Macrosomia Follow-up: Further Outpatient Care, Deterrence/Prevention, Patient Education

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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).^[51]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.^[52]
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%.^[53]These findings were confirmed by Karmon et al, indicating a reduction in maternal morbidity related to obesity after bariatric surgery.^[54]

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.^[55]

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

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