Fetal Macrosomia in the Maternity Ward of the Community University Hospital: Risk Factors and Maternal-Fetal Prognosis

Introduction: Fetal macrosomia is a birth weight greater than or equal to 4000 grams. The aim of this study is to determine the frequency of macrosomia, to identify the risk factors, and to evaluate the maternal and perinatal prognosis in the obstetrics and gynaecology department of the Community University Hospital Centre (CHUC). Methodology: This was a retrospective case-control study over a period of 24 months in the maternity ward of the CHUC. Results: The frequency of delivery of macrosomic fetuses was 4.1%, and the average age of women with large fetuses was 29.5 years. In 65.7% of cases, they were not engaged in any income-generating activity. Most of them had at least secondary education (65.7%) and were mainly multiparous (78.8%). The risk factors found were maternal age greater than or equal to 35 years, multiparity, previous large fœtus, gestational diabetes, obesity and male sex. Maternal complications were dominated by uterine atony (52.2%), perineal tear (31.9%), and cervical tear (15.9%). In our series, macrosomic newborns were three times more likely to present with a neonatal complication than normal-weight newborns. Neonatal mortality was 2.1%. Conclusion: Reducing macrosomia requires a better understanding of the risk factors, early detection, correct management during vaginal delivery and close monitoring of labour with good control of obstetric manoeuvres.

Frequency and Risk Factors of Neonatal Macrosomia at Labe Regional Hospital in Guinea

Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a major health concern. Objectives: To determine the frequency of neonatal macrosomia, describe risk factors and neonatal and maternal complications. Materials and methods: This was a cross-sectional study carried out between January and December 2022, involving newborns whose birth weight was greater than or equal to 4000 grams admitted to the neonatology unit of the Labe regional hospital. Results: 591 deliveries were recorded, 15 of which were macrosomic, representing a frequency of 2.54%. The average age of the women was 30.26 years. History of fetal macrosomia and diabetes was 93.33 and 71.43% respectively. The mean gestational age was 38.71 ± 0.75 SA, the mean antenatal consultation was 3 ± 0.8 and the mode of delivery was caesarean section (66.67%). Third-trimester ultrasound was performed in 53.33% of cases. Macrosomic newborns were male in 80% of cases. Neonatal complications were asphyxia (60%), hypoglycemia (20%) and hypocalcemia (13.33%). Factors associated with neonatal macrosomia were diabetes (P < 0.001), history of macrosomia (P Conclusion: this study shows that the frequency of neonatal macrosomia is 2.54% with high neonatal morbidity among newborns hospitalized in the neonatology unit of the Labé regional hospital. Screening for macrosomia risk factors during pregnancy is essential to prevent perinatal complications.

Outcomes of Fetal Macrosomia and Associated Factors: A Case-Control Facility Based Study

Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.

妊娠期糖尿病产妇与非妊娠期糖尿病产妇分娩巨大儿的影响因素

目的探讨妊娠期糖尿病(GDM)产妇与非GDM产妇分娩巨大儿的影响因素。方法纳入分娩巨大儿的143例产妇和分娩正常体重新生儿的157例产妇作为研究对象,根据孕期是否患GDM,将前者分为GDM巨大儿组、非GDM巨大儿组,将后者分为GDM对照组及非GDM对照组。使用多因素二元Logistic回归模型分析GDM产妇和非GDM产妇分娩巨大儿的影响因素。结果无论是否患GDM,孕前体质指数、孕晚期载脂蛋白A水平和孕期胆固醇差值增加是产妇分娩巨大儿的危险因素(P<0.05),而孕晚期胆固醇水平较高则是产妇分娩巨大儿的保护因素(P<0.05)。在GDM产妇中,孕早期LDL水平、孕中期OGTT前血糖水平较高是其分娩巨大儿的危险因素(P<0.05),孕期HDL差值较高则是其分娩巨大儿的保护因素(P<0.05)。在非GDM产妇中,胎儿为男性、孕期总增重较高、分娩孕周较大、孕晚期LDL水平较高是其分娩巨大儿的危险因素,而孕晚期HDL水平较高、孕期LDL差值较大则是其分娩巨大儿的保护因素(P<0.05)。结论GDM产妇与非GDM产妇分娩巨大儿的影响因素不完全相同。对于GDM产妇,尤其空腹血糖高者,应合理控制血糖并密切监测,关注血脂变化;对于非GDM产妇,应在孕期注意体重管理,避免增重过度,并监测血脂,以降低巨大儿的发生率。

