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      Prevalence and Associated Factors of Macrosomia Among Newborns Delivered in University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia: An Institution-Based Cross-Sectional Study

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          Abstract

          Background

          Macrosomia is defined as a birth weight of newborns ≥4000 grams irrespective of gestational age. It is becoming a burning public health issue in most developing countries and contributes to maternal and newborn complications. Though macrosomia has been increasing in Ethiopia, evidence about its magnitude and associated factors is limited yet. Therefore, this study aimed to assess the prevalence and associated factors of macrosomia among newborns delivered at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

          Methods

          An institution-based cross-sectional study was carried out from February 23rd to April 23rd, 2020. A total of 491 mothers and their newborns were included in the study. The data were collected by interviewing the mothers and reviewing their charts using a structured questionnaire. The outcome variable was newborn birth weight. Data were entered using Epi-data version 4.6 and analyzed using STATA version 14 software. Bivariable and multivariable binary logistic regression were used to identify the factors associated with macrosomia.

          Results

          The prevalence of macrosomia was 7.54%. Gestational age ≥40 weeks (adjusted odds ratio (AOR) = 4.1 (95% CI = 1.7–9.7)), diabetes mellitus (AOR=5.5 (95% CI = 1.2–25)), previous history of macrosomia (AOR = 3.7 (95% CI = 1.4–10)), and male sex (AOR = 3.4 (95% CI = 1.3–8.7)) were significantly associated with macrosomia.

          Conclusion

          In the current study, the prevalence of macrosomia was relatively high. The study revealed that maternal diabetes mellitus, higher gestational age, history of macrosomia, and male newborns were the predictors of macrosomia. Thus, obstetric caregivers should give attention to early detection and management of mothers with diabetes mellitus, history of macrosomia, and gestational age of ≥40 weeks during pregnancy to prevent macrosomia and its complications.

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          Most cited references41

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          Gestational Diabetes Mellitus and Macrosomia: A Literature Review

          Kamana Kc, Sumisti Shakya, Hua Zhang (2015)
          Background: Fetal macrosomia, defined as a birth weight ≥4,000 g, may affect 12% of newborns of normal women and 15-45% of newborns of women with gestational diabetes mellitus (GDM). The increased risk of macrosomia in GDM is mainly due to the increased insulin resistance of the mother. In GDM, a higher amount of blood glucose passes through the placenta into the fetal circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia, which is also called ‘large for gestational age'. This paper reviews studies that explored the impact of GDM and fetal macrosomia as well as macrosomia-related complications on birth outcomes and offers an evaluation of maternal and fetal health. Summary: Fetal macrosomia is a common adverse infant outcome of GDM if unrecognized and untreated in time. For the infant, macrosomia increases the risk of shoulder dystocia, clavicle fractures and brachial plexus injury and increases the rate of admissions to the neonatal intensive care unit. For the mother, the risks associated with macrosomia are cesarean delivery, postpartum hemorrhage and vaginal lacerations. Infants of women with GDM are at an increased risk of becoming overweight or obese at a young age (during adolescence) and are more likely to develop type II diabetes later in life. Besides, the findings of several studies that epigenetic alterations of different genes of the fetus of a GDM mother in utero could result in the transgenerational transmission of GDM and type II diabetes are of concern.
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            Macrosomic births in the united states: determinants, outcomes, and proposed grades of risk.

            Sheree Boulet, Greg Alexander, Hamisu Salihu … (2003)
            We describe maternal risk factors for macrosomia and assess birth weight categories to determine predictive thresholds of adverse outcomes. We analyzed linked live birth and infant death cohort files from 1995 to 1997 for the United States with the use of selected term (37-44 weeks of gestation) single live births to mothers who were US residents. We compared macrosomic infants (4000-4499 g, 4500-4999 g, and >5000 g infants) with a normosomic control group of infants who weighed 3000 to 3999 g. Maternal risk factors for macrosomia included nonsmoking, advanced age, married, diabetes mellitus, hypertension, and previous macrosomic infant or pregnancy loss. The risks of labor complications, birth injuries, and newborn morbidity rose with each gradation of macrosomic birth weight. Infant mortality rates increased significantly among infants weighing >5000 g. Although a definition of macrosomia as >4000 g (grade 1) may be useful for the identification of increased risks of labor and newborn complications, >4500 g (grade 2) may be more predictive of neonatal morbidity, and >5000 g (grade 3) may be a better indicator of infant mortality risk.
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              The macrosomic fetus: a challenge in current obstetrics.

              Tore Henriksen (2007)
              There has been a rise in the prevalence of large newborns over a few decades in many parts of the world. There is ample evidence that fetal macrosomia is associated with increased risk of complications both for the mother and the newborn. In current obstetrics, the macrosomic fetus represents a frequent clinical challenge. Evidence is emerging that being born macrosomic is also associated with future health risks. To provide a review of causes and risks, prevention, prediction and clinical management of suspected large fetus/fetal macrosomia, primarily aimed at clinical obstetricians. Medline and EMBASE were searched between 1980 and 2007 by combining either 'fetal macrosomia' or 'large for gestational age' with other relevant terms. The Cochrane Database of Systematic Reviews was searched for the term 'fetal macrosomia'. Although the causes of high birthweight include both genetic and environmental factors, the rapid increase in the prevalence of large newborns has environmental causes. The evidence is extensive that maternal overweight and associated metabolic changes, including type 2 and gestational diabetes, play a central role. There is a paucity of studies of the effect of intervention before and/or during pregnancy on the risk of having an 'overweight newborn'. It appears rational, however, that preventive measures should primarily be implemented before pregnancy and should include guidance about nutrition and physical activity in order to reduce the prevalence of overweight. In pregnancy, limited weight gain, especially in obese women, seems to reduce the risk of macrosomia, as do good control of plasma glucose among those with diabetes. Prediction of fetal macrosomia remains an inaccurate task even with modern ultrasound equipment. There is little evidence that routine elective delivery (induction or caesarean section) for the mere reason of suspected macrosomia should be employed in a general population. Vaginal delivery of a macrosomic fetus requires considered attention by an experienced obstetrician and preparedness for operative delivery, shoulder dystocia and newborn asphyxia.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pediatric Health Med Ther
                Journal ID (iso-abbrev): Pediatric Health Med Ther
                Journal ID (publisher-id): phmt
                Journal ID (pmc): pedhlth
                Title: Pediatric Health, Medicine and Therapeutics
                Publisher: Dove
                ISSN (Electronic): 1179-9927
                Publication date (Electronic): 16 December 2020
                Publication date Collection: 2020
                Volume: 11
                Pages: 495-503
                Affiliations
                [1 ]Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar , Gondar, Ethiopia
                Author notes
                Correspondence: Dagnew Getnet Adugna Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar , P.O. Box: 196, Gondar, EthiopiaTel +251 932223887 Email dagnewgetnet5@gmail.com
                Article
                Publisher ID: 289218
                DOI: 10.2147/PHMT.S289218
                PMC ID: 7751438
                PubMed ID: 33364874
                SO-VID: ab0a0826-5dd2-4bdc-ac30-5e0ce02411a6
                Copyright © © 2020 Adugna et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 28 October 2020
                Date accepted : 10 December 2020
                Page count
                Figures: 0, Tables: 8, References: 41, Pages: 9
                Categories
                Subject: Original Research

                Keywords: macrosomia,birth weight,newborns,pregnancy,associated factors,ethiopia
                Data availability:
                Keywords: macrosomia, birth weight, newborns, pregnancy, associated factors, ethiopia

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