• Morgen S Doty, Han-Yang Chen, Baha M Sibai, and Suneet P Chauhan.
• Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas.
• Obstet Gynecol. 2019 Jun 1; 133 (6): 1160-1166.

ObjectiveTo evaluate whether, at 37-39 weeks of gestation, delivery of a neonate with a birth weight that is 90% or greater for gestational age but less than 4,000 g is associated with increased composite maternal and neonatal morbidity.MethodsThis retrospective cohort study used U.S. Vital Statistics datasets for the years 2011-2013. Inclusion criteria were singleton pregnancies delivered at 37-39 weeks of gestation after labor in which the neonates were nonanomalous, and either appropriate for gestational age or large for gestational age (LGA) neonates with birth weights of less than 4,000 g (our threshold for macrosomia). The coprimary outcomes were composite maternal morbidity (any of the following: maternal transfusion, ruptured uterus, unplanned hysterectomy, admission to intensive care unit, or unplanned procedure) and composite neonatal morbidity (any of the following: Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure or serious neurologic dysfunction, significant birth injury or neonatal mortality). Multivariable Poisson regression models were used to calculate adjusted relative risk (aRR) and 95% CI.ResultsAmong the 3.9 million women who met inclusion criteria, 1.3% delivered neonates who were LGA but nonmacrosomic. The rate of composite maternal morbidity was 53% higher women who delivered nonmacrosomic LGA neonate (6.27 vs 4.09/1,000 live births; aRR 1.40, 95% CI 1.25-1.56). This increased risk of composite maternal morbidity persisted in analyses stratified by diabetes. The rate of composite neonatal morbidity was 83% higher for nonmacrosomic LGA neonates (11.09 vs 6.07/1,000 live births; aRR 1.47, 95% CI 1.35-1.60) and persisted in analyses stratified by diabetes.ConclusionAt 37-39 weeks of gestation, delivery of a neonate with a birth weight that is 90% or greater for gestational age but less than 4,000 g is associated with increased composite maternal and neonatal morbidity.

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