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

journal contribution
posted on 04.06.2018, 11:10 by 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, SCOPE consortium
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.


The Australian SCOPE study was supported by the Pre-mier’s Science and Research Fund, South AustralianGovernment, and an NHMRC project grant (GNT519225).The New Zealand SCOPE study was funded by the NewEnterprise Research Fund, Foundation for ResearchScience and Technology; Health Research Council [04/198]; and Evelyn Bond Fund, Auckland District HealthBoard Charitable Trust. The Irish SCOPE study was fundedby the Health Research Board of Ireland [CSA/2007/2].The UK SCOPE study was funded by National Health Ser-vice NEAT Grant [Neat Grant FSD025], Biotechnologyand Biological Sciences Research council [GT084] andUniversity of Manchester Proof of Concept Funding(University of Manchester); Guy’s and St Thomas’ Charity(King’s College London) and Tommy’s Charity (King’sCollege London and University of Manchester); and Cere-bra UK (University of Leeds). M.C.V. is supported by aScience Without Borders Fellowship from CAPES (BEX:9571/13-2). L.C.K. is supported by a Science FoundationIreland Program Grant for INFANT (12/RC/2272). D.P.and L.P. are supported by Tommy’s Charity, UK



Acta Obstetricia et Gynecologica Scandinavica, 2018

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