Large for gestational age - a risk factor for long-term pediatric neoplastic morbidity of the offspring

Naama Steiner, Asnat Walfisch, Tamar Wainstock, Idit Sesgal, Daniella Landau, Eyal Sheiner

Research output: Contribution to journalMeeting Abstract

Abstract

Objective
The present study was aimed to evaluate the association between birthweight of large for gestational age (LGA, defined as birth weight>95th centile) and long-term pediatric neoplastic morbidity.

Study Design
A population-based cohort analysis was performed, comparing the risk of long-term childhood neoplastic morbidity (up to the age of 18 years) of children born at term (>37 weeks gestation), according to their birthweight. Deliveries occurred between 1991-2014 at a single regional tertiary medical center. Multiple gestations and fetuses with congenital malformations were excluded. Birthweight was sub-divided into: small for gestational age (SGA; birth weight<5th centile), appropriate for gestational age (AGA) and LGA. Hospitalizations of the offspring up to the age of 18 years involving neoplastic morbidity were evaluated. Neoplastic morbidity was determined using a predefined set of ICD-9 codes, as recorded by the hospital computerized charts. Kaplan-Meier survival curve was constructed to compare cumulative neoplastic morbidity incidence in the three offspring sub-groups. A Cox proportional hazards model was used to control for confounders.

Results
During the study period 225,601 singleton term deliveries met the inclusion criteria. Of them, 4.3% (n= 9,796) were LGA and 4.6% (n=10,415) were SGA . During the 18 years follow-up period, 1,397 (0.62%) children were hospitalized due to neoplastic morbidity. Hospitalizations involving neoplastic morbidity were significantly more common in the LGA group, as compared with the AGA and SGA groups (0.8% vs. 0.6% vs. 0.6% respectively, p=0.026 using the chi-square test for trends). Selected morbidities are shown in the Table. Specifically, leukemia and hemangioma were significantly more common in the LGA group. The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of neoplastic morbidity in the LGA group (Figure, log rank p=0.007). Using a Cox proportional hazards model while controlling for maternal age, hypertensive disorders of pregnancy, and diabetes, LGA was found to be an independent risk factor for long-term pediatric neoplastic morbidity as compared with AGA (adjusted HR=1.3, CI 1.1-1.6, p=0.017).

Conclusion
Large for gestational age offspring are at an increased and independent risk for long-term pediatric neoplastic morbidity
Original languageEnglish
Pages (from-to)S177-S178
JournalAmerican Journal of Obstetrics and Gynecology
Volume218
Issue number1
DOIs
StatePublished - Jan 2018

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