Materiały źródłowe

• #1 Management of Suspected Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0115/p302.html

  Fetal macrosomia, arbitrarily defined as a birth weight of more than 4,000 g (8 lb, 13 oz) complicates more than 10 percent of all pregnancies in the United States. […] Elective cesarean section for suspected macrosomia has been proposed as a way to spare the parturient an unproductive labor and to prevent birth trauma. […] Unfortunately, the difficulties in predicting macrosomia and the favorable outcome for most women who undergo a trial of labor imply that a large number of unnecessary cesarean sections would have to be performed to prevent a single bad outcome in the pregnancy complicated by suspected fetal macrosomia. […] A recent decision analysis estimated that to prevent one case of permanent brachial plexus injury, 3,700 women with an estimated fetal weight of 4,500 g would need to have an elective cesarean section for suspected macrosomia at a cost of $8.7 million per case prevented.

• #2 Fetal Macrosomia: What Is It, Causes & Complications

  https://my.clevelandclinic.org/health/diseases/17795-fetal-macrosomia

  Treatment for macrosomia focuses on controlling any underlying health conditions you have like diabetes or obesity. You and your healthcare provider will work together to manage these and other conditions that may complicate your pregnancy or delivery. In most cases, implementing a healthy diet and exercise plan and controlling diabetes (with insulin, if needed) is all you can do. […] Your healthcare provider will discuss the risks of a vaginal delivery with you. In some cases, a C-section is recommended to reduce the chances of a complication. Its important to know that delivering your baby early doesnt seem to reduce complications, so scheduling a delivery prior to 39 weeks isnt recommended unless there are other medical complications besides your babys size. […] Not necessarily. A C-section is more likely to occur when: […] Youve had a baby with shoulder dystocia. […] You have diabetes, and your baby is estimated to be over 10 pounds. […] You dont have diabetes, and your baby is predicted to weigh more than 11 pounds.

• #3 Fetal macrosomia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/diagnosis-treatment/drc-20372584

  Fetal macrosomia can’t be diagnosed until after the baby is born and weighed. […] When it’s time for your baby to be born, a vaginal delivery won’t necessarily be out of the question. Your health care provider will discuss options as well as risks and benefits. He or she will monitor your labor closely for possible signs of a complicated vaginal delivery. […] Inducing labor stimulating uterine contractions before labor begins on its own isn’t generally recommended. Research suggests that labor induction doesn’t reduce the risk of complications related to fetal macrosomia and might increase the need for a C-section. […] Your health care provider might recommend a C-section if: […] If you had diabetes before pregnancy or you develop gestational diabetes and your health care provider estimates that your baby weighs 9 pounds, 15 ounces (4,500 grams) or more, a C-section might be the safest way to deliver your baby.

• #4 Fetal Macrosomia: What Is It, Causes & Complications

  https://my.clevelandclinic.org/health/diseases/17795-fetal-macrosomia

  Treatment for macrosomia focuses on controlling any underlying health conditions you have like diabetes or obesity. You and your healthcare provider will work together to manage these and other conditions that may complicate your pregnancy or delivery. In most cases, implementing a healthy diet and exercise plan and controlling diabetes (with insulin, if needed) is all you can do. […] Your healthcare provider will discuss the risks of a vaginal delivery with you. In some cases, a C-section is recommended to reduce the chances of a complication. Its important to know that delivering your baby early doesnt seem to reduce complications, so scheduling a delivery prior to 39 weeks isnt recommended unless there are other medical complications besides your babys size. […] Not necessarily. A C-section is more likely to occur when: […] Youve had a baby with shoulder dystocia. […] You have diabetes, and your baby is estimated to be over 10 pounds. […] You dont have diabetes, and your baby is predicted to weigh more than 11 pounds.

