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. 2023 Nov 27.
doi: 10.1111/1471-0528.17706. Online ahead of print.

Neonatal mortality risk of large-for-gestational-age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000-2020

Lorena Suárez-Idueta  1 , Eric O Ohuma  2 , Chia-Jung Chang  2 , Elizabeth A Hazel  3 , Judith Yargawa  2 , Yemisrach B Okwaraji  2 , Ellen Bradley  2 , Adrienne Gordon  4 , Jessica Sexton  5 , Harriet L S Lawford  5 , Enny S Paixao  3   6 , Ila R Falcão  6 , Sarka Lisonkova  7 , Qi Wen  7 , Petr Velebil  8 , Jitka Jírová  9 , Erzsebet Horváth-Puhó  10 , Henrik T Sørensen  10 , Luule Sakkeus  11 , Lili Abuladze  11 , Khalid A Yunis  12 , Ayah Al Bizri  12 , Sonia Lopez Alvarez  1 , Lisa Broeders  13 , Aimée E van Dijk  13 , Fawziya Alyafei  14 , Mai AlQubaisi  14 , Neda Razaz  15 , Jonas Söderling  15 , Lucy K Smith  16 , Ruth J Matthews  16 , Estelle Lowry  17 , Neil Rowland  18 , Rachael Wood  19   20 , Kirsten Monteath  20 , Isabel Pereyra  21 , Gabriella Pravia  22 , Joy E Lawn  2 , Hannah Blencowe  2 ; National Vulnerable Newborn Mortality Collaborative Group and the Vulnerable Newborn Measurement Core Group
Collaborators, Affiliations

Neonatal mortality risk of large-for-gestational-age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000-2020

Lorena Suárez-Idueta et al. BJOG. .

Abstract

Objective: We aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020.

Design: Population-based, multi-country study.

Setting: National healthcare systems.

Population: Liveborn infants.

Methods: We used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th-90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500-3999 g. INTERGROWTH 21st served as the reference population.

Main outcome measures: Prevalence and neonatal mortality risks.

Results: Large for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%-22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77-0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%-13.3%), with 1.2% (IQR 0.7%-2.0%) ≥4500 g and with 0.2% (IQR 0.1%-0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69-0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10-2.11) and ≥5000 g (RR 4.54, 95% CI 2.58-7.99), compared with birthweights of 2500-3999 g, with the highest risk observed in the first 7 days of life.

Conclusions: In this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.

Keywords: fetal macrosomia; infant; large for gestational age; neonatal mortality; pregnancy.

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References

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