Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia
Abstract
:1. Introduction
Study Population
2. Materials and Methods
2.1. Definitions
2.1.1. Neonatal
- Normal birth weight (NBW) is defined a birth weight between 2500 and 3999 g [17].
- Low birth weight (LBW) is defined as a birth weight of less than 2500 g.
- Very low birth weight (VLBW) is defined as a birth weight below 1500 g [17].
- Macrosomia is defined as a birth weight ≥ 4 kg [17].
- Respiratory distress syndrome (RDS) “Newborn babies with RDS have: (1) An arterial oxygen tension (PaO2) < 50 mm Hg and central cyanosis in room air, a requirement for supplemental oxygen to maintain PaO2 > 50 mm Hg, or a requirement for supplemental oxygen to maintain a pulse oximeter saturation > 85%. (2) A characteristic chest radiographic appearance (uniform reticulogranular pattern to lung fields and air bronchogram) within the first 24 h of life. The clinical course of the disease has been changed because of advances in treatment practices, including the use of early Continuous Positive Airway Pressure (CPAP)” [18].
- Transient tachypnea of the newborn (TTN) is a benign, self-limited RDS of term and late-preterm neonates related to delayed clearance of lung liquid. The distress appears shortly after birth and usually resolves within 3 to 5 days [18].
- Neonatal hyperbilirubinemia (or neonatal jaundice) results from elevated total serum bilirubin (TSB) and clinically manifests as yellowish discoloration of the skin, sclera, and mucous membrane [19].
- Gestational age at birth is defined as the time span between the conception and birth of an infant, calculated from the last menstrual period and/or early ultrasound scan when there is a difference between menstrual date and ultrasound date; the latter was taken as the correct date. It is further classified as follows [20]:
- Term pregnancy 39–41 weeks
- Post-term ≥ 42 weeks
- Early-term pregnancy 37–38 weeks
- Late preterm 34–36 weeks
- Early preterm < 34 weeks—it includes early preterm (32–33 weeks), very early preterm (28–31 weeks), and extremely early preterm (<28 weeks).
- Stillbirth: non-living birth ≥ 23 weeks of gestation [21].
2.1.2. Maternal
- Maternal BMI was calculated from maternal weight at delivery and height with the following cutoff values as suggested by Catalano et al. [22]: normal BMI (≤28.4 kg/m2), overweight (28.5–32.9 kg/m2), and obese (≥33 kg/m2).
- Gestational diabetes mellitus (GDM) is diagnosed at any time in pregnancy according to World Health Organization guidelines if one or more of the following criteria are met [23]:
- Fasting plasma glucose 5.1–6.9 mmol/L (92–125 mg/dL).
- 1 h plasma glucose ≥ 10.0 mmol/L (180 mg/dL) following a 75 g oral glucose load.
- 2 h plasma glucose 8.5–11.0 mmol/L (153–199 mg/dL) following a 75 g oral glucose load.
- Pre-gestational diabetes mellitus (PGDM) is a condition in which the mother has diabetes (most commonly type 1 or type 2 diabetes) before the onset of pregnancy [24].