胎儿体质量估计对初产妇巨大儿分娩方式及围产结局的临床观察

目的观察胎儿体质量估计对初产妇巨大儿的分娩方式和围产结局的影响。方法选取2022年1月至2023年12月北京市海淀区妇幼保健院分娩的足月单胎初产妇206例,根据估计体质量分为甲组(估计胎儿体质量<4000 g,118例)和乙组(估计胎儿体质量≥4000 g,88例)。比较两组产妇及新生儿的分娩方式和分娩结局等。结果206例初产妇年龄21~39岁,平均(30.6±3.4)岁。与乙组相比,甲组阴道分娩比例较高(61.9%比40.9%)、剖宫产比例较低(32.2%比56.8%),两组分娩方式的差异有统计学意义(P<0.05)。甲组试产率明显高于乙组(90.7%比59.1%),差异有统计学意义(P<0.05)。甲组产后出血量(容积法)和校正产后出血量均高于乙组[350(300,500)ml比300(300,380)ml,440(230,720)ml比360(160,560)ml],差异有统计学意义(P<0.05)。两组胎儿窘迫、肩难产、新生儿窒息比例的差异无统计学意义(P>0.05)。结论低估胎儿体质量可增加初产妇巨大儿试产率及阴道分娩率,也增加了产后出血量,但并未增加胎儿窘迫、肩难产、新生儿窒息等分娩并发症。建议胎儿估计体质量<4500 g且有阴道分娩意愿的产妇,应该在充分告知的情况下,增加试产机会。

不同分娩体位对初产妇巨大儿分娩结局的影响

目的:探究不同分娩体位对初产妇巨大儿分娩结局的影响。方法:纳入2021年1月至2023年1月于本医院进行分娩的初产妇(合并巨大儿)70例为研究对象进行回顾性研究,2021年1月至2022年1月按方便抽样法抽取35例产妇为对照组,2022年2月至2023年1月按方便抽样法抽取35例产妇为观察组。比较两组产妇分娩时间等。结果:与对照组相比,观察组产妇分娩时间缩短,会阴撕裂度降低(P<0.05)。观察组分娩控制量表(LAS)评分、新生儿Apgar评分高于对照组(P<0.05)。观察组疼痛评定指数(PRI)评分、现实疼痛强度(PPI)评分及视觉模拟评分法(VAS)评分、总出血率低于对照组(P<0.05)。结论:对合并巨大儿的初产妇第二产程进行俯卧位分娩方式结局较好,产程时间缩短,分娩控制感较好,疼痛感减轻,改善母婴不良结局。

