title: The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study.
abstract: BACKGROUND
  It is crucial to identify in large population samples the most important determinants of excessive fetal growth. The aim of the study was to evaluate the independent role of pre-pregnancy body mass index (BMI), gestational weight gain and gestational diabetes on the risk of macrosomia.
  
  
  METHODS
  A prospective study collected data on mode of delivery and maternal/neonatal outcomes in eleven Hospitals in Italy. Multiple pregnancies and preterm deliveries were excluded. The sample included 14109 women with complete records. Associations between exposure variables and newborn macrosomia were analyzed using Pearson's chi squared test. Multiple logistic regression models were built to assess the independent association between potential predictors and macrosomia.
  
  
  RESULTS
  Maternal obesity (adjusted OR 1.7, 95% CI 1.4-2.2), excessive gestational weight gain (adjusted OR 1.9, 95% CI 1.6-2.2) and diabetes (adjusted OR 2.1, 95% CI 1.5-3.0 for gestational; adjusted OR 3.0, 95% CI 1.2-7.6 for pre-gestational) resulted to be independent predictors of macrosomia, when adjusted for other recognized risk factors. Since no significant interaction was found between pre-gestational BMI and gestational weight gain, excessive weight gain should be considered an independent risk factor for macrosomia. In the sub-group of women affected by gestational or pre-gestational diabetes, pre-gestational BMI was not significantly associated to macrosomia, while excessive pregnancy weight gain, maternal height and gestational age at delivery were significantly associated. In this sub-population, pregnancy weight gain less than recommended was not significantly associated to a reduction in macrosomia.
  
  
  CONCLUSIONS
  Our findings indicate that maternal obesity, gestational weight gain excess and diabetes should be considered as independent risk factors for newborn macrosomia. To adequately evaluate the clinical evolution of pregnancy all three variables need to be carefully assessed and monitored.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Alberico
authors.forename: Marcella
authors.initials: M
authors.lastname: Montico
authors.forename: Valentina
authors.initials: V
authors.lastname: Barresi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Monasta
authors.forename: Caterina
authors.initials: C
authors.lastname: Businelli
authors.forename: Valentina
authors.initials: V
authors.lastname: Soini
authors.forename: Anna
authors.initials: A
authors.lastname: Erenbourg
authors.affiliation: Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34137 Trieste Italy. luca.ronfani@burlo.trieste.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Ronfani
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Maso
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D001827:Body Height; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D015430:Weight Gain; D055815:Young Adult