Neonatal mortality risk of large‐for‐gestational‐age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020

Lorena Suárez‐Idueta; Eric O. Ohuma; Chia‐Jung Chang; Elizabeth A. Hazel; Judith Yargawa; Yemisrach B. Okwaraji; Ellen Bradley; Adrienne Gordon; Jessica Sexton; Harriet L. S. Lawford; Enny S. Paixao; Ila Rocha Falcão; Sarka Lisonkova; Qi Wen; Petr Velebil; Jitka Jírová; Erzsebet Horváth‐Puhó; Henrik T. Sørensen; Luule Sakkeus; Lili Abuladze; Khalid A. Yunis; Ayah Al Bizri; Sonia Lopez Alvarez; Lisa Broeders; Aimée E. van Dijk; Fawziya Alyafei; Mai AlQubaisi; Neda Razaz; Jonas Söderling; Lucy K. Smith; Ruth J. Matthews; Estelle Lowry; Neil Rowland; Rachael Wood; Kirsten Monteath; Isabel Pereyra; Gabriella Pravia; Joy E. Lawn; Hannah Blencowe; Vicki Flenady; Kara Warrilow; Harriet Lawford; Mauricio Lima Barreto; Ila Rocha Falcão; Erzsébet Horváth‐Puhó; Liili Abuladze; Pascale Nakad; Arturo Barranco Flores; Jesus Felipe Gonzalez Roldan; Fawzia Alyafei; the National Vulnerable Newborn Mortality Collaborative Group and the Vulnerable Newborn Measurement Core Group

doi:10.1111/1471-0528.17706

Neonatal mortality risk of large‐for‐gestational‐age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020

Lorena Suárez‐Idueta, Eric O. Ohuma, Chia‐Jung Chang, Elizabeth A. Hazel, Judith Yargawa, Yemisrach B. Okwaraji, Ellen Bradley, Adrienne Gordon, Jessica Sexton, Harriet L. S. Lawford, Enny S. Paixao, Ila Rocha Falcão, Sarka Lisonkova, Qi Wen, Petr Velebil, Jitka Jírová, Erzsebet Horváth‐Puhó, Henrik T. Sørensen, Luule Sakkeus, Lili AbuladzeKhalid A. Yunis, Ayah Al Bizri, Sonia Lopez Alvarez, Lisa Broeders, Aimée E. van Dijk, Fawziya Alyafei, Mai AlQubaisi, Neda Razaz, Jonas Söderling, Lucy K. Smith, Ruth J. Matthews, Estelle Lowry, Neil Rowland, Rachael Wood, Kirsten Monteath, Isabel Pereyra, Gabriella Pravia, Joy E. Lawn, Hannah Blencowe^*, Vicki Flenady, Kara Warrilow, Harriet Lawford, Mauricio Lima Barreto, Ila Rocha Falcão, Erzsébet Horváth‐Puhó, Liili Abuladze, Pascale Nakad, Arturo Barranco Flores, Jesus Felipe Gonzalez Roldan, Fawzia Alyafei, the National Vulnerable Newborn Mortality Collaborative Group and the Vulnerable Newborn Measurement Core Group

^*Corresponding author for this work

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Abstract

Objective

We aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020.

Design

Population-based, multi-country study.

Setting

National healthcare systems.

Population

Liveborn infants.

Methods

We used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th–90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500–3999 g. INTERGROWTH 21st served as the reference population.

Main outcome measures
Prevalence and neonatal mortality risks.

Results
Large for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%–22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77–0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%–13.3%), with 1.2% (IQR 0.7%–2.0%) ≥4500 g and with 0.2% (IQR 0.1%–0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69–0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10–2.11) and ≥5000 g (RR 4.54, 95% CI 2.58–7.99), compared with birthweights of 2500–3999 g, with the highest risk observed in the first 7 days of life.

Conclusions
In this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.

