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Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America
- Source :
- BMC Pregnancy and Childbirth
- Publication Year :
- 2015
- Publisher :
- Springer Science and Business Media LLC, 2015.
-
Abstract
- Background No consensus definition of macrosomia currently exists among researchers and obstetricians. We aimed to identify a definition of macrosomia that is more predictive of maternal and perinatal mortality and morbidity in low- and middle-income countries. Methods We conducted a secondary data analysis using WHO Global Survey on Maternal and Perinatal Health data on Africa and Latin America from 2004 to 2005 and Asia from 2007 to 2008. We compared adverse outcomes, which were assessed by the composite maternal mortality and morbidity index (MMMI) and perinatal mortality and morbidity index (PMMI) in subgroups with birthweight (3000–3499 g [reference group], 3500–3999 g, 4000–4099 g, 4100–4199 g, 4200–4299 g, 4300–4399 g, 4400–4499 g, 4500–4999 g) or country-specific birthweight percentile for gestational age (50th–74th percentile [reference group], 75th–89th, 90th–94th, 95th–96th, and ≥97th percentile). Two-level logistic regression models were used to estimate odds ratios of MMMI and PMMI. Results A total of 246,659 singleton term births from 363 facilities in 23 low- and middle-income countries were included. Adjusted odds ratios (aORs) for intrapartum caesarean sections exceeded 2.0 when birthweight was greater than 4000 g (2 · 00 [95 % CI: 1 · 68, 2 · 39], 2 · 42 [95 % CI: 2 · 02, 2 · 89], 2 · 01 [95 % CI: 1 · 74, 2 · 33] in Africa, Asia and Latin America, respectively). aORs of MMMI reached 2.0 when birthweight was greater than 4000 g, 4500 g in Asia and Africa, respectively. aORs of PMMI approached to 2.0 (1 · 78 [95 % CI: 1 · 16, 2 · 74]) when birthweight was greater than 4500 g in Latin America. When birthweight was at the 90th percentile or higher, aORs of MMMI and PMMI increased, but none exceeded 2.0. Conclusions The population-specific definition of macrosomia using birthweight cut-off points irrespective of gestational age (4500 g in Africa and Latin America, 4000 g in Asia) is more predictive of maternal and perinatal adverse outcomes, and simpler to apply compared to the definition based on birthweight percentile for a given gestational age. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0765-z) contains supplementary material, which is available to authorized users.
- Subjects :
- Adult
Maternal mortality
Percentile
medicine.medical_specialty
Asia
Databases, Factual
Term Birth
Birth weight
Neonatal morbidity
Population
Gestational Age
Macrosomia
World Health Organization
Fetal Macrosomia
Pregnancy
Poverty Areas
Surveys and Questionnaires
Obstetrics and Gynaecology
Odds Ratio
Fetal macrosomia
medicine
Humans
Childbirth
education
Perinatal Mortality
Neonatal mortality
education.field_of_study
business.industry
Obstetrics
Infant, Newborn
Infant
Obstetrics and Gynecology
Gestational age
Odds ratio
medicine.disease
Infant mortality
Latin America
Logistic Models
Africa
Female
Morbidity
business
Research Article
Maternal morbidity
Demography
Subjects
Details
- ISSN :
- 14712393
- Volume :
- 15
- Database :
- OpenAIRE
- Journal :
- BMC Pregnancy and Childbirth
- Accession number :
- edsair.doi.dedup.....1617a98d06ea270ee8d856c9d033ce5c