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Perinatal Outcomes in Large Infants Using Customised Birthweight Centiles and Conventional Measures of High Birthweight.
MedLine Citation:
PMID:  23061690     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background:  Large-for-gestational-age (LGA) or macrosomic infants are associated with adverse maternal and neonatal outcomes. It is unclear if these associations are stronger using customised birthweight centiles. We compared outcomes between term infants defined macrosomic by birthweight >4000 g (Macro(4000) ) or LGA by population centiles (LGA(pop) ) with those defined LGA by customised centiles (LGA(cust) ). Methods:  This is a prospective cohort study of 2668 term nulliparous women recruited into the Screening for Pregnancy Endpoints (SCOPE) study centres in Auckland, New Zealand and Adelaide, Australia. Maternal (caesarean delivery, postpartum haemorrhage) and infant (severe neonatal morbidity/mortality and admission to neonatal intensive care) outcomes in Macro(4000) and LGA groups were compared with appropriate-for-gestational-age infants by customised centiles using logistic regression. Results:  Customised centiles defined fewer infants as LGA (10.3% LGA(cust) , 14.8% Macro(4000) , 11.2% LGA(pop) ). However customised centiles showed stronger association with adverse outcomes. Pre-labour and intrapartum caesarean section were increased twofold in LGA(cust) pregnancies, including those that were not Macro(4000) or LGA(pop) . Postpartum haemorrhage was increased twofold in mothers of LGA(cust) infants only when infants were also LGA(pop) . Severe neonatal morbidity/mortality or admission to neonatal intensive care was increased twofold in LGA(cust) who were also either Macro(4000) or LGA(pop) . Importantly 52.3% of Macro(4000) and 25.5% of LGA(pop) infants were AGA(cust) and not at increased risk of most adverse maternal or neonatal outcomes. Conclusions:  The use of customised centiles are more strongly associated with adverse birth outcomes and its use should be considered in the definition of LGA.
Authors:
Dharmintra Pasupathy; Lesley M E McCowan; Lucilla Poston; Louise C Kenny; Gus A Dekker; Robyn A North;
Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Paediatric and perinatal epidemiology     Volume:  26     ISSN:  1365-3016     ISO Abbreviation:  Paediatr Perinat Epidemiol     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8709766     Medline TA:  Paediatr Perinat Epidemiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  543-552     Citation Subset:  -    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Affiliation:
Division of Women's Health, Women's Health Academic Centre, King's Health Partners, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Republic of Ireland Women's and Children's Division, Lyell McEwin Hospital, The Robinson Institute, University of Adelaide, Adelaide, Australia.
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