eMedicine Specialties > Obstetrics and Gynecology > Obstetrical Complications

Macrosomia: Differential Diagnoses & Workup

Author: Allahyar Jazayeri, MD, PhD, Medical Director of Perinatal Services, Bellin Health Hospital Center
Coauthor(s): Mary Jazayeri, WHNP, ; Karen Burr, WHNP,
Contributor Information and Disclosures

Updated: Dec 3, 2007

Differential Diagnoses

Diabetes Mellitus and Pregnancy
Obesity
Postterm Pregnancy

Other Problems to Be Considered

Polyhydramnios
Inaccurate gestational age
Multiple gestations
Pelvic masses
Fibroid uterus
Shoulder dystocia

Workup

Laboratory Studies

  • A glucose tolerance test at 24-28 weeks of gestation screens for gestational diabetes.
  • Early glucose screening is necessary for women with risk factors for the development of diabetes (eg, obesity, strong family history of diabetes, prior pregnancy affected by macrosomia or gestational diabetes).
  • In insulin controlled diabetic mothers, serial testing for presumed macrosomic fetuses is indicated with nonstress testing performed biweekly or with contraction stress testing performed weekly.15 The use of a biophysical profile can be substituted for heart rate monitoring, but, in the presence of diabetes, some authors indicate a need for biweekly testing.
  • Neonatal evaluation for hypoglycemia, polycythemia, hyperbilirubinemia, and electrolyte abnormalities is indicated in all macrosomic newborns because maternal hyperglycemia is the most common cause and sometimes this diagnosis is not made in the mother prior to delivery of her child.
  • Long-term follow-up care of these infants is needed because they are at risk for obesity and perhaps diabetes in later life.

Imaging Studies

  • Ultrasonographic measurements to obtain estimated fetal weights are indicated when clinical assessments indicate a uterine size greater than that expected for the gestational age. An examination within 1-2 weeks of delivery showing an abdominal circumference of 35 cm or larger should alert the clinician to anticipate a fetus with a birth weight of 4000 g or more. The definitive diagnosis can only be made after delivery of the neonate.
  • Ultrasonography of the fetus and its size can be useful for identifying macrosomic infants. In 1999, Jazayeri et al showed that abdominal circumference measurements made within 2 weeks of delivery can be predictive of a birth weight greater than 4000 g.16
    • A measurement of 35 cm or more identified more than 90% of newborns with a birth weight greater than 4000 g and occurred in only 18% of the population.
    • An abdominal circumference measurement within 2 weeks of delivery had sensitivity, specificity, and positive and negative predictive values of approximately 90%.
    • Abdominal circumference measurements in patients at risk for macrosomia can provide some clues to the size of the fetus and thus allow appropriate preparations for delivery (see Surgical Care).
  • Ben-Haroush et al17 reported ultrasonography to be an accurate way of estimating birth weight as a screening measure. In suspected macrosomic fetuses, sensitivity was 75% and specificity was 65% resulting in a positive predictive value of 57% and a negative predictive value of 81%. In controls, sensitivity was 32% and specificity was 92% resulting in a positive predictive value of 33% and a negative predictive value of 90%. In the overall population of 298 newborns, sensitivity was 56% and specificity was 88% resulting in a positive predictive value of 48% and a negative predictive value of 91%.

More on Macrosomia

Overview: Macrosomia
Differential Diagnoses & Workup: Macrosomia
Treatment & Medication: Macrosomia
Follow-up: Macrosomia
References
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References

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Further Reading

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Keywords

megasomia, macrosomic neonate, macrosomic newborn, large for gestational age, LGA, body mass index, BMI, maternal diabetes, maternal obesity, maternal weight gain, hyperglycemia, shoulder dystocia, birth trauma, birth canal laceration, neonatal morbidity, neonatal injury, maternal injury, cesarean delivery, cesarean section, caesarean delivery, caesarean section, cesarean birth, caesarean birth, advanced gestational age, perineal laceration, vaginal laceration, cervical laceration, still birth, stillborn, multiparity, multi-parity, grand multiparity, diabetic pregnancy, poorly controlled diabetes, diabetes, diabetes mellitus, gestational diabetes, macrosomic pregnancy, excessive maternal weight gain, undiagnosed glucose intolerance

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Contributor Information and Disclosures

Author

Allahyar Jazayeri, MD, PhD, Medical Director of Perinatal Services, Bellin Health Hospital Center
Allahyar Jazayeri, MD, PhD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Society for Gynecologic Investigation, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Mary Jazayeri, WHNP, 
Disclosure: Nothing to disclose.

Karen Burr, WHNP, 
Disclosure: Nothing to disclose.

Medical Editor

Gerard S Letterie, DO, Associate Clinical Professor, Medical Director of In-vitro Fertilization Lab, Department of Obstetrics and Gynecology, Virginia Mason Medical Center, University of Washington
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
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