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Maternal and neonatal complications of fetal macrosomia: a systematic review and meta-analysis

Jaroslaw Beta, Naila Khan, Ahmed Khalil, Magdalena Fiolna, Ghada Ramadan, Ranjit Akolekar
Ultrasound in Obstetrics & Gynecology 2019 April 2

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 1.82 (1.68-1.98), 1.98 (1.69-2.30) and 1.82 (1.62-2.03), respectively. The corresponding values for BW >4,500 g were 2.52 (2.26-2.77), 3.14 (2.13-4.65) 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 8.60 (6.35-11.66), 11.03 (7.06-17.23), and 6.43 (3.67-11.28), respectively. The corresponding values for BW >4,500 g were 15.24 (11.31-20.55), 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. This article is protected by copyright. All rights reserved.


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