GDM患者分娩前血糖变异性参数对巨大儿的预测价值

目的探讨妊娠糖尿病(GDM)患者分娩前血糖变异性参数与子代出生体重的相关性。方法选取2019年3月—2021年2月连云港市东方医院GDM患者100例,以各项指标均正常的孕妇261例作为对照。根据GDM患者和正常孕妇分娩的新生儿是否为巨大儿(体重≥4000 g)分为GDM巨大儿组、GDM健康儿组、巨大儿对照组、健康儿对照组。收集所有孕妇一般资料和实验室检测结果[血脂、血糖、糖化血红蛋白(HbA_(1c))等],并检测血糖变异性参数[平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)、餐后血糖波动幅度(PPGE)]。采用Logistic回归分析评估GDM患者子代巨大儿的危险因素。构建列线图预测模型,并进行评价。采用Pearson相关分析评估新生儿体重与产妇血糖变异性参数之间的相关性。通过曲线拟合和阈值效应分析确定MAGE、MODD和PPGE的阈值效应。结果GDM巨大儿组新生儿出生30 min的血糖水平显著低于巨大儿对照组(P<0.05)。GDM巨大儿组孕妇空腹血糖(FBG)、餐后2 h血糖(2 h PG)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、HbA_(1c)、MAGE、PPGE、MODD、载脂蛋白B(apo B)显著高于其他3组孕妇(P<0.05),高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(apo A)显著低于其他3组孕妇(P<0.05)。多因素Logistic回归分析结果显示,MAGE、PPGE、MODD和HbA_(1c)均是GDM患者子代巨大儿的危险因素[比值比(OR)值分别为1.116、1.169、1.072、1.061,95%可信区间(CI)分别为1.021~1.246、1.051~1.301、1.012~1.134、1.004~1.121,P<0.05]。Pearson相关分析结果显示,新生儿体重与MAGE、PPGE、MODD和HbA_(1c)均呈正相关(r值分别为0.77、0.68、0.72、0.75,P<0.05)。曲线拟合和阈值效应分析结果显示,当MAGE、PPGE、MODD分别高于2.75、2.06、3.27 mmol·L^(-1)时,GDM患者子代巨大儿的发生率随3项指标的升高而呈上升趋势。列线图预测模型的受试者工作特征(ROC)曲线下面积为0.887,一致性指数(C-index)为0.887,校正曲线与理想曲线拟合度良好。结论血糖变异性参数可作为GDM患者分娩巨大儿的预测指标,具有较高的临床应用价值。

叶酸补充持续时间与妊娠期糖尿病及不良围产结局的关系

目的:利用广义线性混合模型探讨叶酸补充持续时间、妊娠期糖尿病(GDM)与不良围产结局的关系。方法:收集2021年1月到2022年12月在河北北方学院附属第一医院进行分娩的759对母子临床资料。其中研究的不良围产结局包括剖宫产、早产儿、巨大儿、低出生体质量儿(LBW)、大于胎龄儿(LGA)和小于胎龄儿(SGA)。使用广义线性混合模型分析GDM、叶酸补充持续时间≥3个月对不良围产结局风险影响。对叶酸补充的持续时间进行分层分析,以确定其是GDM与不良围产结局的混杂因素还是影响因素。结果:共有748例(98.55%)研究对象在妊娠前、妊娠期进行了叶酸补充,其中妊娠期补充叶酸累计743例(97.89%)、妊娠前补充496例(65.35%)。77例孕妇发生GDM,发生率为10.14%。与妊娠前叶酸补充持续时间<3个月者相比,妊娠前叶酸补充持续时间≥3个月与GDM发生风险增加相关,调整后RR(aRR)为1.72(95%CI 1.17~2.53);GDM患者妊娠前叶酸补充持续时间≥3个月与SGA发生风险降低相关,aRR为0.40(95%CI 0.18~0.89)。在妊娠期叶酸补充持续时间≥3个月亚组中,GDM与剖宫产(aRR 1.36,95%CI 1.06~1.75)和巨大儿(aRR 2.11,95%CI 1.06~4.20)风险增加有关,但aRR均低于固定效应RR,分别为1.53(95%CI 1.01~2.34)和2.43(95%CI 12.7~4.66),以上差异均有统计学意义(P<0.01)。结论:妊娠前叶酸补充持续时间≥3个月可能增加GDM的风险,但降低GDM患者SGA出生的风险。妊娠期叶酸补充持续时间≥3个月对GDM妇女的剖宫产和巨大儿不良围产结局风险具有降低作用。

149例疑似巨大儿经阴道分娩产妇会阴侧切的影响因素分析

目的:探讨疑似巨大儿产妇经阴道分娩伴会阴侧切的影响因素。方法:回顾性分析2022年1—7月于南京医科大学第一附属医院产科分娩的149例疑似巨大儿产妇的临床资料,根据是否行会阴侧切,将产妇分为会阴侧切组和自然裂伤组。分析疑似巨大儿产妇经阴道分娩的危险因素。结果:149例疑似巨大儿产妇中,40例(26.85%)行会阴侧切分娩,109例(73.15%)阴道分娩伴自然裂伤,其中93例为Ⅰ度裂伤,16例为Ⅱ度裂伤。会阴侧切组中初产妇、助产士工作年限<5年占比高于裂伤组(P<0.001,P=0.021);会阴侧切组中第2产程<47 min的比例显著高于会阴裂伤组(87.5%vs.39.4%,P<0.001)。此外,自然裂伤组羊水性质(清+Ⅰ度)比例显著高于会阴侧切组(87.2%vs.72.5%,P=0.034),而会阴侧切组产后出血率显著低于自然裂伤组(P=0.010)。初产妇、助产士工作年限<5年是疑似巨大儿产妇会阴侧切的独立危险因素(OR=2.708,P=0.021)。结论:初产妇、助产士工作年限<5年时,产妇疑似巨大儿经阴道分娩伴会阴侧切的发生率增高;同时,侧切组产后出血率显著降低。

