Abstract
BackgroundFetal macrosomia is defined as birth weight ≥4000 g. Several risk factors have been shown to be associated with fetal macrosomia. There has been an increased incidence of macrosomic babies delivered and the antecedent complications.This study assessed the risk factors, maternal and neonatal complications of fetal macrosomia in comparison with normal birth weight neonates.MethodsA case-control study was conducted at the Muhimbili National Hospital (MNH) maternity and neonatal wards. Cases comprised of neonates with birth weight ≥4000 g; controls were matched for sex and included neonates weighing 2500–3999 g. Detailed clinical and demographic information and laboratory investigations which included blood glucose, hematocrit and plasma calcium were collected. The child was followed up to discharge/death.ResultsThe prevalence of macrosomic babies was 2.3 % (103 out of 4528 deliveries). Mean birth weight of macrosomic babies was 4.2 ± 0.31 kg whereas in the controls it was 3.2 ± 0.35 kg. Maternal weight ≥80 kg, maternal age ranging between 30 and 39 years, multiparity, presence of diabetes mellitus, and gestational age ≥40 years, previous history of fetal macrosomia and delivery weight ≥80 kg were significantly associated with fetal macrosomia. Macrosomic infants were more likely to have birth asphyxia, shoulder dystocia, hypoglycemia, respiratory distress and perinatal trauma and increased risk of death compared to controls. Maternal complications such as postpartum hemorrhage, second degree perineal tears and prolonged labor occurred more frequently in the macrosomia group compared to controls (p-value <0.05), while shoulder dystocia, uterine rupture and maternal death were recorded only among the cases and none occurred in the controls.ConclusionFetal macrosomia was an important cause of maternal and neonatal morbidity at Muhimbili National Hospital. Presence of risk factors should alert the obstetrician to closely monitor these pregnancies and plan on appropriate mode of delivery. Macrosomic neonates should be routinely screened and appropriately managed for hypoglycemia.
Highlights
Fetal macrosomia is defined as birth weight ≥4000 g
Mean parity was significantly greater in the macrosomia group compared to the controls (2.4 vs. 1.2, p-value
Other parameters including weight at delivery, mean height and gestational age at delivery were significantly higher among the cases compared to the controls
Summary
Fetal macrosomia is defined as birth weight ≥4000 g. Several risk factors have been shown to be associated with fetal macrosomia. This study assessed the risk factors, maternal and neonatal complications of fetal macrosomia in comparison with normal birth weight neonates. Fetal macrosomia is common in obstetrics with problems to both the mother and the newborn It has been associated with significant risk of morbidity and mortality. Several risk factors have been identified in the causation of macrosomia These include maternal diabetes, high pre-pregnancy Body Mass Index (BMI), excessive weight gain during pregnancy, multiparity, male sex, parental height, and prolonged gestation [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18]. The risk increases with a higher birth weight of the infant [20]
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