Macrosomia Follow-up

  • Author: Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM; Chief Editor: David Chelmow, MD   more...
 
Updated: Feb 4, 2010
 

Further Outpatient Care

Diabetes is the major risk associated with macrosomia, and this risk is for both the mother and the neonate. Once a mother gives birth to a macrosomic child, early maternal glucose screening should be considered in subsequent pregnancies.

The macrosomic infant may be at risk of developing diabetes and obesity later in life and deserves careful long-term follow-up care. This risk of developing a metabolic syndrome in adolescents was recently addressed by Boney et al in a study of appropriate for gestational age (AGA) and large for gestational age (LGA) infants of women with normal glucose tolerance and gestational diabetes mellitus (GDM).[30] The metabolic syndrome was defined as 2 or more of the following components being present: obesity, hypertension, glucose intolerance, and dyslipidemia. Children who were LGA at birth had an increased risk of metabolic syndrome (2.19, 95% CI, 1.25–3.82, P=.01) by 11 years of age, as did children of obese women (1.81, 95% CI, 1.03–3.19, P=.04). The presence of maternal GDM was not independently significant, but the risk of metabolic syndrome was significantly different between LGA and AGA children of women with GDM by age 11 (relative risk 3.6).

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Deterrence/Prevention

Although no intervention has been proven to significantly reduce the risk of macrosomia, several potentially useful strategies may be helpful.

  • In diabetic patients, tight glucose control before pregnancy can reduce the risk of congenital malformation. In both diabetic mothers and in those with gestational diabetes, tight control during pregnancy with the use of diet and insulin can reduce the frequency of macrosomia. The association between postmeal glucose levels and fetal macrosomia was studied and illustrated in 1991.[31]
  • Prevention of maternal obesity before pregnancy may reduce the frequency of macrosomia. However, no clinical randomized trials have validated this hypothesis. Obesity is also associated with other morbidities in pregnancy, including higher rates of preeclampsia and cesarean delivery.
  • Recent studies have indicated an association between maternal obesity and a number of adverse pregnancy outcomes. Macrosomia, pregnancy-induced hypertension, operative vaginal delivery, gestational diabetes, blood loss at delivery, and hospital length of stay were increased in this group of patients.[32]
  • Maggard et al recently published data on pregnancy outcome from obese women after bariatric surgery. These results showed improvements in pregnancy outcome, including macrosomia, which was reduced by almost 50%.[33]
  • These findings were confirmed by Karmon et al, indicating a reduction in maternal morbidity related to obesity after bariatric surgery.[34]
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Patient Education

  • As with obesity, excessive maternal weight gain can be prevented by appropriate education of expecting mothers regarding weight gain in pregnancy. Such interventions may reduce the risk of macrosomia in specific pregnancies that may have been placed at risk because of excessive maternal weight gain. However, although excessive maternal weight or weight gain in pregnancy has been associated with fetal macrosomia, the effectiveness of reducing prepregnancy weight or curtailing excessive weight gain in pregnancy has not been tested to determine whether these measures will reduce rates of fetal macrosomia.
  • For excellent patient education resources, visit eMedicine's Pregnancy and Reproduction Center. Also, see eMedicine's patient education article Pregnancy.
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Contributor Information and Disclosures
Author

Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM  Medical Director of Perinatal Services, Bellin Health Hospital Center; Consulting Staff, Women's Specialty Care of Green Bay, WI

Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM 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.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David Chelmow, MD  Leo J Dunn Distinguished Professor and Chair, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

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.

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

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  Leo J Dunn Distinguished Professor and Chair, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

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.

References

  1. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S. Births: final data for 2004. Natl Vital Stat Rep. Sep 29 2006;55(1):1-101. [Medline].

  2. Okun N, Verma A, Mitchell BF, Flowerdew G. Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia. J Matern Fetal Med. Sep-Oct 1997;6(5):285-90. [Medline].

  3. Spellacy WN, Miller S, Winegar A, Peterson PQ. Macrosomia--maternal characteristics and infant complications. Obstet Gynecol. Aug 1985;66(2):158-61. [Medline].

  4. McFarland LV, Raskin M, Daling JR, Benedetti TJ. Erb/Duchenne's palsy: a consequence of fetal macrosomia and method of delivery. Obstet Gynecol. Dec 1986;68(6):784-8. [Medline].

  5. Mondestin MA, Ananth CV, Smulian JC, Vintzileos AM. Birth weight and fetal death in the United States: the effect of maternal diabetes during pregnancy. Am J Obstet Gynecol. Oct 2002;187(4):922-6. [Medline].

