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    SECTIONS

    Drugs & Diseases > Obstetrics & Gynecology

    Macrosomia Clinical
    Presentation
    Updated: Dec 16, 2020 | Author: Easha A Patel, MD; Chief Editor:
    Christine Isaacs, MD more...

    History
    Fetal macrosomia has been defined to include birth
    weight greater than 4000 g or greater than 4500 g. [1]
    Macrosomia may place the mother and fetus or
    neonate at risk for adverse outcomes. Identification of
    pregnancies with antenatal risk factors for macrosomia
    may allow intervention to reduce the risk, to provide
    appropriate counseling, and to implement appropriate
    plans for monitoring and follow-up care during
    pregnancy and after delivery.

    Note the following:

    Maternal diabetes is a strong risk factor


    associated with giving birth to an infant that is
    considered large for gestational age.
    Pregestational and gestational diabetes result in
    fetal macrosomia in as many as 50% of
    pregnancies complicated by gestational diabetes
    and in 40% of those complicated by type 1
    diabetes mellitus. Studies of macrosomic infants
    of diabetic mothers reveal a greater amount of
    total body fat, thicker upper-extremity skin fold
    measurements, and smaller ratios of head to
    abdominal circumference than macrosomic
    infants of nondiabetic mothers. [10]

    Maternal weight prior to pregnancy can affect the


    weight of the fetus. Women who are obese are
    more likely to have larger infants. [26, 27, 3]

    Excessive weight gain in pregnancy is a risk


    factor for macrosomia. The risk is greater for
    women with obesity than for women without
    obesity. [26, 3] Maternal obesity is linked to a 4- to
    12-fold increase in the risk of macrosomia. [28]

    Gestational age is associated with macrosomia.


    Birth weight increases as gestational age
    increases. Prolonged pregnancies (>41 wk) are
    associated with an increased incidence of
    macrosomia. Macrosomic infants account for
    about 1% of term deliveries and 3-10% of postterm
    deliveries. [5] See the Gestational Age from
    Estimated Date of Delivery (EDD) calculator.

    Multiparity and grand multiparity increase the risk


    of macrosomia. [29] Parity has been reported to
    be associated with 100-150 grams of weight gain
    at birth. [30] The risk increases with women with
    parity greater than three. Multiparity is not a major
    maternal risk factor, but it contributes to the risk
    of diabetes and obesity. [28]

    A history of macrosomia can influence future


    pregnancies. Women who previously delivered a
    macrosomic fetus are 5-10 times more likely than
    women without such a history to deliver a baby
    considered large for gestational age the next time
    they become pregnant. [31] In a large study that
    controlled for BMI, excess weight gain, diabetes,
    race, parity, and age, a history of macrosomia was
    a strong individual risk factor for macrosomia. [32]

    Fetal sex influences macrosomic potential. Male


    infants weigh more than female infants at any
    gestational age. Recent studies have confirmed
    this association. [33, 17]

    Excessive amniotic fluid defined as greater than


    or equal to 60th percentile for gestational age
    has recently been associated with macrosomia.
    [34]

    Despite these so-called risk factors for


    macrosomia, much of the variation in birth
    weights remains unexplained. Most infants who
    weigh more than 4500 g have no identifiable risk
    factors. Kim et al found that 46.8-61.0% of the
    mothers with macrosomic infants assessed in
    their study had none of the three primary risk
    factors studied, which included maternal
    overweight, excessive gestational weight gain
    and GDM. [3]

    Certain genetic and congenital disorders are


    associated with an increased risk of macrosomia,
    including Beckwith-Weidemann syndrome, Sotos
    syndrome, fragile X syndrome, and Weaver
    syndrome. [35]

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    SECTIONS
    Macrosomia

    Overview

    Presentation

    History

    Physical Examination

    Complications

    DDx

    Workup

    Treatment

    Follow-up

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