MATERNAL AND INFANT COMPLICATIONS IN HIGH AND NORMAL-WEIGHT INFANTS BY METHOD OF DELIVERY

Objective: To estimate the population risks of maternal and infant com plications with the birth of macrosomic (at least 4000 g) compared wit h normal weight infants. Methods: Term, singleton infants were identif ied from the state of Washington's birth event records database for 19 90. Diagnosis codes from the Internal Classification of Diseases (9(th ) revision) were used to identify delivery method and previously defin ed complications. We adjusted for maternal demographic and clinical fa ctors using multivariable logistic regression to derive the risk of ea ch maternal and infant complication. Results: The incidence of macroso mia was 13% (8815 of 66,086). Vaginal birth of macrosomic infants was associated with low incidence of complications except for shoulder dys tocia (11%) and postpartum hemorrhage (5%). Postpartum infection was t he most common complication for women who had cesarean delivery after labor (5%), and complications for women who had cesarean without labor were rare (less than 3%). Neonatal complications were rare. Among inf ants with shoulder dystocia, the risks of asphyxia (adjusted relative risk [RR] 1.2, 95% confidence interval [CI] 0.6, 2.3), birth trauma (R R 0.6, 95% CI 0.2, 1.6), long-bone injury (RR 1.2, 95% CI 0.6, 2.4), s eizures (RR 1.0, 95% CI 0.0, 25.0), and facial palsy (RR 2.2, 95% CI 0 .2, 44.4) were not significantly different for macrosomic and normal w eight infants; however, macrosomic infants had a significantly increas ed risk of Erb palsy (RR 3.5, 95% CI 1.8, 7.5). Conclusion: This popul ation-based study showed that most macrosomic infants are delivered va ginally with low rates of maternal and neonatal complications. Macroso mic infants have higher rates of Erb palsy, but similar rates of other serious complications of shoulder dystocia when compared with normal weight infants. (Obstet Gynecol 1998;92: 507-13. (C) 1998 by The Ameri can College of Obstetricians and Gynecologists.).