• #5 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  A systematic review that included 18 RCTs with 1151 women revealed that dietary changes/interventions resulted in a greater decrease in fasting and postprandial glucose values and a lower need for medication treatment for gestational diabetes. Dietary interventions were also shown to be associated with lower birth weight and lower rates of macrosomia (relative risk, 0.49 [95% CI, 0.27-0.88]; P =.02). […] […] ACOG recommends that women without any contraindications should be encouraged to participate in aerobic and strength conditioning exercises during pregnancy to reduce the risk of macrosomia. The U.S. Department of Health and Human Services Physical Activity Guidelines for Americans recommends at least 150 minutes of moderate intensity aerobic exercise per week during pregnancy and postpartum. […] […] Several potentially useful strategies may be helpful in prevention of macrosomia. 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. […]

• #6 What Causes Fetal Macrosomia?

  https://www.icliniq.com/articles/newborn-and-baby/fetal-macrosomia

  Fetal macrosomia can be managed by medical management and following proper diet and exercise. […] Early Induction of Labor: The fetus continues to gain about 0.6 pounds per week after the 37th week. So, stimulating the uterine contractions before the labor begins on its own (naturally) is early labor induction. However, this is generally not recommended and may lead to a cesarean. […] Elective Cesarean Surgery: To avoid any birth complications for the mother and the baby, a vaginal delivery is not frequently recommended. In such a case, an elective cesarean in a suspected case of macrosomia is advised to prevent birth trauma, which can prevent shoulder dystocia, brachial plexus injury, etc., in the baby. […] The most important factor for macrosomia is uncontrolled maternal diabetes and excessive weight gain. So dietary control and insulin therapy reduce the chances of macrosomia in the baby, along with tolerable exercise programs for preventing weight gain.

• #7 Macrosomia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557577/

  Macrosomia refers to excessive fetal growth, typically defined by an absolute birth weight rather than gestational age. […] Management of suspected macrosomia involves careful consideration of delivery options. While cesarean delivery may reduce certain risks, it does not entirely prevent complications. Scheduled cesarean sections are often recommended for suspected birth weights above 5,000 g in women without diabetes and 4,500 g in women with diabetes. However, this approach remains controversial due to the lack of conclusive evidence from randomized trials. […] For vaginal deliveries, individualized counseling is essential, taking into account maternal and fetal health, prior obstetric history, and the suspected degree of macrosomia. […] The ADA and ACOG also recommend nutritional counseling by a registered dietitian and the development of a personalized plan based on the patient’s BMI to ensure that the patient’s caloric demand is met while avoiding excessive weight gain.

• #8 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  A systematic review that included 18 RCTs with 1151 women revealed that dietary changes/interventions resulted in a greater decrease in fasting and postprandial glucose values and a lower need for medication treatment for gestational diabetes. Dietary interventions were also shown to be associated with lower birth weight and lower rates of macrosomia (relative risk, 0.49 [95% CI, 0.27-0.88]; P =.02). […] […] ACOG recommends that women without any contraindications should be encouraged to participate in aerobic and strength conditioning exercises during pregnancy to reduce the risk of macrosomia. The U.S. Department of Health and Human Services Physical Activity Guidelines for Americans recommends at least 150 minutes of moderate intensity aerobic exercise per week during pregnancy and postpartum. […] […] Several potentially useful strategies may be helpful in prevention of macrosomia. 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. […]

• #9 Macrosomia – VALINTERMED treatment in Valencia

  https://valintermed.com/en/medlibrary/macrosomy/

  Monitoring the condition of the mother and fetus is essential to prevent complications. Key control steps include: […] Regular ultrasound examinations to assess fetal growth. […] Monitoring maternal blood glucose levels. […] Psychological support and consultations for the mother to ensure emotional comfort. […] The prognosis for mothers with macrosomia can be good with timely diagnosis and appropriate follow-up, but caution and assessment for possible complications such as birth trauma or need for surgery are recommended.

• #10 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  A systematic review that included 18 RCTs with 1151 women revealed that dietary changes/interventions resulted in a greater decrease in fasting and postprandial glucose values and a lower need for medication treatment for gestational diabetes. Dietary interventions were also shown to be associated with lower birth weight and lower rates of macrosomia (relative risk, 0.49 [95% CI, 0.27-0.88]; P =.02). […] […] ACOG recommends that women without any contraindications should be encouraged to participate in aerobic and strength conditioning exercises during pregnancy to reduce the risk of macrosomia. The U.S. Department of Health and Human Services Physical Activity Guidelines for Americans recommends at least 150 minutes of moderate intensity aerobic exercise per week during pregnancy and postpartum. […] […] Several potentially useful strategies may be helpful in prevention of macrosomia. 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. […]

