Foetal Macrosomia: A 5-Year Review of the Prevalence, Risk Factors and Foeto-Maternal Outcomes at Federal Medical Centre (FMC), Abeokuta, Nigeria.

Abstract

BACKGROUND: Fetal macrosomia is a condition associated with an increased risk of poor fetal and maternal outcomes. Therefore, a good understanding of the condition is necessary to improve fetomaternal status at delivery and puerperium.

AIM: This study was designed to determine the prevalence, risk factors, and feto-maternal outcomes in pregnancies that ended with the delivery of macrosomic neonates. 

MATERIALS AND METHODS: The study was a retrospective observational study conducted at the Federal Medical Centre, Abeokuta, (FMCA). All case notes of the postpartum women delivered during the study period from the 1^st of January, 2017 to the 31^st of December, 2021 were retrieved and reviewed. The age, booking status, parity, maternal body mass index, presence of co-morbidities, gestational age at delivery, mode of delivery, and complications at delivery were extracted, and entered into a proforma. The birth weight, gender, Apgar score, neonatal admission, and morbidity were also recorded. The data were analyzed using the statistical package for the social sciences (SPSS 22 for Windows).

RESULTS: The total number of deliveries during the period of study was 4920; of these, 124 deliveries resulted in macrosomic babies. Thus, the prevalence of fetal macrosomia was 2.5%. Fetal macrosomia was highest in multiparous parturient n=104 (88%). The commonest maternal age group was 30-34 years n=41 (35%). It was more prevalent in male fetuses n=62 (53%) than in female fetuses n=56 (47%). The common factors identified were maternal obesity at term n=82 (70%), postdatism n=61 (52%), pre-gestational diabetes mellitus n=6 (5%), gestational diabetes mellitus n=3 (2.5%), and previous history of fetal macrosomia n=3 (2.5%). The commonest maternal complication was postpartum hemorrhage n=5 (4.2%).  The rate of cesarean section among women delivering macrosomic babies was n=82 (69.5%). The APGAR score at 5min was less than 7 in 3 neonates (2.5%). There was one(0.8%) stillbirth, and two neonates had congenital anomalies (0.8%). The common reasons for neonatal admission were respiratory distress (18%), neonatal jaundice (13%), and presumed sepsis (8.4%).

CONCLUSION: This study reveals that the commonest risks for fetal macrosomia are maternal obesity and postdatism. This requires action, as these are modifiable factors that can be mitigated by counseling women about healthy living and prevention of prolonged pregnancy by induction of labor. However, despite the associated fetal and maternal complications, the feto-maternal outcome is good if managed appropriately.