正常孕妇妊娠期增重和糖脂代谢与巨大儿发生风险的关系

目的:分析妊娠期体质量和糖脂水平在分娩巨大儿的无妊娠合并症/并发症、非肥胖、非高龄的正常孕妇中的变化特点,探讨其对巨大儿发生风险的影响。方法:选取2020年9—12月在上海交通大学医学院附属国际和平妇幼保健院定期产检的正常孕妇,根据是否分娩巨大儿分为巨大儿组(104例)和对照组(258例),比较2组基本情况和妊娠期糖脂水平,并采用Logistic回归分析正常孕妇分娩巨大儿的影响因素。结果:相较于正常对照组,巨大儿组妊娠期空腹血糖、妊娠早晚期三酰甘油(triglyceride,TG)水平更高,妊娠早晚期高密度脂蛋白(high density lipoprotein,HDL)水平更低,且巨大儿组妊娠期TG变化差值更大、HDL变化差值更小(均P<0.05)。与妊娠期增重适宜的正常孕妇相比,增重过多的正常孕妇分娩巨大儿的风险升高142%(OR=2.42,95%CI:1.34~4.39),增重不足的正常孕妇分娩巨大儿的风险降低73%(OR=0.27,95%CI:0.10~0.77);妊娠晚期HDL每升高1 mmol/L,分娩巨大儿风险下降79%(OR=0.21,95%CI:0.08~0.57)。结论:正常孕妇群体仍需严格控制妊娠期体质量以降低巨大儿的发生风险,并且仍需关注血脂代谢,其中妊娠晚期HDL的水平及变化情况或可辅助筛查隐匿性巨大儿。

基于机器学习算法构建初产妇合并巨大儿试产结局的预测模型

目的:探究妊娠合并巨大儿的初产妇经阴道试产结局的影响因素及预测模型。方法:收集2022年1月至2023年12月于安徽省妇女儿童医学中心住院并经阴道试产的巨大儿初产妇临床资料,根据分娩结局分为阴道分娩组及剖宫产组。单因素分析比较两组间资料,LASSO分析进一步筛选变量,分别采用支持向量机(SVM)、一般线性模型(GLM)、K最近邻(KNN)、随机森林(RF)建立预测模型,最后得出最佳模型。结果:阴道分娩组产妇的年龄、孕前及产前体质量指数(BMI)低于剖宫产组,阴道分娩组产妇身高、Bishop评分、胎儿股骨长高于剖宫产组,阴道分娩组自然临产比例高于剖宫产组,差异均有统计学意义。LASSO分析筛选出变量,结合机器学习算法构建预测模型,最终通过受试者工作曲线(ROC)对预测模型进行比较,GLM在4种预测模型中表现最佳,曲线下面积(AUC)达0.7699。结论:妊娠合并巨大儿的初产妇人群,可运用产妇年龄、身高、孕前及产前BMI、Bishop评分、胎儿股骨长、临产方式结合机器学习算法构建GLM预测模型,为初产妇合并巨大儿分娩方式的选择提供参考依据。

