Mode of delivery and the survival of macrosomic infants in the United States, 1995-1999.
BACKGROUND
Although increases in perinatal mortality risk associated with fetal macrosomia are well documented, the optimal route of delivery for fetuses with suspected macrosomia remains controversial. The objective of this investigation was to assess the risk of neonatal death among macrosomic infants delivered vaginally compared with those delivered by cesarean section.


METHODS
Data were derived from the U.S. 1995-1999 Linked Live Birth-Infant Death Cohort files and term (37-44 wk), single live births to United States resident mothers selected. A proportional hazards model was used to analyze the risk of neonatal death associated with cesarean delivery among 3 categories of macrosomic infants (infants weighing 4,000-4,499 g; 4,500-4,999 g; and 5,000+ g).


RESULTS
After controlling for maternal characteristics and complications, the adjusted hazard ratio for neonatal death associated with cesarean delivery among the 3 categories of macrosomic infants was 1.40, 1.30, and 0.85.


CONCLUSIONS
Although cesarean delivery may reduce the risk of death for the heaviest infants (5,000+ g), the relative benefit of this intervention for macrosomic infants weighing 4,000-4,999 g remains debatable. Thus, policies in support of prophylactic cesarean delivery for suspected fetal macrosomia may need to be reevaluated.
Boulet
Sheree L
SL
Centers for Disease Control and Prevention, National Center for Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA.
Salihu
Hamisu M
HM
Alexander
Greg R
GR
D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005320:Fetal Macrosomia / Q000401:mortality* / Q000473:pathology; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States