Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, TX, USA.
Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
Birth. 2020 Jun;47(2):202-210. doi: 10.1111/birt.12479. Epub 2020 Jan 10.
To evaluate the association between macrosomia and stillbirth over the previous four decades and to determine the consistency of the relationship.
This was a population-based retrospective cohort study using United States Natality and Fetal Death Data from 1982 to 2017 and restricted to the gestational age range of 37-41 weeks inclusive. Macrosomia was defined as birthweight ≥4000 g and subdivided into its grades as previously recommended: grade 1 (4000-4499 g), grade 2 (4500-4999 g), and grade 3 (≥5000 g). We calculated temporal trends of stillbirth among fetuses with macrosomia over the years using joinpoint regression. We generated odds ratios from adjusted binomial logistic regression models to examine the association between macrosomia and risk of stillbirth stratified by grades using normal-weight infants (2500-3999 g) as referent.
Within the fetal macrosomia group, the rate of stillbirth declined from 2.04/1000 in 1982 to 1.05/1000 by the end of the study period (2017), representing a drop of about 48.5%. For the normal-weight fetuses, stillbirth rate declined from 1.95/1000 to 0.83/1000, equivalent to a decline of 57.4%. Macrosomia was significantly associated with elevated risk for stillbirth: grade 2 (OR = 1.27; 95% CI = 1.22-1.32) and grade 3 (OR = 5.97; 95% CI = 5.69-6.22).
Fetal macrosomia is a significant risk factor for fetal demise with the worst intrauterine survival observed among those classified as grade 3. Fetal macrosomia is a heterogeneous rather than a homogeneous entity in terms of risk profiles, and this needs to be considered in future policy guidelines.
评估过去四十年中巨大儿与死胎之间的关联，并确定这种关系的一致性。
这是一项基于人群的回顾性队列研究，使用了 1982 年至 2017 年美国出生率和胎儿死亡数据，并仅限于胎龄 37-41 周的范围。巨大儿定义为出生体重≥4000g，并按先前建议的等级进行细分：1 级（4000-4499g）、2 级（4500-4999g）和 3 级（≥5000g）。我们使用 Joinpoint 回归计算了多年来巨大儿胎儿死产的时间趋势。我们使用调整后的二项逻辑回归模型生成比值比，以检查按等级分层的巨大儿与死产风险之间的关联，以正常体重婴儿（2500-3999g）为参照。
在胎儿巨大儿组中，死产率从 1982 年的 2.04/1000 下降到研究期末（2017 年）的 1.05/1000，下降了约 48.5%。对于正常体重胎儿，死产率从 1.95/1000 下降到 0.83/1000，相当于下降了 57.4%。巨大儿与死产风险显著相关：2 级（OR=1.27；95%CI=1.22-1.32）和 3 级（OR=5.97；95%CI=5.69-6.22）。
胎儿巨大儿是胎儿死亡的一个重要危险因素，其中 3 级分类的胎儿宫内存活率最差。巨大儿在风险特征方面是异质的而不是同质的实体，这需要在未来的政策指导中加以考虑。
