Perinatal outcomes in large infants using customised birthweight centiles and conventional measures of high birthweight.
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.
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. dharmintra.pasupathy@kcl.ac.uk
Dharmintra
D
Pasupathy
Lesley M E
LM
McCowan
Lucilla
L
Poston
Louise C
LC
Kenny
Gus A
GA
Dekker
Robyn A
RA
North
D001724:Birth Weight / Q000502:physiology*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005320:Fetal Macrosomia / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D009520:New Zealand; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D013021:South Australia