• #11 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  Decision making regarding delivery should be individualized to the patient, taking into account risks and benefits of both macrosomia and other delivery factors such as surgical risks, including implications for future childbearing, and the neonatal risks of early term delivery. […] […] In patients with poorly controlled diabetes resulting in macrosomia, consultation with a maternal fetal medicine specialist to obtain better control may be useful. […] […] Pregestational obesity and excessive gestational weight gain in pregnancy are two of the strongest predictors of macrosomia at birth; therefore, a possible intervention to prevent macrosomia may be nutrition education and an exercise program. Excessive maternal weight gain can double the risk of macrosomia; thus, a reasonable suggestion is careful weight control for women who exceed the recommended weight gain in pregnancy. […]

• #12 Fetal macrosomia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/diagnosis-treatment/drc-20372584

  Fetal macrosomia can’t be diagnosed until after the baby is born and weighed. […] When it’s time for your baby to be born, a vaginal delivery won’t necessarily be out of the question. Your health care provider will discuss options as well as risks and benefits. He or she will monitor your labor closely for possible signs of a complicated vaginal delivery. […] Inducing labor stimulating uterine contractions before labor begins on its own isn’t generally recommended. Research suggests that labor induction doesn’t reduce the risk of complications related to fetal macrosomia and might increase the need for a C-section. […] Your health care provider might recommend a C-section if: […] If you had diabetes before pregnancy or you develop gestational diabetes and your health care provider estimates that your baby weighs 9 pounds, 15 ounces (4,500 grams) or more, a C-section might be the safest way to deliver your baby.

• #13 Fetal Macrosomia: Causes, Symptoms, and More

  https://www.webmd.com/baby/what-is-fetal-macrosomia

  It isnt necessary to get a C-section if your baby is expected to have fetal macrosomia. Your doctor will monitor your labor carefully for any complications that might arise. […] Your doctor may suggest a C-section if you have diabetes, your baby weighs 11 pounds or more, or youve given birth to a baby with shoulder dystocia. These factors will put you and your baby at risk, and alternate birth options will likely be suggested.

• #14 Fetal Macrosomia | Birth Injury Center

  https://birthinjurycenter.org/delivery-complications/fetal-macrosomia/

  Fetal macrosomia refers to a baby with a birth weight that is particularly high. The exact definition varies, but medical sources usually use 4000g (approximately 8 pounds, 13 ounces) or 4500g (approximately 9 pounds, 15 ounces) as the cutoff point. […] The management of fetal macrosomia may involve two main steps. During the pregnancy, treatments may be helpful to manage risk factors and decrease the risk of macrosomia. […] In pregnant women with diabetes, keeping blood sugar under control helps to avoid fetal macrosomia. The better controlled the mother’s diabetes is, the less likely the baby is to grow too large. […] Monitoring the mother’s weight gain, and counseling her on how to stay healthy during pregnancy, is also an important part of prenatal care. […] The delivery should also be carefully managed in order to reduce the chances of significant injuries to the mother and/or the baby.

• #15 Treating Fetal Macrosomia | Delivery Error | Stern Law, PLLC| The CP Lawyer

  https://www.thecplawyer.com/birth-injury/injury-pregnancy/fetal-macrosomia/treating/

  Should a doctor suspect that an unborn baby has fetal macrosomia, a vaginal birth may still be a viable option. However, it may require the use of more invasive medical devices such as forceps and vacuum extractors, which also present risks of injury to your newborn. […] Another option is an episiotomy in order to accommodate your child’s larger size. This procedure calls for a doctor to make a surgical incision on the perineum and posterior vaginal wall during the second stage of labor for the purposes of enlarging the opening of the vagina. This may be necessary if your child is overly large. […] If your doctor feels that a vaginal delivery is too risky, he or she will order a cesarean section. If a c-section is ordered before the 39th week of pregnancy, a doctor may conduct an amniocentesis to determine the extent of your baby’s lung development before going ahead with delivery.

