Abstract
Objectives Children born large for gestational age (LGA) are at risk of numerous adverse outcomes. While the racial/ethnic disparity in LGA risk has been studied among women with Gestational Diabetes Mellitus (GDM), the independent effect of race on LGA risk by maternal prepregnancy BMI is still unclear among women without GDM. Therefore, the objective of this study was to assess the association between maternal race/ethnicity and LGA among women without GDM. Methods This was a population-based cohort study of 2,842,278 singleton births using 2012 U.S. Natality data. We conducted bivariate and multivariate logistic regression analyses to assess the association between race and LGA. Due to effect modification by maternal prepregnancy BMI, we stratified our analysis by four BMI subgroups. Results The prevalence of LGA was similar across the different racial/ethnic groups at about 9%, but non-Hispanic Asian Americans had slightly higher prevalence of 11%. After controlling for potential confounders, minority women had higher odds of birthing LGA babies compared to non-Hispanic white women. Non-Hispanic Asian Americans had the highest odds of LGA babies across all BMI categories: underweight (aOR = 2.67; 95% CI: 2.24, 3.05); normal weight (aOR = 2.53; 2.43, 2.62); overweight (aOR = 2.45; 2.32, 2.60) and obese (aOR = 2.05; 1.91, 2.20). Conclusions for practice Racial/ethnic disparities exist in LGA odds, particularly among women with underweight or normal prepregnancy BMI. Most minorities had higher LGA odds than non-Hispanic white women regardless of prepregnancy BMI category. These racial/ethnic disparities should inform public health policies and interventions to address this problem.
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References
Alexander, G. R., et al. (1996). A United States national reference for fetal growth. Obstetrics & Gynecology, 87(2), 163–168.
Alexander, G. R., Kogan, M. D., & Himes, J. H. (1999). 1994–1996 US singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender. Maternal and Child Health Journal, 3(4), 225–231.
Alexander, G. R., Korenbrot, C. C.(1995). The role of prenatal care in preventing low birth weight. The Future Of Children, p. 103–120.
Anderson, G., & Horvath, J. (2004). The growing burden of chronic disease in America. Public Health Reports, 119(3), 263.
Boulet, S. L., et al. (2003). Macrosomic births in the united states: Determinants, outcomes, and proposed grades of risk. American Journal of Obstetrics and Gynecology, 188(5), 1372–1378.
Bowers, K., et al. (2013). Gestational diabetes, pre-pregnancy obesity and pregnancy weight gain in relation to excess fetal growth: Variations by race/ethnicity. Diabetologia, 56(6), 1263–1271.
Brown, H.L., et al. (2007). The “Hispanic paradox”: An investigation of racial disparity in pregnancy outcomes at a tertiary care medical center. American Journal of Obstetrics and Gynecology, 197(2), 197–e1.
Capra, L., et al. (2013). The origins of health and disease: The influence of maternal diseases and lifestyle during gestation. Italian Journal of Pediatrics, 39(1), 1.
Chiavaroli, V., et al. (2014). Progression of cardio-metabolic risk factors in subjects born small and large for gestational age. PLoS ONE, 9(8), e104278.
Curtin, S., & Matthews, T. (2016). Smoking prevalence and cessation before and during pregnancy: Data from the birth certificate, 2014. National vital statistics reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, 65(1), 1–14.
Dai, L., et al. (2014). Birth weight reference percentiles for Chinese. PLoS ONE, 9(8), e104779.
DeSisto, C. L., (2014). Prevalence estimates of gestational diabetes mellitus in the United States, pregnancy risk assessment monitoring system (PRAMS), 2007–2010. Preventing Chronic Disease, 11.
DeVader, S. R., et al. (2007). Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstetrics and Gynecology, 110(4), 745–751.
Donahue, S. M., et al. (2010). Trends in birth weight and gestational length among singleton term births in the United States: 1990–2005. Obstetrics and Gynecology, 115(2 Pt 1), 357.
