Appendix Two

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Appendix Two The Incidence of Fetal Macrosomia
and Birth Complications in Chinese Immigrant
Women
Susan Campbell Westerway, John Keogh, Rob Heard
and Jonathan Morris University of Sydney,
Department of Obstetrics Gynaecology Royal
North Shore Hospital

• Background
• Chinese women constitute a significant proportion
  of antenatal patients at both the Royal North
  Shore Hornsby Ku-Ring-Gai Hospitals.A large
  number of these women are referred for antenatal
  ultrasound during the third trimester of
  pregnancy for fetal size assessment due to
  clinical determination of small for dates.
• The ultrasonic fetal growth charts used at major
  centres in Hong Kong and China differ
  significantly for some fetal parameters, such as
  abdominal circumference, when compared with the
  Australian charts. Could this size difference be
  real and so account for the smaller baby when
  compared with the Caucasian baby?
• Hypothesis
• Babies born to Chinese immigrant women are
  smaller than those born to Caucasian women.
• Birth weights of babies of Chinese immigrant
  women are increasing.
• The increasing rate of fetal macrosomia in
  babies born to Chinese immigrant women is
  associated with an increase in obstetric
  complications
• Inclusion criteria
• Single term births in 1992 or July 1999-June 2000
  at either Royal North Shore (RNSH) or Hornsby
  Ku-Ring-Gai Hospital (HKH).
• Chinese immigrant born in Hong Kong, Taiwan or
  China.
• Macrosomic baby defined as gt 4000gms.
• Post-partum haemorrhage defined as blood loss gt
  500mls
• Methodology
• 1992 was a year when Chinese births were of
  significant numbers at both RNSH HKH for
  adequate statistical analysis. Data was
  abstracted from
• computerised birth records of Northern Sydney
  Health obstetric database and
• a search of handwritten birth registers - cross
  matched with medical records.

1999/2000 pph rate comparison
Weight range Caucasian Chinese
3000-3499g 43 / 749 6 13 / 93 14
3500-3999g 65 / 791 8 17 / 76 22
gt4000g 40 / 308 13 5 / 25 20
Chinese immigrants weight comparison
Total births 1992 179 1999-2000 255
lt 3000g 47 27 61 24
3000 3499g 83 46 93 36
3500 3999g 42 23 76 30
4000g gt 7 4 25 10
Chinese immigrant pph comparison
1992 1999/2000
Total single births 179 255
Pph rate 30003499g 11 / 83 13 13 / 93 14
Pph rate 35003999g 5 / 42 12 17 / 76 22
Pph rate gt 4000g 2 / 7 29 5 / 25 20
1992 Birth weight range comparisonTotal single
births Caucasian 1802 Chinese immigrant 179
Weight Range lt 3000g 3000 3499g 3500-3999g gt 4000g
Caucasian 389 22 687 38 530 29 196 11
Chinese Immigrant 47 27 83 46 42 23 7 4

• Results
• Literature search failed to find any references
  to Chinese fetal macrosomia or Chinese pph.
• The increase in birth weight of babies born to
  Chinese immigrant women from 1992 to 1999/2000 is
  significant at 0.02 (plt0.05)
• Incidence of pph in Chinese women for both 1992
  1999/2000 is highly significant at plt0.001
• pph rate for Chinese women is similar for parity
  0 and parity 1
• Discussion
• Pph rate for babies gt 3kg in the Chinese
  population is similar
• to those for babies gt 4kg in the Caucasian
  population.
• Possible Causes
• herbal medicines containing anti-coagulants
• genetic susceptibility
• constitutional hypofibrinogenemia
• Conclusion
• The incidence of fetal macrosomia in Chinese
  immigrant woman is increasing.
• The incidence of pph in Chinese women is
  significantly higher than Caucasians and
  increases with increasing birth weight.
• Acknowledgements

1992 pph rate comparison
Weight range Caucasian Chinese
3000-3499g 19 / 687 3 11 / 83 13
3500-3999g 18 / 530 3 5 / 42 12
gt4000g 6 / 196 3 2 / 7 29
1999/2000 Birth weight range comparisonTotal
single births Caucasian 2261 Chinese 255
Weight range lt 3000g 3000 3499g 3500 3999g gt 4000g
Caucasian 413 18 749 33 791 35 308 14
Chinese 61 24 93 36 76 30 25 10
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