• #16 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  Midpelvic operative vaginal delivery is the most important consideration for labor and delivery in the case of suspected fetal macrosomia. […] The ACOG committee provides the following recommendations for the management of fetal macrosomia: […] Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. […] With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. […] Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

• #17 Fetal macrosomia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/diagnosis-treatment/drc-20372584

  Fetal macrosomia can’t be diagnosed until after the baby is born and weighed. […] When it’s time for your baby to be born, a vaginal delivery won’t necessarily be out of the question. Your health care provider will discuss options as well as risks and benefits. He or she will monitor your labor closely for possible signs of a complicated vaginal delivery. […] Inducing labor stimulating uterine contractions before labor begins on its own isn’t generally recommended. Research suggests that labor induction doesn’t reduce the risk of complications related to fetal macrosomia and might increase the need for a C-section. […] Your health care provider might recommend a C-section if: […] If you had diabetes before pregnancy or you develop gestational diabetes and your health care provider estimates that your baby weighs 9 pounds, 15 ounces (4,500 grams) or more, a C-section might be the safest way to deliver your baby.

• #18 Mayo Clinic Health Library – Fetal macrosomia | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20372561

  When it’s time for your baby to be born, a vaginal delivery won’t necessarily be out of the question. Your health care provider will discuss options as well as risks and benefits. He or she will monitor your labor closely for possible signs of a complicated vaginal delivery. […] Inducing labor stimulating uterine contractions before labor begins on its own isn’t generally recommended. Research suggests that labor induction doesn’t reduce the risk of complications related to fetal macrosomia and might increase the need for a C-section. […] Your health care provider might recommend a C-section if: […] If you had diabetes before pregnancy or you develop gestational diabetes and your health care provider estimates that your baby weighs 9 pounds, 15 ounces (4,500 grams) or more, a C-section might be the safest way to deliver your baby.

• #19 Management of Suspected Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0115/p302.html

  Given that the fetus continues to gain about 230 g (8.1 oz) per week after the 37th week, elective induction of labor before or near term has been suggested to prevent macrosomia and its complications. […] However, observational studies suggest that induction actually increases the cesarean section rate without favorably altering perinatal outcomes. […] The medical literature confirms that prediction of fetal macrosomia is difficult. […] What clinicians really want to predict is not macrosomia, per se, but the serious complications that physicians mistakenly associate as occurring only with macrosomia, such as brachial plexus injury or shoulder dystocia. […] Moreover, the vast majority of macrosomic infants who are delivered vaginally do very well, even if they experience shoulder dystocia.

• #20 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  Midpelvic operative vaginal delivery is the most important consideration for labor and delivery in the case of suspected fetal macrosomia. […] The ACOG committee provides the following recommendations for the management of fetal macrosomia: […] Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. […] With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. […] Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

• #21 Macrosomia: Determination of EFW and Recommendations for Delivery – The ObG Project

  https://www.obgproject.com/2017/02/07/macrosomia-role-early-delivery/

  The term fetal macrosomia implies growth beyond an absolute birth weight of 4000 grams or 4500 grams, regardless of gestational age. The risk of morbidity for both infants and mothers increases when the birthweight is between 4000 and 4500 grams. Risks for maternal and newborn morbidity rise considerably with birthweights >4500g. A correct diagnosis can only be made after weighing an infant at birth, as ultrasound prediction is not precise. […] Consider a prophylactic cesarean for suspected fetal macrosomia if the EFW (estimated fetal weight) is > 5000 grams in women without diabetes. […] Consider a prophylactic cesarean for suspected fetal macrosomia if the EFW is > 4500 grams in women with diabetes. […] Induction before 39w0d is not suggested for suspected fetal macrosomia as induction has not been shown to improve maternal or fetal outcomes.

