Impact of maternal height on birthweight classification in singleton births at term: a cohort study in The Netherlands.

OBJECTIVE: To assess the association between maternal height and birthweight in a healthy population and to study the effect of maternal height on the classification of birthweight as small for gestational age (SGA) and large for gestational age (LGA). METHODS: A descriptive, observational retrospective study was conducted in a low risk population in the Netherlands. The study included term singleton healthy nonsmoking pregnant women with normal body mass index (n = 9291). We calculated the impact of maternal height on birthweight using multiple linear regression analyses with adjustment for gestational age, gender, and parity. We calculated the number of newborns classified as SGA and LGA using the cutoff point of the Dutch Birthweight chart, which does not customize for maternal height. Subsequently, we calculated the changes in classification from SGA and LGA to appropriate for gestational age (AGA) in case of customization for maternal height. RESULTS: A significant association was found between maternal height and birthweight; 15.0 g higher birthweight per extra cm maternal height (95% confidence interval 13.8-16.1; p<.001; R2 model = 0.28). The incidence of SGA was 7.1% (range 17.4-2.0% form shortest to tallest maternal height category) and of LGA 8.4% (range 1.9-21.5% from shortest to tallest maternal height category). We calculated a shift in classification: 114 newborns (17.3%) in shorter (<167 cm) women previously SGA and 165 newborns (21.1%) in taller (>173 cm) women previously LGA were classified as AGA when controlling for maternal height. CONCLUSIONS: Maternal height is significantly associated with birthweight. Birthweight charts customized for maternal height change classification in one out of six SGA or LGA newborns at term.

Effect of the use of a national information brochure about fetal movements on patient delay.

BACKGROUND: Perinatal audits in the Netherlands showed that stillbirth was nearly always preceded by a period of reduced fetal movements. Patient or caregiver delay was identified as a substandard care factor. AIM: To determine whether the use of a new information brochure for pregnant women on fetal movements results in less patient delay in contacting their maternity caregiver. METHODS: A pre- and post-survey cohort study in the Netherlands, including 140 women in maternity care with a singleton pregnancy, expecting their first child. All participating women filled out a baseline questionnaire, Cambridge Worry Scale and pre-test questionnaire at the gestational age of 22-24 weeks. Subsequently, the intervention group received a newly developed information brochure on fetal movements. At a gestational age of 28 weeks, all women received the post-test questionnaire. Multiple regression analyses were used. FINDINGS: Per-protocol analysis showed less patient delay in the intervention group compared to the control group (Odds Ratio 0.43; 95% Confidence Interval 0.17-0.86, p=0.02). A significant linear relation was observed between reading the information brochure and an increase of knowledge about fetal movements (B=1.2, 95% Confidence Interval 1.0-1.4, p<0.001). Maternal concerns did not affect patient delay to report reduced fetal movements. CONCLUSION: Use of an information brochure regarding fetal movements has the potential to reduce patient delay and increase knowledge about reduced fetal movements. A national survey to determine the effect of an information brochure about reduced fetal movements on patient delay and stillbirth rates is needed.