GDM孕妇分娩巨大儿风险预测模型的构建

目的:探讨妊娠期糖尿病(GDM)孕妇分娩巨大儿的危险因素,并构建相关风险预测模型.方法:回顾性收集2022年1-12月在杭州市妇产科医院/杭州市妇幼保健院建档立卡并分娩的218例GDM孕妇临床资料.根据新生儿出生体重分为巨大儿组(27例)和正常体重儿组(191例),采用logistic回归分析GDM孕妇分娩巨大儿的危险因素,并应用R软件建立风险模型列线图;并绘制校准曲线图.结果:218例GDM孕妇分娩巨大儿27例,发生率为12.4%.孕前体质质量(BMI)≥28kg/m^(2)(OR=5.410,95%CI2.142~11.938)、孕期体重增长>14kg(OR=3.056,95%CI1.427~7.016)、孕周延长(OR=2.724,95%CI1.180~5.794)、妊娠晚期空腹血糖(FBG)≥4.7mmol/L(OR=3.218,95%CI1.049~5.801)、血清甘油三酯(TG)≥2.9mmol/L(OR=1.841,95%CI1.132~4.017)为GDM孕妇分娩巨大儿的独立危险因素.以此建立GDM孕妇发生巨大儿的列线图模型,模型曲线下面积AUC值为0.921(95%CI 0.896~0.938),灵敏度为83.7%,特异度为86.9%.提示模型准确性尚可.结论:GDM孕妇分娩巨大儿与孕前肥胖、孕期体重增长过高、孕周延长,甘油三酯、空腹血糖水平升高等因素有关.预测模型的区分度良好,可以科学、直观、简便的识别存在发生巨大儿风险的GDM孕妇.

新生儿体重及巨大儿预测的诊断性试验评价

目的比较预测新生儿出生体重的5种公式,以找出一种准确度较高的公式。方法选取2019年5月至2021年9月于本院产科住院的168名单胎足月孕妇为研究对象,测量孕妇宫高、腹围(AC),超声检测胎儿腹围(FAC)、头围(HC)、双顶径(BPD)、股骨长(FL),分别用5种公式计算胎儿体重。以出生体重为金标准,分别计算5种公式的灵敏度、特异度、假阴性率、假阳性率、准确度、阳性预测值、阴性预测值、约登指数、阳性似然比和阴性似然比。结果通过5种公式对巨大儿、非巨大儿筛查出的数量和实际巨大儿、非巨大儿的数量进行计算比较,实际巨大儿发生率为10.12%(17/168)。公式5的灵敏度最高,为70.59%;其次为公式3、4,均为58.82%;公式1、2、3、4、5的准确度分别为89.29%、88.69%、89.88%、88.10%、87.50%,5种公式的准确度较为接近。结论巨大儿可能带来诸多不良妊娠结局,公式2联合宫高≥38 cm(公式5)对巨大儿预测的灵敏度更高,可作为产科医生判断巨大儿的主要参考依据,指导产程处理,减少母婴并发症发生。

经阴道分娩260例产妇阴道壁血肿形成的主要危险因素分析

目的通过回顾性病例对照研究,对经阴道分娩产妇阴道壁血肿形成的主要危险因素进行分析,为预防其发生及制定护理干预提供支持。方法将2013年1月—2022年9月在厦门市妇幼保健院经阴道分娩发生阴道壁血肿的260例产妇纳入观察组,按照1∶1比例选取同期未发生阴道壁血肿260例作为对照组。对比2组产妇各项资料之间的差异,分析导致阴道壁血肿发生的相关危险因素,通过logistic回归分析产妇阴道壁血肿形成的主要危险因素。结果2013年1月—2022年9月阴道分娩81545例,发生阴道壁血肿260例,经阴道分娩产妇阴道壁血肿的平均发生率为0.318%(260/81545);2组产妇年龄、身高、体质量、第一产程时间、第二产程时间、贫血、乙肝病毒表面抗原携带、妊娠期肝损伤、身体质量指数(body mass index,BMI)比较,差异无统计学意义(P>0.05);2组产次、急产、巨大儿、阴道助产、产道切开、妊娠期高血压比较,差异有统计学意义(P<0.05);通过多因素logistic回归分析结果显示,急产、巨大儿、阴道助产以及妊娠期高血压是阴道壁血肿形成的主要危险因素(P<0.05)。结论急产、巨大儿、阴道助产以及妊娠期高血压的产妇经阴道分娩过程中出现阴道壁血肿的风险较高,在分娩前对产妇进行评估并护理,可降低阴道壁血肿的发生率,改善预后。