• #22 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  Induction of labor for presumed fetal macrosomia has in recent history been discouraged due to unclear benefit. However, in a randomized controlled trial (RCT) by Boulvain et al, 822 women with estimated fetal weight 95th percentile at term were randomized to induction versus expectant management. Induction of labor was associated with reduced risk of shoulder dystocia; however, the study was underpowered to detect a difference in brachial plexus injury and none occurred in either group. In addition, induction of labor did not increase cesarean section rate as had been feared. A Cochrane systematic review of four RCTs that included 1190 patients examined outcomes with induction of labor for large for gestational age. The Boulvain RCT contributed 800 of the 1190 patients and dominated the findings of the review. The review concluded that induction of labor in suspected fetal macrosomia does not reduce the risk of brachial plexus injury but does reduce birth weight, or the risk of skeletal injury and shoulder dystocia. […]

• #23 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  Induction of labor for presumed fetal macrosomia has in recent history been discouraged due to unclear benefit. However, in a randomized controlled trial (RCT) by Boulvain et al, 822 women with estimated fetal weight 95th percentile at term were randomized to induction versus expectant management. Induction of labor was associated with reduced risk of shoulder dystocia; however, the study was underpowered to detect a difference in brachial plexus injury and none occurred in either group. In addition, induction of labor did not increase cesarean section rate as had been feared. A Cochrane systematic review of four RCTs that included 1190 patients examined outcomes with induction of labor for large for gestational age. The Boulvain RCT contributed 800 of the 1190 patients and dominated the findings of the review. The review concluded that induction of labor in suspected fetal macrosomia does not reduce the risk of brachial plexus injury but does reduce birth weight, or the risk of skeletal injury and shoulder dystocia. […]

• #24 Fetal macrosomia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/diagnosis-treatment/drc-20372584

  Fetal macrosomia can’t be diagnosed until after the baby is born and weighed. […] When it’s time for your baby to be born, a vaginal delivery won’t necessarily be out of the question. Your health care provider will discuss options as well as risks and benefits. He or she will monitor your labor closely for possible signs of a complicated vaginal delivery. […] Inducing labor stimulating uterine contractions before labor begins on its own isn’t generally recommended. Research suggests that labor induction doesn’t reduce the risk of complications related to fetal macrosomia and might increase the need for a C-section. […] Your health care provider might recommend a C-section if: […] If you had diabetes before pregnancy or you develop gestational diabetes and your health care provider estimates that your baby weighs 9 pounds, 15 ounces (4,500 grams) or more, a C-section might be the safest way to deliver your baby.

• #25 Fetal Macrosomia: What Is It, Causes & Complications

  https://my.clevelandclinic.org/health/diseases/17795-fetal-macrosomia

  Treatment for macrosomia focuses on controlling any underlying health conditions you have like diabetes or obesity. You and your healthcare provider will work together to manage these and other conditions that may complicate your pregnancy or delivery. In most cases, implementing a healthy diet and exercise plan and controlling diabetes (with insulin, if needed) is all you can do. […] Your healthcare provider will discuss the risks of a vaginal delivery with you. In some cases, a C-section is recommended to reduce the chances of a complication. Its important to know that delivering your baby early doesnt seem to reduce complications, so scheduling a delivery prior to 39 weeks isnt recommended unless there are other medical complications besides your babys size. […] Not necessarily. A C-section is more likely to occur when: […] Youve had a baby with shoulder dystocia. […] You have diabetes, and your baby is estimated to be over 10 pounds. […] You dont have diabetes, and your baby is predicted to weigh more than 11 pounds.

• #26 Fetal macrosomia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/diagnosis-treatment/drc-20372584

  Fetal macrosomia can’t be diagnosed until after the baby is born and weighed. […] When it’s time for your baby to be born, a vaginal delivery won’t necessarily be out of the question. Your health care provider will discuss options as well as risks and benefits. He or she will monitor your labor closely for possible signs of a complicated vaginal delivery. […] Inducing labor stimulating uterine contractions before labor begins on its own isn’t generally recommended. Research suggests that labor induction doesn’t reduce the risk of complications related to fetal macrosomia and might increase the need for a C-section. […] Your health care provider might recommend a C-section if: […] If you had diabetes before pregnancy or you develop gestational diabetes and your health care provider estimates that your baby weighs 9 pounds, 15 ounces (4,500 grams) or more, a C-section might be the safest way to deliver your baby.

