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Antenatal risk factors associated with neonatal morbidity in large for gestational age infants: an international prospective cohort study

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Matias C. Vieira, Lesley M.e. Mccowan, Robyn A. North, Jenny E. Myers, James J. Walker, Philip N. Baker, Gustaaf A. Dekker, Louise C. Kenny, Lucilla Poston, Dharmintra Pasupathy

Original languageEnglish
Pages (from-to)1015-1024
JournalActa Obstetricia et Gynecologica Scandinavica
Volume97
Issue number8
Early online date12 May 2018
DOIs
Accepted/In press27 Apr 2018
E-pub ahead of print12 May 2018
Published1 Aug 2018

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Abstract

 Introduction Large for gestational age (LGA) infants are associated with increased risk of neonatal morbidity and mortality, however most of them will not have adverse outcomes. Our aim was to identify antenatal clinical factors associated with neonatal morbidity in LGA infants. Material and methods Nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study were included. We compared maternal and fetal factors between LGA infants (birthweight >90th customized centile) with and without neonatal morbidity, defined as admission to neonatal intensive care unit or severe neonatal morbidity. Factors were selected based on a‐priori hypotheses of association and included maternal demography, anthropometric measures and self‐reported physical activity (15 and 20 weeks), fetal biometry (20 weeks), and clinical information. Multivariable logistic regression was used to identify risk factors. Stratified analyses were performed by maternal obesity and physical activity. Results Amongst term pregnancies, prevalence of LGA infants was 9.3% (491/5,255), with 11.8% (58/491) prevalence of neonatal morbidity. Random glucose at 20 weeks (OR 1.52; 95% CI1.17 to 1.97, per 1mmol/L increase) and no regular physical activity at 20 weeks (3.93; 1.75 to 8.83) were associated with increased risk of neonatal morbidity after adjustment for birthweight, gestational age at delivery and gestational diabetes. The increased risk associated with higher glucose levels was not evident in women with regular physical activity or without obesity. Conclusions Regular physical activity in mid‐pregnancy is associated with lower risk for neonatal morbidity in LGA infants and seems to offer protection against the increased risk associated with higher maternal glucose levels. This article is protected by copyright. All rights reserved.

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