巨大儿产生的影响因素及妊娠结局分析

目的探究巨大儿产生的相关影响因素及分娩结局。方法回顾性分析本院798例产妇的临床资料,分娩巨大儿的399例产妇为观察组,同期分娩正常体质量儿的399例产妇为对照组,分析产生巨大儿的影响因素,比较两组妊娠结局。结果年龄大、分娩次数多、营养过剩、产前体质量重、合并妊娠期糖尿病、巨大儿分娩史、>40周妊娠、肥胖家族史是产生巨大儿的危险因素(P<0.05)。受教育程度(初中及以上)、运动量(良好)、定期产检是产生巨大儿的保护因素(P<0.05)。对照组剖宫产、产道裂伤、肩难产、胎儿窘迫、产后出血发生率均低于观察组,差异有统计学意义(P<0.05)。结论巨大儿产生的影响因素较多,定期产检对改善母婴结局意义重大,合理膳食,适宜运动,对预防巨大儿的产生有一定的促进作用。

Risk factors and long-term health consequences of macrosomia:a prospective study in Jiangsu Province,China

We sought to determine risk factors associated with fetal macrosomia and to explore the long-term consequence of infant macrosomia at the age of 7 years.A prospective population based cohort study was designed to examine the associations between maternal and perinatal characteristics and the risk of macrosomia.A nested case-control study was conducted to explore the long-term health consequence of infant macrosomia.The mean maternal age of the macrosomia group was 24.74±3.32 years,which is slightly older than that in the control group（24.35±3.14 years,P = 0.000）.The mean maternal body mass index（BMI） at early pregnancy was 22.75±2.81 kg/m 2,which was also higher than that in the control group（21.76±2.59 kg/m 2,P = 0.000）.About 64.6% of macrosomic neonates were males,compared with 51.0% in the control group（P = 0.000）.Compared with women with normal weight（BMI：18.5-23.9 kg/m 2）,women who were overweight（BMI：24-27.9 kg/m 2） or obese（BMI ≥ 28 kg/m 2）,respectively,had a 1.69-fold（P = 0.000） and a 1.49-fold（P = 0.000） increased risks of having a neonate with macrosomia,while light weight（BMI〈18.5 kg/m 2） women had an approximately 50% reduction of the risk.Furthermore,macrosomia infant had a 1.52-fold and 1.50-fold risk,respectively,of developing overweight or obesity at the age of 7 years（P = 0.001 and P = 0.000）.Older maternal age,higher maternal BMI at early pregnancy and male gender were independent risk factors of macrosomia.Macrosomic infant was associated with an increased predisposition to develop overweight or obesity at the beginning of their childhood.

Macrosomia in non-gestational diabetes pregnancy:glucose tolerance test characteristics and feto-maternal complications in tropical Asia Pacific Australia

Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record.Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.Results:Ninety-one non-CDM mothers with macrosomia were studied and compared with 41normoglycemic subjects without macrosomia.Of the subjects with non-GDM macrosomia,45(49.4%)had normal SO g glucose challenge test(GCT)without further testing,another 8(8.8%)had abnormal GCT but normal 75 g oral glucose tolerance test(OGTT).A total of 4(4.4%)subjects had normal GCT and OGTT.Interestingly.14 out of 16(87.5%)subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies.Only 12 subjects had both GCT and OGTT,the rest of the cohort had either of the two tests.Subjects with non-CDM macrosomia had higher frequency of neonatal hypoglycaemia 34%as compared to 10%in nonmacrosomic babies(P=0.003).Other feto-maternal complications were similar in both groups.Conclussions:No significant pattern of glucose tolerance characteristics was identified in nonGDM mothers with macrosomic babies.In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies.Further prospective studies on a larger population are needed to verify our findings.