• #27 Gestational Diabetes, Macrosomia and Shoulder Dystocia: A Short Commentary

  https://www.gavinpublishers.com/article/view/gestational-diabetes-macrosomia-and-shoulder-dystocia-a-short-commentary

  Therefore, the recommendation of the American of Obstetricians and Gynecologists remains that elective cesarean section can be considered for women with GDM and an estimated fetal weight 4500 grams (women without diabetes and fetuses with an estimated to fetal weight of 5000 grams). […] In summary, although we cannot prevent shoulder dystocia and BPI in women with GDM, we can work to reduce the rate of macrosomia and many of its other sequelae. Our best way to attack this problem would be to diagnose GDM and treat it effectively.

• #28 Fetal macrosomia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/diagnosis-treatment/drc-20372584

  If you don’t have pre-gestational or gestational diabetes and your health care provider estimates that your baby weighs 11 pounds (5,000 grams) or more, a C-section might be recommended. […] If you’ve delivered one baby with shoulder dystocia, you’re at increased risk of the problem occurring again. A C-section might be recommended to avoid the risks associated with shoulder dystocia, such as a fractured collarbone. […] If your health care provider recommends an elective C-section, be sure to discuss the risks and benefits. […] After your baby is born, he or she will likely be examined for signs of birth injuries, abnormally low blood sugar (hypoglycemia) and a blood disorder that affects the red blood cell count (polycythemia). He or she might need special care in the hospital’s neonatal intensive care unit.

• #29 The management of the macrosomic fetus and the assessment of wellbeing in gestational diabetes mellitus – hjog.org

  https://hjog.org/?p=1686

  Fetal macrosomia is defined as a birth weight above the 90th percentile for gestational age or alternatively over 4,000 g. […] The 1545% of diabetic mother babies present macrosomia, which is a 3-fold higher risk compared to normoglycemic ones. […] There are various recommendations for the management of macrosomia varying from expectant management and elective induction of labor before term to elective cesarean section for an estimated fetal weight of 4,250 g or 4,500 g depending on the study. […] The ACOG recommends prophylactic Caesarean section if fetal macrosomia with an EFW 5000 g in pregnant women without diabetes and 4500 g in those with GDM. […] After 37 weeks of gestation the fetus continues to grow 230 g/week and elective induction of labor before or near term has been proposed to prevent macrosomia and its complications.

• #30 Fetal macrosomia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/diagnosis-treatment/drc-20372584

  If you don’t have pre-gestational or gestational diabetes and your health care provider estimates that your baby weighs 11 pounds (5,000 grams) or more, a C-section might be recommended. […] If you’ve delivered one baby with shoulder dystocia, you’re at increased risk of the problem occurring again. A C-section might be recommended to avoid the risks associated with shoulder dystocia, such as a fractured collarbone. […] If your health care provider recommends an elective C-section, be sure to discuss the risks and benefits. […] After your baby is born, he or she will likely be examined for signs of birth injuries, abnormally low blood sugar (hypoglycemia) and a blood disorder that affects the red blood cell count (polycythemia). He or she might need special care in the hospital’s neonatal intensive care unit.

• #31 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  Cesarean delivery to reduce the risk associated with macrosomia may place the mother at risk, and subsequent pregnancies are at risk of uterine dehiscence before or during the onset of labor. Not all cases of nerve injuries can be prevented by cesarean delivery because some occur in utero. Estimates indicate that as many as 3695 cesarean deliveries in non-diabetic women and 443 cesarean deliveries in diabetic women must be performed to prevent a single permanent brachial plexus nerve injury in infants of estimated fetal weight greater than 4500 g. Expert opinion suggests that there may be some benefit to offering scheduled cesarean section to mothers with suspected macrosomia (5000 g in nondiabetic mothers and 4500 g in diabetic mothers); however, the decision to perform cesarean section for macrosomia is left to the provider and patient. […]

• #32 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  Cesarean delivery to reduce the risk associated with macrosomia may place the mother at risk, and subsequent pregnancies are at risk of uterine dehiscence before or during the onset of labor. Not all cases of nerve injuries can be prevented by cesarean delivery because some occur in utero. Estimates indicate that as many as 3695 cesarean deliveries in non-diabetic women and 443 cesarean deliveries in diabetic women must be performed to prevent a single permanent brachial plexus nerve injury in infants of estimated fetal weight greater than 4500 g. Expert opinion suggests that there may be some benefit to offering scheduled cesarean section to mothers with suspected macrosomia (5000 g in nondiabetic mothers and 4500 g in diabetic mothers); however, the decision to perform cesarean section for macrosomia is left to the provider and patient. […]