Dörner, G., & Plagemann, A. (1994). Perinatal hyperinsulinism as possible predisposing factor for diabetes mellitus, obesity and enhanced cardiovascular risk in later life. Hormone and Metabolic Research, 26(05), 213–221.
Dyer, J. S., et al. (2007). Insulin resistance in Hispanic large-for-gestational-age neonates at birth. The Journal of Clinical Endocrinology and Metabolism, 92(10), 3836–3843.
Fulda, K.G., et al. (2014). Paternal race/ethnicity and very low birth weight. BMC Pregnancy and Childbirth, 14(1), p. 385.
Hadfield, R. M., et al. (2009). Are babies getting bigger? An analysis of birthweight trends in New South Wales, 1990–2005. The Medical Journal of Australia, 190(6), 312–315.
Haghighat, N., et al. (2016). Comparison of birth certificates and hospital-based birth data on pregnancy complications in Los Angeles and Orange County, California. BMC Pregnancy and Childbirth, 16(1), p. 1.
Han, E., et al. (2016). Validity of self-reported pre-pregnancy weight and body mass index classification in an integrated health care delivery system. Paediatric and Perinatal Epidemiology, 30(4), 314–319.
Hediger, M. L., et al. (1999). Growth and fatness at three to six years of age of children born small-or large-for-gestational age. Pediatrics, 104(3), 1–6.
Institute of Medicine and National Research Council, (2009). Weight gain during pregnancy: Reexamining the guidelines, Washington DC: National Academies Press.
Kotelchuck, M. (1994). An evaluation of the Kessner Adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. American Journal of Public Health, 84(9), 1414–1420.
Kozuki, N., et al. (2013). The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: A meta-analysis. BMC Public Health, 13(Suppl 3), p. S2.
Li, C., Liu, Y., & Zhang, W. (2015). Joint and independent associations of gestational weight gain and pre-pregnancy body mass index with outcomes of pregnancy in chinese women: a retrospective cohort study. PloS ONE, 10(8), e0136850.
Mickey, R. M. & Greenland S., (1989). The impact of confounder selection criteria on effect estimation. American Journal of Epidemiology, 129(1), 125–137.
Moore, M. L., & Zaccaro, D. J. (2000). Cigarette Smoking, Low Birth Weight, and Preterm Births in Low-Income Aftican American Women. Journal of Perinatology, 3, 176–180.
Moynihan, R.N., et al. (2013). Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States. PLoS medicine, 10(8), p. e1001500.
Ouzounian, J. G., et al. (2011). Pre-pregnancy weight and excess weight gain are risk factors for macrosomia in women with gestational diabetes. Journal of Perinatology, 31(11), 717–721.
Sridhar, S. B., et al. (2013). Risk of large-for-gestational-age newborns in women with gestational diabetes by race and ethnicity and body mass index categories. Obstetrics and gynecology, 121(6), 1255–1262.
Storms, M. R., & Van Howe R. S. (2004). Birthweight by gestational age and sex at a rural referral center. Journal of Perinatology, 24(4), 236–240.
Surkan, P. J., et al. (2004). Reasons for increasing trends in large for gestational age births. Obstetrics and Gynecology, 104(4), 720–726.
The National Center for Health Statistics (NCHS), User Guide to the 2012 Natality Public Use File. 2013.
Williams, D. R. (1996). Race/ethnicity and socioeconomic status: measurement and methodological issues. International Journal of Health Services, 26(3), 483–505.
Xu, H., Simonet, F., & Luo, Z. C. (2010). Optimal birth weight percentile cut-offs in defining small—or large—for—gestational—age. Acta Paediatrica, 99(4), 550–555.
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Tutlam, N.T., Liu, Y., Nelson, E.J. et al. The Effects of Race and Ethnicity on the Risk of Large-for-Gestational-Age Newborns in Women Without Gestational Diabetes by Prepregnancy Body Mass Index Categories. Matern Child Health J 21, 1643–1654 (2017). https://doi.org/10.1007/s10995-016-2256-x
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DOI: https://doi.org/10.1007/s10995-016-2256-x