1. 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 > 4000gms. Post-partum haemorrhage defined as blood loss > 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. Weight Range < 3000g3000 –3499g3500-3999g> 4000g Caucasian 389 22% 687 38% 530 29% 196 11% Chinese Immigrant 47 27% 83 46% 42 23% 7 4% 1992 Birth weight range comparison Total single births: Caucasian 1802 Chinese immigrant 179 Weight rangeCaucasianChinese 3000-3499g 19 / 687 3% 11 / 83 13% 3500-3999g 18 / 530 3% 5 / 42 12% >4000g 6 / 196 3% 2 / 7 29% 1992 pph rate comparison Weight range< 3000g3000 – 3499g3500 – 3999g> 4000g Caucasian 413 18% 749 33% 791 35% 308 14% Chinese 61 24% 93 36% 76 30% 25 10% 1999/2000 Birth weight range comparison Total single births Caucasian 2261 Chinese 255 Weight rangeCaucasianChinese 3000-3499g 43 / 749 6% 13 / 93 14% 3500-3999g 65 / 791 8% 17 / 76 22% >4000g 40 / 308 13% 5 / 25 20% 1999/2000 pph rate comparison Total births 1992 179 1999-2000 255 < 3000g 47 27% 61 24% 3000 – 3499g 83 46% 93 36% 3500 – 3999g 42 23% 76 30% 4000g > 7 4% 25 10% Chinese immigrants weight comparison 19921999/2000 Total single births 179 255 Pph rate 3000–3499g 11 / 83 13% 13 / 93 14% Pph rate 3500–3999g 5 / 42 12% 17 / 76 22% Pph rate > 4000g 2 / 7 29% 5 / 25 20% Chinese immigrant pph comparison 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 (p<0.05) Incidence of pph in Chinese women for both 1992 & 1999/2000 is highly significant at p<0.001 pph rate for Chinese women is similar for parity 0 and parity 1+ Discussion Pph rate for babies > 3kg in the Chinese population is similar to those for babies > 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 Carolyn Smith - Senior nurse manager Obstetric, Child, Adolescent and Family Health Services, Hornsby Ku-Ring-Gai Hospital Catriona Andronicos - Data manager, OBSTET Database - NSAHS 228