Pevalence and outcome of fetal macrosomia at the University of Maiduguri Teaching Hospital: A case - control study

Abstract

Background: The birth of macrosomic babies (those with a birth weight of ≥4000 grams) is always a cause for concern for both patients and obstetricians due to the associated increase in perinatal morbidity and mortality. Objectives: To determine the prevalence and risk factors of fetal macrosomia and compare the outcomes of macrosomic babies' and normal birth weight babies' deliveries. Methodology: A case-control study design was employed to compare the outcomes of deliveries from macrosomic babies and those with normal birth weight from January 1, 2019, to December 31, 2020, at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. The labour, antenatal, and postnatal wards registers were used to obtain the hospital numbers of the patients, which were then used to retrieve their folders from the medical records department. Information was extracted from the folders using a proforma design for the study. For each macrosomic baby delivery, the next normal-weight baby delivery was taken as a control. Data obtained was analyzed using SPSS version 25, and the results were presented as simple percentages in a frequency table. Chi-square and student t-test were used for statistical analysis as appropriate. A p-value of < 0.05 was considered statistically significant. Results: There were 216 deliveries of macrosomic babies out of 6556 deliveries during the study period, giving a prevalence of 3.3%. The mean birth weight of the babies was 4.33 kg. Compared to mothers who deliver normal-weight babies, mothers of macrosomic babies were significantly older than 35 years (P < 0.001) and grandmultiparous (P < 0.001). There was a higher rate of cephalopelvic disproportion (P<0.001) and increased risk of Caesarean delivery (P=0.006) in the mothers of macrosomic babies compared to mothers who gave birth to normal-weight babies. The majority of the macrosomic babies were males (P<0.001) and were more likely to have more birth trauma, perinatal asphyxia, and admission to the special care baby unit with P values of 0.010, 0.001, and <0.001, respectively. Conclusion: The prevalence of fetal macrosomia was 3.3%, with a predilection for male fetuses. Fetal macrosomia was associated with advanced maternal age and grandmultiparity. Deliveries of macrosomic babies should be conducted in a tertiary centre and by an experienced obstetric team, given the increased risk of operative delivery, birth trauma, shoulder dystocia, and PPH.