Risk factors and prediction of macrosomia in a cohort study

Objective: To investigate the risk factors of macrosomia and to predict the risk of macrosomia so as to reduce the incidence of macrosomia. Methods: A total of 2063 pregnant women who met the inclusion criteria were selected as the subjects from February 2016 to April 2017 in Jiading District Maternal and Child Health Hospital of Shanghai and Pudong New Area Maternal and Child Health Hospital. According to the birth weight of the neonates, the neonates were divided into the macrosomia group (neonatal weight > 4000 g, n=125) and the normal infant group (2500 g < neonatal weight < 4000 g, n=1938).The general data of age, number of pregnant women, BMI before pregnancy, gestational diabetes mellitus, glucose tolerance, weight gain during pregnancy, birth weight and gestational week were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors of macrosomia. Results: ①There were significant differences in BMI, glucose tolerance, fasting blood sugar, weight gain in the second trimester, weight gain in the third trimester, birth weight and gestational week between the two groups (P<0.05). ②Single factor analysis showed that pre-pregnancy BMI, gestational week at first diagnosis, fasting blood glucose tolerance, weight gain in the second trimester, weight gain in the third trimester, gestational week and birth weight were the influencing factors of macrosomia (P<0.05). ③Multi-factor analysis showed that gestational weeks, gestational diabetes, fasting glucose tolerance and weight growth in the second trimester were the main factors affecting the production of macrosomia, among which gestational diabetes was the protective factor, while gestational weeks, fasting glucose tolerance and weight growth in the second trimester were the risk factors. Conclusion: The high risk factors for macrosomia are gestational weeks, glucose tolerance, fasting blood sugar and weight gain in the second trimester of pregnancy.We should strengthen regular obstetric examination, health care during pregnancy, reasonable diet and proper exercise, and strictly control the weight gain during the second trimester of pregnancy. At the same time, we should monitor blood sugar in time so as to reduce the incidence of macrosomia.

Macrosomia at the Center Hospital of Montelimar (France): 141 Cases Report

Introduction: Macrosomia is usually defined by the delivery of a child over 4000 g at term. Because of the margins of error, the obstetrician must take into account, in addition to ultrasound, the constitutional and acquired factors of the mother in order to be able to prevent the complications expected during the delivery of a large fetus. Material and method: We carried out a cross-sectional, descriptive, 12-month study in a level 2 hospital in southern France (Montélimar). The aim of the study was to assess the prevalence of macrosomia, to identify the epidemiological characteristics of the patients, to specify the management of obstetrics and complications in this hospital. Results: We recorded 141 births with a weight greater than or equal to 4000 g. That is a rate of 7.95%. The average age of our patients is 30 years. Half of them had a BMI of less than 25 and were not diabetic. 75% of the patients gave birth by a low-dose route. The sex ratio of the children is male to female 2:1. The main maternal complications were the perineovaginal tears (39 cases) and the hemorrhages of the deliverance (6 cases). Conclusion: The delivery of macrosomia is not uncommon at the Hospital Center of Montélimar. It predominates among Caucasians. Usual risk factors have rarely been found. Overall management was without major complications for both the mother and the child.

Trends of Macrosomia at University Clinics of Kinshasa

Context. The prevalence of macrosomia varies through the world according to racial and ethnic factors, life style and importance of non communicable diseases (maternal obesity, diabetes-gestational and type 2), post-term gestation and multiparity. At the University Clinics of Kinshasa (UCK), 30 years ago, the frequency of macrosomia was 2.4%. Objectives. To update data on the frequency of macrosomia at UCK, regarding variations in maternal anthropometrics (obesity) and socio-demographic factors. Methods. A cross-sectional study was conducted at UCK from 1 January 2007 to 31 December 2016. Mothers who delivered babies weighing at least 4000 g were included in this study. Results. The frequency of macrosomia was 3.7%. Trend shows a variation of this frequency over time with lowest frequency (2.1%) in 2012 and highest (5.3%) in 2009. The mother average age and parity were 32.3 ± 5.4 years and 3 ± 2, respectively. Pregnancies were complicated by polyhydramnios (48%) and gestational diabetes (19.7%). Caesarean section was performed in 60.5% cases, mainly for macrosomia (47.8%) and 81.6% of newborns had constitutional macrosomia. Adverse obstetrical outcomes of macrosomia were dominated by caesarean section (28.9%), lacerations of birth canal (23%) and neonatal distress (9.2%). Conclusion. Macrosomia remains a constant finding at UCK, and is associated with maternal, fetal and neonatal adverse outcomes. Trend shows a variation of the frequency over time between 2.1% and 5.3%.