The Role of Maternal Weight in the Hierarchy of Macrosomia Predictors; Overall Effect of Analysis of Three Prediction Indicators.

Małgorzata Lewandowska

doi:10.3390/nu13030801

Abstract

So far it has not been established which maternal features play the most important role in newborn macrosomia. The aim of this study is to provide assessment of a hierarchy of twenty six (26) maternal characteristics in macrosomia prediction. A Polish prospective cohort of women with singleton pregnancy (N = 912) which was recruited in the years 2015–2016 has been studied. Two analyses were performed: for probability of macrosomia > 4000 g (n = 97) (vs. 755 newborns 2500–4000 g); and for birthweight > 90th percentile (n = 99) (vs. 741 newborns 10–90th percentile). A multiple logistic regression was used (with 95% confidence intervals (CI)). A hierarchy of significance of potential predictors was established after summing up of three prediction indicators (NRI, IDI and AUC) calculated for the basic prediction model (maternal age + parity) extended with one (test) predictor. ‘Net reclassification improvement’ (NRI) focuses on the reclassification table describing the number of women in whom an upward or downward shift in the disease probability value occurred after a new factor had been added, including the results for healthy and ill women. ‘Integrated discrimination improvement’ (IDI) shows the difference between the value of mean change in predicted probability between the group of ill and healthy women when a new factor is added to the model. The area under curve (AUC) is a commonly used indicator. Results. The macrosomia risk was the highest for prior macrosomia (AOR = 7.53, 95%CI: 3.15–18.00, p < 0.001). A few maternal characteristics were associated with more than three times higher macrosomia odds ratios, e.g., maternal obesity and gestational age ≥ 38 weeks. A different hierarchy was shown by the prediction study. Compared to the basic prediction model (AUC = 0.564 (0.501–0.627), p = 0.04), AUC increased most when pre-pregnancy weight (kg) was added to the base model (AUC = 0.706 (0.649–0.764), p < 0.001). The values of IDI and NRI were also the highest for the model with maternal weight (IDI = 0.061 (0.039–0.083), p < 0.001), and (NRI = 0.538 (0.33–0.746), p < 0.001). Adding another factor to the base model was connected with significantly weaker prediction, e.g., for gestational age ≥ 38 weeks (AUC = 0.602 (0.543–0.662), p = 0.001), (IDI = 0.009 (0.004; 0.013), p < 0.001), and (NRI = 0.155 (0.073; 0.237), p < 0.001). After summing up the effects of NRI, IDI and AUC, the probability of macrosomia was most strongly improved (in order) by: pre-pregnancy weight, body mass index (BMI), excessive gestational weight gain (GWG) and BMI ≥ 25 kg/m2. Maternal height, prior macrosomia, fetal sex-son, and gestational diabetes mellitus (GDM) occupied an intermediate place in the hierarchy. The main conclusions: newer prediction indicators showed that (among 26 features) excessive pre-pregnancy weight/BMI and excessive GWG played a much more important role in macrosomia prediction than other maternal characteristics. These indicators more strongly highlighted the differences between predictors than the results of commonly used odds ratios.

Highlights

Numerous tests have revealed that newborns with excessive birth weight exhibit higher risk of birth complications and long-term negative health issues, such as diabetes and obesity [1,2,3,4]
In this assessment of the significance hierarchy of 26 maternal characteristics as potential macrosomia predictors, excessive pre-pregnancy weight/body mass index (BMI) and excessive gestational weight gain (GWG) played the most important role in macrosomia prediction. This analysis based on newer prediction indices (NRI, Integrated discrimination improvement’ (IDI) and area under curve (AUC)) showed that the importance of BMI and GWG was much higher than that of other maternal characteristics and this difference was stronger than the odds ratio results showed
The role of maternal obesity and overweight in the development of excessive birth weight is known, the finding of such a strong role for these factors in macrosomia prediction confirms and emphasizes the need to improve the nutritional status of women before and during pregnancy in order to reduce the occurrence of this adverse newborn outcome

Summary

Introduction

Numerous tests have revealed that newborns with excessive birth weight exhibit higher risk of birth complications and long-term negative health issues, such as diabetes and obesity [1,2,3,4]. Excessive birth weight can be an important element in the concept of noninfectious disease development according to the Developmental Origins of Health and Disease (DOHaD) and may result in a worse start to life compared to newborns with appropriate weight [2,5]. Maternal obesity and diabetes mellitus are considered to be independent factors of macrosomia risk, which has been confirmed in meta-analyses [12,13]. Women with appropriate weight and without diabetes mellitus give birth to children with macrosomia [14]. The hierarchy of clinical factors in prediction of macrosomia is unknown, and the choice of its determination method is difficult

Objectives

Methods

Results

Discussion

Conclusion