  6. Mulik V, Usha Kiran TS, Bethal J, Bhal PS. The outcome of macrosomic fetuses in a low risk primigravid population. Int J Gynaecol Obstet. Jan 2003;80(1):15-22. [Medline].

  7. Catalano PM. Management of obesity in pregnancy. Obstet Gynecol. Feb 2007;109(2 Pt 1):419-33. [Medline].

  8. GIBSON JR, McKEOWN T. Observations on all births (23, 970) in Birmingham, 1947. VII. Effect of changing family size on infant mortality. Br J Soc Med. Jul 1952;6(3):183-7. [Medline].

  9. Thomson AM, Billewicz WZ, Hytten FE. The assessment of fetal growth. J Obstet Gynaecol Br Commonw. Sep 1968;75(9):903-16. [Medline].

  10. Di Renzo GC, Rosati A, Sarti RD, Cruciani L, Cutuli AM. Does fetal sex affect pregnancy outcome?. Gend Med. Mar 2007;4(1):19-30. [Medline].

  11. Hackmon R, Bornstein E, Ferber A, Horani J, O'Reilly Green CP, Divon MY. Combined analysis with amniotic fluid index and estimated fetal weight for prediction of severe macrosomia at birth. Am J Obstet Gynecol. Apr 2007;196(4):333.e1-4. [Medline].

  12. Institute of Medicine. Nutritional status and weight gain. In: Nutrition During Pregnancy. National Academies Press; 27-233.

  13. Smith GC, Smith MF, McNay MB, Fleming JE. The relation between fetal abdominal circumference and birthweight: findings in 3512 pregnancies. Br J Obstet Gynaecol. Feb 1997;104(2):186-90. [Medline].

  14. Chauhan SP, Hendrix NW, Magann EF, Morrison JC, Kenney SP, Devoe LD. Limitations of clinical and sonographic estimates of birth weight: experience with 1034 parturients. Obstet Gynecol. Jan 1998;91(1):72-7. [Medline].

  15. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 60, March 2005. Pregestational diabetes mellitus. Obstet Gynecol. Mar 2005;105(3):675-85. [Medline].

  16. Jazayeri A, Heffron JA, Phillips R, Spellacy WN. Macrosomia prediction using ultrasound fetal abdominal circumference of 35 centimeters or more. Obstet Gynecol. Apr 1999;93(4):523-6. [Medline].

  17. Ben-Haroush A, Yogev Y, Bar J, et al. Accuracy of sonographically estimated fetal weight in 840 women with different pregnancy complications prior to induction of labor. Ultrasound Obstet Gynecol. Feb 2004;23(2):172-6. [Medline].

  18. De Reu PA, Smits LJ, Oosterbaan HP, Nijhuis JG. Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population. J Perinat Med. 2008;36(4):324-9. [Medline].

  19. Coomarasamy A, Connock J, Thornton J, Khan KS. Accuracy of ultrasound biometry in the prediction of macrosomia: a systematic quantitative review. BJOG. 2005;112:1461-66.

  20. Loetworawanit R, Chittacharoen A, Sututvoravut, S. Intrapartum fetal abdominal circumference by ultrasonography for predicting fetal macrosomia. J Med Assoc Thai. 2006;Suppl 4:S60-4.

  21. Rouse DJ, Owen J, Goldenberg RL, Cliver SP. The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. JAMA. Nov 13 1996;276(18):1480-6. [Medline].

  22. Combs CA, Singh NB, Khoury JC. Elective induction versus spontaneous labor after sonographic diagnosis of fetal macrosomia. Obstet Gynecol. Apr 1993;81(4):492-6. [Medline].

  23. Acker DB, Gregory KD, Sachs BP, Friedman EA. Risk factors for Erb-Duchenne palsy. Obstet Gynecol. Mar 1988;71(3 Pt 1):389-92. [Medline].

  24. Buchanan TA, Kjos SL, Montoro MN, et al. Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care. Apr 1994;17(4):275-83. [Medline].

  25. Walkinshaw SA. Dietary regulation for 'gestational diabetes'. Cochrane Database Syst Rev. 2000;(2):CD000070. [Medline].

  26. Parker JD, Abrams B. Prenatal weight gain advice: an examination of the recent prenatal weight gain recommendations of the Institute of Medicine. Obstet Gynecol. May 1992;79(5 (Pt 1)):664-9. [Medline].

  27. Cogswell ME, Serdula MK, Hungerford DW, Yip R. Gestational weight gain among average-weight and overweight women--what is excessive?. Am J Obstet Gynecol. Feb 1995;172(2 Pt 1):705-12. [Medline].

  28. Bianco AT, Smilen SW, Davis Y, et al. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol. Jan 1998;91(1):97-102. [Medline].