Original language	English
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Early online date	27 Nov 2023
DOIs	https://doi.org/10.1111/1471-0528.17706
Publication status	Early online date - 27 Nov 2023

Keywords

large for gestational age
fetal macrosomia
neonatal mortality
pregnancy
infant

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/1471-0528.17706Licence: CC BY

Neonatal mortality risk of large-for-gestational-age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020
Copyright 2023 the authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 3.47 MBLicence: CC BY

Cite this

Suárez‐Idueta, L., Ohuma, E. O., Chang, CJ., Hazel, E. A., Yargawa, J., Okwaraji, Y. B., Bradley, E., Gordon, A., Sexton, J., Lawford, H. L. S., Paixao, E. S., Falcão, I. R., Lisonkova, S., Wen, Q., Velebil, P., Jírová, J., Horváth‐Puhó, E., Sørensen, H. T., Sakkeus, L., ... the National Vulnerable Newborn Mortality Collaborative Group and the Vulnerable Newborn Measurement Core Group (2023). Neonatal mortality risk of large‐for‐gestational‐age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020. BJOG: An International Journal of Obstetrics and Gynaecology. Advance online publication. https://doi.org/10.1111/1471-0528.17706

@article{a1b9d036a6bc49ccb462e113e3906229,

title = "Neonatal mortality risk of large‐for‐gestational‐age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020",

abstract = "ObjectiveWe aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020.DesignPopulation-based, multi-country study.SettingNational healthcare systems.PopulationLiveborn infants.MethodsWe used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th–90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500–3999 g. INTERGROWTH 21st served as the reference population.Main outcome measuresPrevalence and neonatal mortality risks.ResultsLarge for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%–22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77–0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%–13.3%), with 1.2% (IQR 0.7%–2.0%) ≥4500 g and with 0.2% (IQR 0.1%–0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69–0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10–2.11) and ≥5000 g (RR 4.54, 95% CI 2.58–7.99), compared with birthweights of 2500–3999 g, with the highest risk observed in the first 7 days of life.ConclusionsIn this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.",

keywords = "large for gestational age, fetal macrosomia, neonatal mortality, pregnancy, infant",

author = "Lorena Su{\'a}rez‐Idueta and Ohuma, {Eric O.} and Chia‐Jung Chang and Hazel, {Elizabeth A.} and Judith Yargawa and Okwaraji, {Yemisrach B.} and Ellen Bradley and Adrienne Gordon and Jessica Sexton and Lawford, {Harriet L. S.} and Paixao, {Enny S.} and Falc{\~a}o, {Ila Rocha} and Sarka Lisonkova and Qi Wen and Petr Velebil and Jitka J{\'i}rov{\'a} and Erzsebet Horv{\'a}th‐Puh{\'o} and S{\o}rensen, {Henrik T.} and Luule Sakkeus and Lili Abuladze and Yunis, {Khalid A.} and Ayah Al Bizri and Alvarez, {Sonia Lopez} and Lisa Broeders and {van Dijk}, {Aim{\'e}e E.} and Fawziya Alyafei and Mai AlQubaisi and Neda Razaz and Jonas S{\"o}derling and Smith, {Lucy K.} and Matthews, {Ruth J.} and Estelle Lowry and Neil Rowland and Rachael Wood and Kirsten Monteath and Isabel Pereyra and Gabriella Pravia and Lawn, {Joy E.} and Hannah Blencowe and Vicki Flenady and Kara Warrilow and Harriet Lawford and Barreto, {Mauricio Lima} and Falc{\~a}o, {Ila Rocha} and Erzs{\'e}bet Horv{\'a}th‐Puh{\'o} and Liili Abuladze and Pascale Nakad and Flores, {Arturo Barranco} and {Gonzalez Roldan}, {Jesus Felipe} and Fawzia Alyafei and {the National Vulnerable Newborn Mortality Collaborative Group and the Vulnerable Newborn Measurement Core Group}",

year = "2023",

month = nov,

day = "27",

doi = "10.1111/1471-0528.17706",

language = "English",

journal = "BJOG: An International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

publisher = "John Wiley & Sons Inc.",

}

Suárez‐Idueta, L, Ohuma, EO, Chang, CJ, Hazel, EA, Yargawa, J, Okwaraji, YB, Bradley, E, Gordon, A, Sexton, J, Lawford, HLS, Paixao, ES, Falcão, IR, Lisonkova, S, Wen, Q, Velebil, P, Jírová, J, Horváth‐Puhó, E, Sørensen, HT, Sakkeus, L, Abuladze, L, Yunis, KA, Al Bizri, A, Alvarez, SL, Broeders, L, van Dijk, AE, Alyafei, F, AlQubaisi, M, Razaz, N, Söderling, J, Smith, LK, Matthews, RJ, Lowry, E , Rowland, N, Wood, R, Monteath, K, Pereyra, I, Pravia, G, Lawn, JE, Blencowe, H, Flenady, V, Warrilow, K, Lawford, H, Barreto, ML, Falcão, IR, Horváth‐Puhó, E, Abuladze, L, Nakad, P, Flores, AB, Gonzalez Roldan, JF, Alyafei, F & the National Vulnerable Newborn Mortality Collaborative Group and the Vulnerable Newborn Measurement Core Group 2023, 'Neonatal mortality risk of large‐for‐gestational‐age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020', BJOG: An International Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/1471-0528.17706

