SAT-230 Risk of Macrosomia: A Study of 42,633 Pregnancies in Uruguay

Abstract

Introduction: Obesity and gestational diabetes (GD) are recognized risk factors (RF) for adverse neonatal and maternal outcomes, in relation to an increased frequency of macrosomia (MS) (neonate birthweight ≥ 4,000 g). In a cohort of 23832 Uruguayan women high pre-gestational BMI and excessive gestational weight gain (EGWG) were significantly associated with MS. The aim of this study was to evaluate the risk of MS in newborns form women with GD and obesity in Uruguay in 2012, as well as its association with prolonged pregnancy (PP), maternal age and multiparity. In addition, we evaluated prevalence and risk of MS in newborns from mothers with pregestational diabetes (PGD) and from those with EGWG. Methods: We performed a cross-sectional study of 42,663 pregnant women in Uruguay in 2012. The risk of macrosomía was studied using logistic regression, expressed as OR with 95% CIs. Results: Mean maternal age was 26.7 ± 6.8 years. Pre-gestational overweight and obesity was present in 20.9% and 10.7% of women, respectively. There were 28.1% and 19.8 % of women overweight (OW) and obese (OB) at the end of the pregnancy, respectively. Furthermore, 0.5% had PGD and 8.5% were multiparous. Twenty two percent developed GD and 44,9 % had EGWG. The prevalence of MS was 7,9 %, significantly more prevalent in males (10% vs. 5.5%, p<0.005). The prevalence of MS was 15%, 9.6% and 4.4% in women who were OB, OW and with normal weight at the end of pregnancy, respectively. Macrosomia in newborns from mothers with EGWG was 13%, compared with 5.6% in those with normal weight gain. Macrosomia was present in 14.5%, 11% and 7% of newborns from mothers diagnosed with PGD, GD, and normal glucose status, respectively. Moreover, MS was present in 20 % of newborns of PP, as well as in 10% of that born to multiparous women. Macrosomia was more likely in pre-gestational OB women (OR 1.24; CI 1.07-1.45), OW women (OR 1.65; CI 1.47-1.87), OB women (OR 2.21; CI 1.90-2.58), women with EGWG (OR 1.77; CI 1.58-1.97), PGD (OR 1.68; CI 1.10-2.57), GD (OR 1.37; CI 1.24-1.52), PP (OR 2.74; CI 2.35-3.19) and multiparity (OR 1.26; CI 1.06-1.50). Maternal age >35 years did not increase the risk of MS. Discussion: In this large Urugayan cohort of pregnant women almost half had BMI ≥ 25kg/m2 at the end of pregnancy and EGWG. In agreement with the published literature, we found that pregestational BMI, overweight and obesity during pregnancy, EGWG, PGD and GD are RF for MS in the Uruguayan pregnant women. Obesity is a recognized RF for PGD and GD. PP is a reported RF for MS, as fetuses gain 150-200 g weekly near term. Multiparity has been associated with MS, maybe due to the fact that birth weight increases with parity. Conclusion: Maternal overweight, obesity and EGWG are prevalent in Uruguay, increasing the risk of MS. Efforts to implement strategies to decrease the prevalence of overweight and obesity among women of reproductive age are essential to improve maternal and neonatal outcomes.