eMedicine Specialties > Obstetrics and Gynecology > Obstetrical Complications

Macrosomia: Follow-up

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

Follow-up

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).27 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).

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 1991.28
    • 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.

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.

Miscellaneous

Medicolegal Pitfalls

  • Delivery of an immature fetus for fear of macrosomia
  • Shoulder dystocia and permanent nerve injury in a macrosomic fetus
  • Surgical complications due to a prophylactic cesarean delivery for fear of macrosomia in a newborn that is of appropriate age for its gestational size
  • Shoulder dystocia in a newborn delivered by operative vaginal delivery found to be macrosomic at birth
  • Failure to diagnose macrosomia and birth injury at delivery
  • Use of incorrect maneuvers for releasing shoulder dystocia in a macrosomic newborn
  • In a large study by Raio et al43 , 3356 newborns who weighed more than 4500 g at birth were studied. Shoulder dystocia occurred in 310 of the newborns, and brachial plexus injuries occurred in 94 of the newborns (about 10% and 3%, respectively). In this population, gestational diabetes increased the risk of shoulder dystocia by a factor of 2, while preexisting diabetes increased the risk 4-fold.
 


More on Macrosomia

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