Abstract
Objective
To identify factors known in mid-pregnancy to be associated with risk of macrosomia
(≥4000 g) among non-diabetic women and to develop a risk score to allow early identification
of women at high risk.
Methods
Data were obtained from a population-based perinatal database and a hospital laboratory
database in Nova Scotia, Canada. The study included singleton live births born to
non-diabetic women between 1998 and 2005. Logistic regression was used to identify
risk factors significantly associated with macrosomia. Risk scoring systems were developed
for nulliparous and parous women separately and validated using the C-statistic.
Results
Of the 23 857 mother-infant pairs included in the study, 16.7% of the infants were
macrosomic. In nulliparous women, seven risk factors were identified, of which pre-pregnancy
weight ≥90 kg with an OR of 4.8 (95% CI: 3.9 to 6.0) contributed a greater number
of points to the risk score. The resulting risk score corresponded to a range of estimated
risk of 0.2% to 47.0% and had a C-statistic of 0.70. In parous women, the most points
were assigned to women with a previous large birth (OR: 3.7; 95% CI: 3.2–4.0) and
a pre-pregnancy weight ≥90 kg (OR: 3.8; 95% CI: 3.1–4.7). The resulting risk score
corresponded to a range of estimated risk of 0.4% to 88.0% and had a C-statistic of
0.75.
Conclusions
Macrosomia risk can be estimated by a simple calculation based on a woman’s risk factor
profile at mid-pregnancy.
Résumé
Objectif
Mettre en évidence des facteurs qui, à la moitié de la grossesse, sont associés à
un risque de macrosomie (≥4 000 g) chez les femmes non diabétiques, et mettre au point
un score de risque permettant la détection précoce des femmes à risque élevé.
Méthodologie
Les données ont été tirées d’une base de données périnatales représentative de la
population et d’une base de données de laboratoire en milieu hospitalier de la Nouvelle-Écosse.
L’étude s’est penchée sur les naissances vivantes uniques survenues entre 1998 et
2005 pour lesquelles la mère ne souffrait pas de diabète. Les facteurs de risque présentant
une association significative avec la macrosomie ont été mis en évidence par régression
logistique, et des systèmes de scores de risque distincts ont été mis au point pour
les femmes nullipares et pares, puis validés au moyen de la statistique C.
Résultats
Parmi les 23 857 paires mères-enfants retenues dans l’étude, 16,7 % des nouveau-nés
présentaient une macrosomie. Chez les mères nullipares, sept facteurs de risque ont
été mis en évidence; celui qui valait le plus de points dans le score de risque était
un poids avant grossesse de 90 kg ou plus, associé à un rapport de cotes (RC) de 4,8
(IC à 95 % : 3,9–6,0). Le score de risque résultant correspondait à une étendue de
risque estimé de 0,2 % à 47,0 %, et la statistique C était de 0,70. Chez les femmes
pares, les facteurs qui comptaient le plus dans le score étaient la naissance précédente
d’un bébé présentant une macrosomie (RC : 3,7; IC à 95 % : 3,2 à 4,0), ainsi qu’un
poids avant grossesse de 90 kg ou plus (RC : 3,8; IC à 95 % : 3,1–4,7). Le score de
risque résultant correspondait à une étendue de risque estimé de 0,4 % à 88,0 %, et
la statistique C était de 0,75.
Conclusions
Le risque de macrosomie peut être estimé par un simple calcul fondé sur le profil
de risque de la femme à la moitié de la grossesse.
Key Words
Abbreviations:
GCT (glucose challenge test), GDM (gestational diabetes), LBW (low birth weight), MSAFP (maternal serum alpha-fetoprotein levels), NSAPD (Nova Scotia Atlee Perinatal Data), ROC (receiver operator characteristic)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 02, 2017
Accepted:
May 29,
2017
Received:
March 3,
2017
Footnotes
Competing interests: None declared.
Identification
Copyright
© 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