- Hypertensive events during pregnancy according to the report of the national high blood pressure [25]: Pre-eclampsia is defined as new onset of elevated blood pressure after 20 weeks of pregnancy in a previously normotensive woman (≥140 mm Hg systolic or ≥90 mm Hg diastolic on at least two occasions 6 h apart) in addition to proteinuria of at least 1+ on a urine dipstick or ≥300 mg in a 24 h urine collection. Eclampsia is defined as seizures in a pre-eclamptic woman that cannot be attributed to other causes. Gestational hypertension is defined as a new onset of elevated blood pressure (≥140 mm Hg systolic or ≥90 mm Hg diastolic on at least two occasions 6 h apart) after 20 weeks of gestation in a previously normotensive woman, and defines superimposed pre-eclampsia as new onset of pre-eclampsia after 20 weeks of pregnancy. For this study, and due to the low prevalence of these conditions, all cases who developed gestational hypertension, pre-eclampsia, or eclampsia were aggregated in one category
2.2. Statistical Analysis
2.3. Ethical Consideration
3. Results
4. Discussion
Strength and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Birthweight Categories | p-Value | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
NBW N = 1638 | LBW N = 153 | VLBW N = 27 | Macrosomia N = 37 | |||||||
N | % | N | % | N | % | N | % | |||
Mother Age | <30 years | 816 | 49.94 | 75 | 49.34 | 13 | 50.00 | 17 | 45.95 | 0.94 |
≥30 years | 818 | 50.06 | 77 | 50.66 | 13 | 50.00 | 20 | 54.05 | ||
Parity | Primiparous | 902 | 55.07 | 84 | 54.90 | 20 | 74.07 | 21 | 56.76 | 0.27 |
Multipara | 736 | 44.93 | 69 | 45.10 | 7 | 25.93 | 16 | 43.24 | ||
BMI | Normal | 552 | 35.57 | 65 | 44.52 | 8 | 33.33 | 6 | 18.18 | <0.01 |
Overweight | 543 | 34.99 | 50 | 34.25 | 7 | 29.17 | 8 | 24.24 | ||
Obesity | 457 | 29.45 | 31 | 21.23 | 9 | 37.50 | 19 | 57.58 | ||
Gestational Age | Early preterm | 10 | 0.62 | 20 | 13.33 | 24 | 88.89 | 0 | 0.00 | <0.01 |
Late preterm | 61 | 3.75 | 48 | 32.00 | 1 | 3.70 | 0 | 0.00 | ||
Early term | 432 | 26.57 | 53 | 35.33 | 1 | 3.70 | 8 | 21.62 | ||
Full term | 1107 | 68.08 | 28 | 18.67 | 1 | 3.70 | 28 | 75.68 | ||
Post term | 16 | 0.98 | 1 | 0.67 | 0 | 0.00 | 1 | 2.70 | ||
Diabetes | No diabetes | 1468 | 89.62 | 140 | 91.50 | 23 | 85.19 | 27 | 72.97 | <0.01 |
GDM/PGDM | 170 | 10.38 | 13 | 8.50 | 4 | 14.81 | 10 | 27.03 | ||
Hypertension | No | 1594 | 97.79 | 135 | 88.24 | 21 | 80.77 | 34 | 91.89 | <0.01 |
Yes | 36 | 2.21 | 18 | 11.76 | 5 | 19.23 | 3 | 8.11 |
Variables | NBW (N = 1638) | LBW (N = 153) | VLBW (N = 27) | Macrosomia (N = 37) | p Value |
---|---|---|---|---|---|
Freq. (%) | Freq. (%) | Freq. (%) | Freq. (%) | ||
NICU Admission | 282 (17.26) | 73 (47.71) | 22 (81.48) | 8 (21.62) | <0.01 |
Respiratory distress | 49 (3.00) | 36 (23.68) | 16 (59.26) | 1 (2.70) | <0.01 |
Transient tachypnea | 62 (3.79) | 14 (9.21) | 1 (3.70) | 4 (10.81) | <0.01 |
Resuscitation | 89 (5.44) | 20 (13.16) | 12 (44.44) | 2 (5.41) | <0.01 |
Mechanical ventilation | 113 (6.92) | 37 (24.34) | 16 (59.26) | 4 (10.81) | <0.01 |
CPAP/HFNC > 2 h | 45 (2.77) | 37 (24.18) | 16 (59.26) | 0 (0.00) | <0.01 |
FIO2 > 30% ≥ 4 h | 15 (0.92) | 10 (6.62) | 5 (19.23) | 1 (2.70) | <0.01 |
Received surfactant | 10 (0.61) | 6 (3.95) | 5 (19.23) | 0 (0.00) | <0.01 |
Arterial cord acidosis | 8 (0.56) | 0 (0.00) | 1 (5.88) | 0 (0.00) | 0.04 |
Hyperbilirubinemia | 364 (22.26) | 52 (34.21) | 10 (37.04) | 7 (18.92) | <0.01 |
Initiated breast feeding | 1173 (72.32) | 92 (61.74) | 9 (33.33) | 20 (55.56) | <0.01 |
Feeding difficulty | 26 (1.59) | 4 (2.63) | 2 (7.41) | 0 (0.00) | <0.01 |
Sepsis | 21 (1.28) | 2 (1.32) | 5 (18.52) | 0 (0.00) | <0.01 |
Stillbirth | 1 (0.06) | 2 (1.33) | 4 (17.39) | 0 (0.00) | <0.01 |
CS | 480 (29.30) | 70 (45.76) | 16 (59.26) | 19 (51.35) | <0.01 |
