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).^[70]Metabolic syndrome was defined as two or more of the following 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

Several potentially useful strategies may be helpful in prevention of macrosomia. Note the following:

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 post-meal glucose levels and fetal macrosomia has been studied and illustrated.^[71]
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.
Maggard et al 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%.^[72]These findings were confirmed by Karmon et al, indicating a reduction in maternal morbidity related to obesity after bariatric surgery.^[73] The rate of LGA infants was decreased in those who had bariatric surgery in a large study that included 627,693 women with a history of bariatric surgery from the Swedish birth registry. The risk of gestational diabetes was also reduced. However, the rate of small for gestational age (SGA) infants was also higher in this group. The risk of preterm birth was not different.^[74] Nonetheless, ACOG recommends counseling patients with class 2 or class 3 obesity regarding the risks and benefits of bariatric surgery prior to pregnancy.^[1]

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. Furthermore, one must consider the risk of insufficient gestational weight gain including increased risk of growth restriction.^[75]

For patient education resources, see Pregnancy Center, as well as Pregnancy.

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Media Gallery

Photograph of a macrosomic newborn soon after birth.

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Author

Easha A Patel, MD Resident Physician, Department of Obstetrics and Gynecology, Virginia Commonwealth University Health System

Disclosure: Nothing to disclose.

Coauthor(s)

Edward H Springel, MD, FACOG Assistant Professor, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Virginia Commonwealth University School of Medicine; Medical Director for Labor and Delivery, Department of Obstetrics and Gynecology, Virginia Commonwealth University Hospital

Edward H Springel, MD, FACOG is a member of the following medical societies: American Congress of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Society for Maternal-Fetal Medicine, Society for Reproductive Investigation

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: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

Additional Contributors

Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM Medical Director of Perinatal Services, Aspirus Hospital; Consulting Staff and Owner, Women's Specialty Care and NEWMOMS of Green Bay

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 Reproductive Investigation, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Anna R Baur, MD Resident Physician, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Anna R Baur, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association

Disclosure: Nothing to disclose.

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