Antenatal risk factors associated with neonatal morbidity in large-for-gestational-age infants: an international prospective cohort study

作者：Vieira Matias C; Mccowan Lesley M E; North Robyn A; Myers Jenny E; Walker James J; Baker Philip N; Dekker Gustaaf A; Kenny Louise C; Poston Lucilla; Pasupathy Dharmintra^*

来源：Acta Obstetricia et Gynecologica Scandinavica, 2018, 97(8): 1015-1024.

DOI：10.1111/aogs.13362

• Large-for-gestational age
• macrosomia
• risk factors
• adverse outcome
• neonatal morbidity

IntroductionLarge-for-gestational-age infants are associated with increased risk of neonatal morbidity and mortality. However, most of them will not have adverse outcomes. Our aim was to identify antenatal clinical factors associated with neonatal morbidity in large-for-gestational-age infants.
Material and methodsNulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study were included. We compared maternal and fetal factors between large-for-gestational-age infants (birthweight >90th customized centile) with and without neonatal morbidity, defined as admission to a neonatal intensive care unit or severe neonatal morbidity. Factors were selected based on a priori hypotheses of association and included maternal demography, anthropometric measures and self-reported physical activity (15 and 20weeks), fetal biometry (20weeks), and clinical information. Multivariable logistic regression was used to identify risk factors. Stratified analyses were performed by maternal obesity and physical activity.
ResultsAmong term pregnancies, prevalence of large-for-gestational-age infants was 9.3% (491/5255), with 11.8% (58/491) prevalence of neonatal morbidity. Random glucose at 20weeks (odds ratio 1.52; 95% confidence interval 1.17-1.97, per 1mmol/L increase) and no regular physical activity at 20weeks (odds ratio 3.93; 95% confidence interval 1.75-8.83) were associated with increased risk of neonatal morbidity after adjustment for birthweight, gestational age at delivery and gestational diabetes. The increased risk associated with higher glucose levels was not evident in women with regular physical activity or without obesity.
ConclusionsRegular physical activity in mid-pregnancy is associated with lower risk for neonatal morbidity in large-for-gestational-age infants and seems to offer protection against the increased risk associated with higher maternal glucose levels.

• 出版日期2018-8