Mean gestational age * | 39 ± 1 | 36 ± 2 | 29 ± 4 | 40 ± 1 | <0.01 |
Mean Apgar score * | 9 ± 0.7 | 8.7 ± 1.2 | 6.2 ± 1.2 | 8.9 ± 0.28 | <0.01 |
Number | Gender | Mode of Delivery | Gestational Age | Birthweight | Stillbirth/Neonatal Death | Motherage | Parity | Associated Risk Factor/Cause of Death |
---|---|---|---|---|---|---|---|---|
1 | male | emergency CS | 38 | 2430 | Stillbirth | 33 | 2 | IUDF abruptio placenta |
2 | male | vaginal delivery | 25 | 445 | Stillbirth | 33 | 0 | IUDF Mother had severe PET, HELLP syndrome |
2 | male | emergency CS | 37 | 3720 | Stillbirth | 36 | 0 | IUDF Mother had severe PET and admitted to ICU |
2 | female | vaginal delivery | 31 | 1300 | Stillbirth | 40 | 0 | IUFD unexplained |
4 | female | emergency CS | 37 | 2250 | Neonatal death | 21 | 0 | IUGR. Neonatal sepsis, admitted to NICU for poor feeding, developed apnea then died |
5 | male | vaginal delivery | 33 | 2690 | Stillbirth | 25 | 1 | IUDF Mother has thrombophilia abruptio placenta |
6 | male | emergency CS | 28 | 1200 | Neonatal death | 35 | 0 | Respiratory complications of prematurity |
7 | male | vaginal delivery | 33 | 3010 | Stillbirth | 27 | 0 | IUFD congenital heart disease |
8 | female | vaginal delivery | 23 | 550 | Neonatal death | 23 | 0 | Respiratory complications of prematurity |
9 | female | vaginal delivery | 36 | 2100 | Stillbirth | 32 | 2 | IUFD unexplained |
10 | male | vaginal delivery | 34 | 2400 | Stillbirth | 29 | 2 | IUFD multiple congenital anomalies |
11 | male | vaginal delivery | 35 | 2040 | Stillbirth | 35 | 0 | IUFD IUGR abruptio placenta |
12 | male | vaginal delivery | 32 | 770 | Neonatal death | 25 | 0 | Diaphragmatic hernia, hypoplasia of the lung, sepsis, and acidosis |
13 | female | emergency CS | 23 | 540 | Neonatal death | 24 | 3 | Mother PET with HELLP syndrome. Respiratory complications of prematurity |
Variables | LBW | VLBW | Macrosomia * | |||
---|---|---|---|---|---|---|
OR | 95% CI | OR | 95% CI | OR | 95% CI | |
Multipara | 0.94 | 0.59–1.50 | 0.14 | 0.01–1.72 | 0.89 | 0.40–1.96 |
Overweight 28.5–32.9 kg/m2 | 0.76 | 0.48–1.19 | 0.89 | 0.12–1.76 | 1.23 | 0.42–3.61 |
Obesity ≥ 33 kg/m2 | 0.54 | 0.32–0.91 * | 0.59 | 0.07–5.16 | 3.18 | 1.24–8.14 * |
Mother age ≥ 30 years | 0.84 | 0.52–1.35 | 0.42 | 0.04–4.03 | 1.21 | 0.54–2.73 |
Gestational hypertension | 3.50 | 1.60–7.63 * | 5.83 | 0.69–49.36 | - | - |
Diabetes (GDM/PGDM) | 0.52 | 0.25–1.08 | 5.65 | 0.42–75.61 | 3.75 | 1.67–8.41 * |
Gestational age | 0.51 | 0.46–0.57 * | 0.41 | 0.31–0.53 * | 1.69 | 1.24–2.30 * |
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Wahabi, H.; Elmorshedy, H.; Amer, Y.S.; Saeed, E.; Razak, A.; Hamama, I.A.; Hadid, A.; Ahmed, S.; Aleban, S.A.; Aldawish, R.A.; et al. Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia. Medicina 2024, 60, 193. https://doi.org/10.3390/medicina60020193
Wahabi H, Elmorshedy H, Amer YS, Saeed E, Razak A, Hamama IA, Hadid A, Ahmed S, Aleban SA, Aldawish RA, et al. Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia. Medicina. 2024; 60(2):193. https://doi.org/10.3390/medicina60020193
Chicago/Turabian StyleWahabi, Hayfaa, Hala Elmorshedy, Yasser S. Amer, Elshazaly Saeed, Abdul Razak, Ibrahim Abdelaziz Hamama, Adnan Hadid, Samia Ahmed, Sarah A. Aleban, Reema Abdullah Aldawish, and et al. 2024. "Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia" Medicina 60, no. 2: 193. https://doi.org/10.3390/medicina60020193