Neonatal mortality risk of large‐for‐gestational‐age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020. / Suárez‐Idueta, Lorena; Ohuma, Eric O.; Chang, Chia‐Jung et al.
In: BJOG: An International Journal of Obstetrics and Gynaecology, 27.11.2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Neonatal mortality risk of large‐for‐gestational‐age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020

AU - Suárez‐Idueta, Lorena

AU - Ohuma, Eric O.

AU - Chang, Chia‐Jung

AU - Hazel, Elizabeth A.

AU - Yargawa, Judith

AU - Okwaraji, Yemisrach B.

AU - Bradley, Ellen

AU - Gordon, Adrienne

AU - Sexton, Jessica

AU - Lawford, Harriet L. S.

AU - Paixao, Enny S.

AU - Falcão, Ila Rocha

AU - Lisonkova, Sarka

AU - Wen, Qi

AU - Velebil, Petr

AU - Jírová, Jitka

AU - Horváth‐Puhó, Erzsebet

AU - Sørensen, Henrik T.

AU - Sakkeus, Luule

AU - Abuladze, Lili

AU - Yunis, Khalid A.

AU - Al Bizri, Ayah

AU - Alvarez, Sonia Lopez

AU - Broeders, Lisa

AU - van Dijk, Aimée E.

AU - Alyafei, Fawziya

AU - AlQubaisi, Mai

AU - Razaz, Neda

AU - Söderling, Jonas

AU - Smith, Lucy K.

AU - Matthews, Ruth J.

AU - Lowry, Estelle

AU - Rowland, Neil

AU - Wood, Rachael

AU - Monteath, Kirsten

AU - Pereyra, Isabel

AU - Pravia, Gabriella

AU - Lawn, Joy E.

AU - Blencowe, Hannah

AU - Flenady, Vicki

AU - Warrilow, Kara

AU - Lawford, Harriet

AU - Barreto, Mauricio Lima

AU - Falcão, Ila Rocha

AU - Horváth‐Puhó, Erzsébet

AU - Abuladze, Liili

AU - Nakad, Pascale

AU - Flores, Arturo Barranco

AU - Gonzalez Roldan, Jesus Felipe

AU - Alyafei, Fawzia

AU - the National Vulnerable Newborn Mortality Collaborative Group and the Vulnerable Newborn Measurement Core Group

PY - 2023/11/27

Y1 - 2023/11/27

N2 - ObjectiveWe aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020.DesignPopulation-based, multi-country study.SettingNational healthcare systems.PopulationLiveborn infants.MethodsWe used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th–90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500–3999 g. INTERGROWTH 21st served as the reference population.Main outcome measuresPrevalence and neonatal mortality risks.ResultsLarge for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%–22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77–0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%–13.3%), with 1.2% (IQR 0.7%–2.0%) ≥4500 g and with 0.2% (IQR 0.1%–0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69–0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10–2.11) and ≥5000 g (RR 4.54, 95% CI 2.58–7.99), compared with birthweights of 2500–3999 g, with the highest risk observed in the first 7 days of life.ConclusionsIn this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.

AB - ObjectiveWe aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020.DesignPopulation-based, multi-country study.SettingNational healthcare systems.PopulationLiveborn infants.MethodsWe used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th–90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500–3999 g. INTERGROWTH 21st served as the reference population.Main outcome measuresPrevalence and neonatal mortality risks.ResultsLarge for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%–22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77–0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%–13.3%), with 1.2% (IQR 0.7%–2.0%) ≥4500 g and with 0.2% (IQR 0.1%–0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69–0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10–2.11) and ≥5000 g (RR 4.54, 95% CI 2.58–7.99), compared with birthweights of 2500–3999 g, with the highest risk observed in the first 7 days of life.ConclusionsIn this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.

KW - large for gestational age

KW - fetal macrosomia

KW - neonatal mortality

KW - pregnancy

KW - infant

U2 - 10.1111/1471-0528.17706

DO - 10.1111/1471-0528.17706

M3 - Article

SN - 1470-0328

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

ER -

Neonatal mortality risk of large‐for‐gestational‐age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020

Abstract

Keywords

UN SDGs

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