• #33 Mayo Clinic Health Library – Fetal macrosomia | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20372561

  If you don’t have pre-gestational or gestational diabetes and your health care provider estimates that your baby weighs 11 pounds (5,000 grams) or more, a C-section might be recommended. […] If you’ve delivered one baby with shoulder dystocia, you’re at increased risk of the problem occurring again. A C-section might be recommended to avoid the risks associated with shoulder dystocia, such as a fractured collarbone. […] If your health care provider recommends an elective C-section, be sure to discuss the risks and benefits. […] After your baby is born, he or she will likely be examined for signs of birth injuries, abnormally low blood sugar (hypoglycemia) and a blood disorder that affects the red blood cell count (polycythemia). He or she might need special care in the hospital’s neonatal intensive care unit.

• #34 Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/10/6/e002915

  Flexible treatment of GDM according to the measurement of fetal AC does not improve neonatal outcomes for large and small newborns in terms of gestational age, but could reduce the number of newborn macrosomia and reduces neonatal hypoglycemia without increasing the number of ultrasound checks and medical visits, and halves insulin treatment. […] The treatment of flexible GDM according to the measurement of fetal AC is safe for the mother and the fetus and almost halves the number of pregnant women who require insulin treatment, without increasing the number of ultrasound checks or medical visits. […] Flexible GDM treatment according to the measurement of fetal AC in daily clinical practice: (1) does not improve neonatal outcomes for LGA and SGA newborns but appears to reduce macrosomia in newborns by almost 60%; (2) reduces insulinization needs in 48% of pregnant women; (3) decreases hypoglycemia by 76% in the newborn, without modifying other perinatal outcomes; and (4) does not modify the complications of pregnancy associated with GDM or its treatment.

• #35 Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/10/6/e002915

  Flexible treatment of GDM according to the measurement of fetal AC does not improve neonatal outcomes for large and small newborns in terms of gestational age, but could reduce the number of newborn macrosomia and reduces neonatal hypoglycemia without increasing the number of ultrasound checks and medical visits, and halves insulin treatment. […] The treatment of flexible GDM according to the measurement of fetal AC is safe for the mother and the fetus and almost halves the number of pregnant women who require insulin treatment, without increasing the number of ultrasound checks or medical visits. […] Flexible GDM treatment according to the measurement of fetal AC in daily clinical practice: (1) does not improve neonatal outcomes for LGA and SGA newborns but appears to reduce macrosomia in newborns by almost 60%; (2) reduces insulinization needs in 48% of pregnant women; (3) decreases hypoglycemia by 76% in the newborn, without modifying other perinatal outcomes; and (4) does not modify the complications of pregnancy associated with GDM or its treatment.

• #36 Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/10/6/e002915

  Flexible treatment of GDM according to the measurement of fetal AC does not improve neonatal outcomes for large and small newborns in terms of gestational age, but could reduce the number of newborn macrosomia and reduces neonatal hypoglycemia without increasing the number of ultrasound checks and medical visits, and halves insulin treatment. […] The treatment of flexible GDM according to the measurement of fetal AC is safe for the mother and the fetus and almost halves the number of pregnant women who require insulin treatment, without increasing the number of ultrasound checks or medical visits. […] Flexible GDM treatment according to the measurement of fetal AC in daily clinical practice: (1) does not improve neonatal outcomes for LGA and SGA newborns but appears to reduce macrosomia in newborns by almost 60%; (2) reduces insulinization needs in 48% of pregnant women; (3) decreases hypoglycemia by 76% in the newborn, without modifying other perinatal outcomes; and (4) does not modify the complications of pregnancy associated with GDM or its treatment.

