Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis
Beta, J., Khan, N., Khalil, A., Fiolna, M., Ramadan, G. and Akolekar, R. 2019. Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis. Ultrasound in Obstetrics and Gynecology. 54 (3), pp. 308-318.
|Authors||Beta, J., Khan, N., Khalil, A., Fiolna, M., Ramadan, G. and Akolekar, R.|
Objectives: To determine accurate estimates of maternal and neonatal risks of fetal macrosomia by undertaking a systematic review and meta-analysis
Methods: A search of MEDLINE, EMBASE, CINHAL and The Cochrane Library was performed to review relevant citations reporting maternal and neonatal complications of pregnancies with macrosomia with birthweight (BW) >4,000g and >4,500g. We selected prospective and retrospective cohort and population studies that provided data regarding both, cases and controls. Meta-analysis using random effects model was used to estimate weighted pooled estimates of summary statistics (odds ratio (OR) [95% confidence intervals (CI)]). Heterogeneity between studies was estimated using Cochrane’s Q, I2 statistic and Funnel plots.
Results: There were 16 studies reporting data on maternal and neonatal complications of macrosomia. In pregnancies with macrosomia with BW > 4,000g, there is an increased risk of maternal complications such as emergency cesarean section, post-partum hemorrhage and obstetric anal sphincter injury with OR (95%CI) of 1.98 (1.80-2.18), 2.05 (1.90-2.22) and 1.91 (1.56-2.33), respectively. The corresponding values for BW >4,500 g were 2.55 (2.33-2.78), 3.15 (2.14-4.63) and 2.56 (1.97-3.32), respectively. Similarly, there was an increased risks of neonatal complications such as shoulder dystocia, obstetric brachial plexus injury and birth fractures with OR (95%CI) of 9.54 (6.76-13.46), 11.03 (7.06-17.23), and 6.43 (3.67-11.28), respectively. The corresponding values for BW >4,500 g were 15.64 (11.31-21.64), 19.87 (12.19-32.40), and 8.16 (2.75-24.23), respectively.
Conclusion: Macrosomia is associated with serious maternal and neonatal adverse outcomes. This study provides accurate estimates of these risks that can be used for decisions on pregnancy management.
|Keywords||Macrosomia; Large for gestational age; Pregnancy complications; Shoulder 22 dystocia; Brachial plexus injury; Obstetric sphincter injury|
|Journal||Ultrasound in Obstetrics and Gynecology|
|Journal citation||54 (3), pp. 308-318|
|Digital Object Identifier (DOI)||doi:10.1002/uog.20279|
|Online||02 Aug 2019|
|Publication process dates|
|Accepted||25 Mar 2019|
|Deposited||21 May 2020|
Accepted author manuscript
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