  29. ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol. Sep 2005;106(3):671-5. [Medline].

  30. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. Mar 2005;115(3):e290-6. [Medline].

  31. Jovanovic-Peterson L, Peterson CM, Reed GF, Metzger BE, Mills JL, Knopp RH. Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development--Diabetes in Early Pregnancy Study. Am J Obstet Gynecol. Jan 1991;164(1 Pt 1):103-11. [Medline].

  32. Schrauwers C, Dekker G. Maternal and perinatal outcome in obese pregnant patients. J Matern Fetal Neonatal Med. Mar 2009;22(3):218-26. [Medline].

  33. Maggard MA, Yermilov I, Maglione M, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300(19):2286-96.

  34. Karmon A, Sheiner E. Pregnancy after bariatric surgery: a comprehensive review. Arch Gynecol Obstet. May 2008;277(5):381-8. [Medline].

  35. Raio L, Ghezzi F, Di Naro E, et al. Perinatal outcome of fetuses with a birth weight greater than 4500 g: an analysis of 3356 cases. Eur J Obstet Gynecol Reprod Biol. Aug 15 2003;109(2):160-5. [Medline].

  36. Alexander GR, Himes JH, Kaufman RB, et al. A United States national reference for fetal growth. Obstet Gynecol. Feb 1996;87(2):163-8. [Medline].

  37. Babinszki A, Kerenyi T, Torok O, et al. Perinatal outcome in grand and great-grand multiparity: effects of parity on obstetric risk factors. Am J Obstet Gynecol. Sep 1999;181(3):669-74. [Medline].

  38. Benedetti TJ, Gabbe SG. Shoulder dystocia. A complication of fetal macrosomia and prolonged second stage of labor with midpelvic delivery. Obstet Gynecol. Nov 1978;52(5):526-9. [Medline].

  39. Deter RL, Hadlock FP. Use of ultrasound in the detection of macrosomia: a review. J Clin Ultrasound. Oct 1985;13(8):519-24. [Medline].

  40. Dooley SL, Metzger BE, Cho NH. Gestational diabetes mellitus. Influence of race on disease prevalence and perinatal outcome in a U.S. population. Diabetes. Dec 1991;40 Suppl 2:25-9. [Medline].

  41. Ecker JL, Greenberg JA, Norwitz ER, et al. Birth weight as a predictor of brachial plexus injury. Obstet Gynecol. May 1997;89(5 Pt 1):643-7. [Medline].

  42. Flamm BL, Goings JR. Vaginal birth after cesarean section: is suspected fetal macrosomia a contraindication?. Obstet Gynecol. Nov 1989;74(5):694-7. [Medline].

  43. Gonen O, Rosen DJ, Dolfin Z, et al. Induction of labor versus expectant management in macrosomia: a randomized study. Obstet Gynecol. Jun 1997;89(6):913-7. [Medline].

  44. Homko CJ, Sivan E, Nyirjesy P, Reece EA. The interrelationship between ethnicity and gestational diabetes in fetal macrosomia. Diabetes Care. Nov 1995;18(11):1442-5. [Medline].

  45. Juntunen K, Kirkinen P, Kauppila A. The clinical outcome in pregnancies of grand grand multiparous women. Acta Obstet Gynecol Scand. Sep 1997;76(8):755-9. [Medline].

  46. Klebanoff MA, Mills JL, Berendes HW. Mother's birth weight as a predictor of macrosomia. Am J Obstet Gynecol. Oct 1 1985;153(3):253-7. [Medline].

  47. Larsen CE, Serdula MK, Sullivan KM. Macrosomia: influence of maternal overweight among a low-income population. Am J Obstet Gynecol. Feb 1990;162(2):490-4. [Medline].

  48. Little RE, Sing CF. Genetic and environmental influences on human birth weight. Am J Hum Genet. Jun 1987;40(6):512-26. [Medline].

  49. McFarland MB, Trylovich CG, Langer O. Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers. J Matern Fetal Med. Nov-Dec 1998;7(6):292-5. [Medline].

  50. Sermer M, Naylor CD, Gare DJ, et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. The Toronto Tri-Hospital Gestational Diabetes Project. Am J Obstet Gynecol. Jul 1995;173(1):146-56. [Medline].

  51. Spellacy WN. Shoulder dystocia risks. Am J Obstet Gynecol. Apr 1999;180(4):1047. [Medline].

  52. Toohey JS, Keegan KA, Morgan MA, et al. The "dangerous multipara": fact or fiction?. Am J Obstet Gynecol. Feb 1995;172(2 Pt 1):683-6. [Medline].

 
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Photograph of a macrosomic newborn soon after birth.
 
 
 
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