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Fetal Macrosomia
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Risk factors commonly associated with fetal macrosomia are shown in Table 48.1. A large study done in United States identifying the risk factors for excess fetal growth concluded that GDM, pre-pregnancy adiposity, pregnancy weight gain were independently associated with higher risk of macrosomia/LGA across all races (except GDM among non-Hispanic Whites). Among non-Hispanic Whites, non-Hispanic Black and Hispanic women, the joint effect of all three factors substantially increased the risks of LGA [9].
Fetal growth restriction
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Daniel L. Jackson, M. Y. Divon, Hung N. Winn
For pregnancies at high risk for FGR, there is a role for third-trimester screening. A prior history of stillbirth confers a 50% increase in the risk of FGR. Patients with diabetes during pregnancy are traditionally thought of as being at risk for macrosomia. However, these patients are also at a significantly increased risk for FGR, and screening is appropriate (7). Multiple gestation is also a risk factor for FGR. Obesity is not traditionally associated with FGR unless the patient also suffers from some other disorder such as chronic hypertension. Excessive weight gain during pregnancy is associated with macrosomia (34). The use of customized fetal growth curves has demonstrated that a subset of pregnancies in obese women who are categorized as having normal growth by population-based norms in fact have impaired growth and are at increased risk for perinatal mortality (7). While there have been no studies showing improvements in neonatal morbidity or mortality with screening of routine pregnancies for FGR with third-trimester ultrasound examination, it is a reasonable approach in pregnancies at high risk for FGR. Pregnant women whose weight gain is inadequate or fundal height is decreased stand an increased risk of having FGR. Further evaluation by sonographic assessment should be offered to patients with risk factors and a high index of suspicion.
Diabetes mellitus
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Macrosomia has different definitions, but is conventionally defined as a birthweight >4.5 kg or >90th percentile for gestational age. Insulin is an anabolic, growth-promoting hormone, and the macrosomic baby of the mother with diabetes is characteristically fat and plethoric, with all organs, but particularly the liver, being enlarged.
Early universal screening of gestational diabetes in a university hospital in Thailand
Published in Journal of Obstetrics and Gynaecology, 2022
Buraya Phattanachindakun, Kanokwaroon Watananirun, Dittakarn Boriboonhirunsarn
Data were extracted from medical records including baseline and obstetric characteristics, risks of GDM, GA at screening, prevalence and characteristics of GDM, GA at delivery, route of delivery, pregnancy and neonatal outcomes. Pregnancy outcomes included, GA at delivery, gestational weight gain, route of delivery, pregnancy complications, such as postpartum haemorrhage and preeclampsia. Neonatal outcomes included birth weight, birth weight for GA category, macrosomia, Apgar score, neonatal hypoglycaemia, the need for phototherapy, and NICU admission. GDM risks included age ≥30 years, family history of DM, body mass index (BMI) ≥25 kg/m2, previous GDM, previous unexplained foetal anomaly or deaths, previous macrosomia, and hypertension (Sunsaneevithayakul et al. 2003). Those with at least one risk factor were considered as being high-risk and those without any risk factor were considered as being low-risk for GDM. BMI and gestational weight gain were categorised according to the Institute of Medicine (IOM) and ACOG recommendations (Rasmussen and Yaktine 2009; Anon 2013). Newborn birth weight was categorised into small for gestational age (SGA), appropriate for gestational age (AGA) or large for gestational age (LGA), using cut-off at 10th and 90th percentile derived from WHO weight percentiles calculator (Mikolajczyk et al. 2011). Macrosomia was defined as birthweight of the newborn of ≥4000 g.
Prevalence of gestational diabetes mellitus in Argentina according to the Latin American Diabetes Association (ALAD) and International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria and the associated maternal-neonatal complications
Published in Health Care for Women International, 2021
Silvia Gorban de Lapertosa, Stella Sucani, Susana Salzberg, Jorge Alvariñas, Cristina Faingold, Alicia Jawerbaum, Gabriela Rovira
Maternal obesity/overweight is a known risk factor for GDM in different populations (Egan et al., 2017; Kim et al., 2013). In our population, we found that the prevalence of obesity/overweight was clearly associated with increasing fasting glycemia values. Indeed, obesity/overweight was evidenced in 48% of the patients with GDM diagnosed by ALAD and in 45% of the patients diagnosed by IADPSG, data that illustrate the relevance of obesity/overweight as a risk factor in GDM. Moreover, we observed similar adverse maternal and fetal outcomes in all patients that had macrosomic newborns, and this included mothers without GDM and with GDM diagnosed both through the ALAD and the IADPSG diagnostic criteria. It should be noted that the maternal BMI of patients without GDM was lower than that of patients with GDM (diagnosed by either the ALAD or IADPSG criterion), whereas the maternal BMI of patients without GDM that had macrosomic newborns was similar to that of those with GDM diagnosed by either the ALAD or IADPSG criterion. All this points to obesity/overweight as a possible inducer of macrosomia.
Relationship between 50-g glucose challenge test and large for gestational age infants among pregnant women without gestational diabetes
Published in Journal of Obstetrics and Gynaecology, 2019
Dittakarn Boriboonhirunsarn, Prasert Sunsaneevithayakul
The data were obtained from medical records, including the baseline clinical characteristics, obstetrics data, GDM risk factors, results of 50 g GCT and 100 g OGTT, delivery data, and the pregnancy outcomes. The pre-pregnancy BMI status and the gestational weight gain were categorised according to the Institute of Medicine (IOM) recommendation (Rasmussen and Yaktine 2009). The trimester-specific weight gain was assessed from the pre-pregnancy weight, with the body weight at 14–16, 26–28 weeks of gestation, and at delivery. The gestational age was assessed from the reported last menstrual period and confirmed by the crown-rump length measurement during the first trimester. Large for gestational age was diagnosed when a birth weight was ≥90th percentile for normal newborns, according to the standard reference data used at the Department of Pediatrics, Siriraj Hospital. Macrosomia was defined as an infant birth weight ≥4000 g.