Macrosomic infants are not all equal.
OBJECTIVE
To see whether macrosomic infants have different morbidity according to maternal screening results for gestational diabetes mellitus (GDM) and ethnicity.


METHODS
After excluding infants of women with diabetes, the National Women's Hospital database identified 134 infants who were delivered in 2003 and weighed >or= 4500 g. Case notes were reviewed to record risk factors for macrosomia, delivery details and neonatal morbidity. Outcomes were analysed according to screening results for GDM and compared between Polynesian and Asian women.


RESULTS
Body mass index (BMI) was calculated in 29% of women, and GDM screening was undertaken in 51%. Infants of women who had a screening glucose < 7.2 mmol/L compared to >or= 7.8 mmol/L had lower rates of admission to the neonatal intensive care unit (NICU) (6.4 vs 28.6%, P=0.049), had less respiratory distress (3.2 vs 23.8%P=0.033) and display a trend to less require intravenous dextrose (6.4 vs 23.8%P=0.10). Maternal BMI was lower in Asian (26.5 +/- 4.4 kg/m(2)) compared to Polynesian women (35.2 +/- 8.1 kg/m(2), P=0.008). More Asian women had a Caesarean delivery (73.3 vs 25%P<0.001) and their infants were more likely to be admitted to NICU (33.3 vs 7.7%P=0.02), require intravenous dextrose (20 vs 1.9%P=0.03) and have respiratory distress (26.7 vs 3.8%P=0.02).


CONCLUSIONS
Risk factors for macrosomia are not assessed adequately, which may contribute to morbidity. Using a birthweight >or= 4500 g to define macrosomia is associated with disparate morbidity between ethnicities that have different body compositions.
Sinclair
Bronwyn Anne
BA
National Women's Health, Auckland City Hospital, Auckland, New Zealand.
Rowan
Janet Alison
JA
Hainsworth
Oliver Timothy
OT
D000328:Adult; D044466:Asian People; D001724:Birth Weight / Q000502:physiology*; D015992:Body Mass Index; D016640:Diabetes, Gestational; D005006:Ethnicity; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D007231:Infant, Newborn; D009017:Morbidity; D009520:New Zealand; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D044465:White People