RCOG World Congress 2025

Pregnancy Outcomes for Women with Large-For-Gestational-Age Fetuses- A Systematic Review and Meta-analysis

Shwetha SHANMUGAM,¹ Jessele Lai Shian YI,²Ruochen DU,² Shiao-Yng CHAN,¹′³ Citra MATTAR,¹′³Mahesh CHOOLANI,¹′³ Ling-Jun LI ³’⁴′⁵′⁶
¹Department of Obstetrics and Gynaecology, National University Health System, Singapore ²NUS Yong Loo Lin School of Medicine, National University Singapore, Singapore³Department of Obstetrics and Gynaecology, NUS Yong Loo Lin School of Medicine, Singapore⁴Global Centre for Asian Women’s Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore ⁵Bia-Echo Centre for Asian Women’s Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore , ⁶Institute for Human Development & Potential (iHDP), Agency for Sciences, Technologies & Research (A*STAR), Singapore. Email: Shwetha.Shanmugam@mohh.com.sg

Objective :

Suspected Large-for-gestational-age (LGA) fetuses, defined as estimated fetal weight (EFW) or abdominal circumference > 90thpercentile are associated with adverse neonatal and maternal outcomes. However, there are no clear guidelines on the management of these pregnancies in non diabetic women.

This systematic review and metanalysis is to evaluate the existing evidence on non-diabetic pregnancies with suspected LGA ,as identified by either Estimated fetal weight in antenatal ultrasound at 36-37 weeks >90thpercentile or estimated birth weight >90th percentile or 97th percentile or birth weight >95th percentile for the population and compare the maternal and neonatal outcomes between induction of labour (IOL) at 38 to 40 weeks and expectant management.

METHODS:

A thorough literature search was performed using electronic databases, including PubMed, MEDLINE, EMBASE, Cochrane Library, Scopus, and ClinicalTrials .gov, from inception to 1 October 2024.

Randomized controlled trials and observational studies that assessed maternal and neonatal outcomes in non-diabetic pregnancies with suspected LGA foetuses, comparing IOL between 38 to 40 weeks and expectant management, were included. A random-effects meta-analysis was performed. The pooled risk ratio (RR) for each outcome was calculated, with 95% confidence intervals (CI). Statistical heterogeneity was assessed using the Cochran Q-test and I² statistic, with two-sided p-values. The study protocol was pre-registered on PROSPERO (CRD42024614984).

RESULTS :

A total of 7482 articles were identified, with four studies meeting the inclusion criteria for final analysis. Compared with expectant management group, women with LGA-suspected fetus showed significant reduction in obstetric anal sphincter injury (OASIS) (RR 0.73 ;95% CI:[0.62, 0.86] There was no significant difference in caesarean section rates (RR 1.10; 95% CI [0.80, 1.52). Although our analysis showed reduction in shoulder dystocia (RR 0.66; 95% CI:0.35, 1.24 )postpartum haemorrhage (RR 0.59; 95% CI: 0.24, 1.44 )these findings were not statistically significant. There was no difference in neonatal outcomes such as 5-minute Apgar score <7 and morbidity .

CONCLUSION:

In non-diabetic pregnancies with ultrasound-suspected LGA, induction before 41 weeks is associated with a significant reduction in obstetric anal sphincter injury (OASIS).

Reductions in shoulder dystocia and postpartum hemorrhage were observed, though not statistically significant. The directional consistency and absence of increased risk suggest potential benefit in selected cases.

However, current evidence does not support routine early induction for all LGA pregnancies.

Further randomized trials, especially within Asian populations, are needed to define the optimal timing of delivery and evaluate maternal and neonatal outcomes.

RCOG World Congress 2025

Review on Pregnancy Outcomes for Non-Diabetic Women with Large-For-Gestational- Age Fetuses

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