• #37 Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/10/6/e002915

  Flexible treatment of GDM according to the measurement of fetal AC does not improve neonatal outcomes for large and small newborns in terms of gestational age, but could reduce the number of newborn macrosomia and reduces neonatal hypoglycemia without increasing the number of ultrasound checks and medical visits, and halves insulin treatment. […] The treatment of flexible GDM according to the measurement of fetal AC is safe for the mother and the fetus and almost halves the number of pregnant women who require insulin treatment, without increasing the number of ultrasound checks or medical visits. […] Flexible GDM treatment according to the measurement of fetal AC in daily clinical practice: (1) does not improve neonatal outcomes for LGA and SGA newborns but appears to reduce macrosomia in newborns by almost 60%; (2) reduces insulinization needs in 48% of pregnant women; (3) decreases hypoglycemia by 76% in the newborn, without modifying other perinatal outcomes; and (4) does not modify the complications of pregnancy associated with GDM or its treatment.

• #38 Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/10/6/e002915

  Flexible treatment of GDM according to the measurement of fetal AC does not improve neonatal outcomes for large and small newborns in terms of gestational age, but could reduce the number of newborn macrosomia and reduces neonatal hypoglycemia without increasing the number of ultrasound checks and medical visits, and halves insulin treatment. […] The treatment of flexible GDM according to the measurement of fetal AC is safe for the mother and the fetus and almost halves the number of pregnant women who require insulin treatment, without increasing the number of ultrasound checks or medical visits. […] Flexible GDM treatment according to the measurement of fetal AC in daily clinical practice: (1) does not improve neonatal outcomes for LGA and SGA newborns but appears to reduce macrosomia in newborns by almost 60%; (2) reduces insulinization needs in 48% of pregnant women; (3) decreases hypoglycemia by 76% in the newborn, without modifying other perinatal outcomes; and (4) does not modify the complications of pregnancy associated with GDM or its treatment.

• #39 Can Macrosomia Be Prevented?

  https://www.contemporaryobgyn.net/view/can-macrosomia-be-prevented

  To determine whether strict glycemic control during diabetic pregnancy combined with elective early induction of labor reduces the rate of macrosomia, birth trauma, and its influences on the C/S rate. […] Maintaining strict glycemic control and adhering to early elective delivery have a significant effect on reducing the rate of macrosomia, without affecting the rate of cesarean deliveries. […] Our objective was to investigate the effectiveness of strict metabolic control during pregnancy coupled with term (~38 wks) early induction of labor based on estimated fetal weight in reducing macrosomia, birth trauma and C/S rates. […] The maintenance of strict metabolic control in the GDM patients combined with the early induction of labor protocol was accompanied by rates of macrosomia, LGA fetuses, shoulder dystocia, and cesarean births not significantly higher than those for the non-GDM subjects.

• #40 Can Macrosomia Be Prevented?

  https://www.contemporaryobgyn.net/view/can-macrosomia-be-prevented

  Macrosomia rates declined gradually from 17.9% to 8.8% and 4.5% in 1985-1992, 1992-1995 and 1998, respectively. […] We hypothesized that in the management of pregnancies with GDM combining early detection and strict metabolic control with early induction of labor near term- to avoid excessive fetal growth in utero, could lead to more favorable perinatal outcome. […] The main perinatal complication of GDM is accelerated fetal growth. It increases the risk of birth trauma and the likelihood of performing a cesarean delivery. […] Contrary to the conflicting results regarding management of fetal macrosomia, our study clearly demonstrates that although it might not be sufficient to pursue one of the two approaches, by combining the two management protocols and strictly implementing them together, the problem of macrosomia can be overcome, achieving rates similar to the healthy non-diabetic pregnant population. […] This has been attainable at low cost and minimal clinical recourses, without increasing the rate of cesarean or instrumental deliveries, but merely by adhering and strictly implementing tight glycemic control together with early induction of labor.

• #41 Can Macrosomia Be Prevented?

  https://www.contemporaryobgyn.net/view/can-macrosomia-be-prevented

  To determine whether strict glycemic control during diabetic pregnancy combined with elective early induction of labor reduces the rate of macrosomia, birth trauma, and its influences on the C/S rate. […] Maintaining strict glycemic control and adhering to early elective delivery have a significant effect on reducing the rate of macrosomia, without affecting the rate of cesarean deliveries. […] Our objective was to investigate the effectiveness of strict metabolic control during pregnancy coupled with term (~38 wks) early induction of labor based on estimated fetal weight in reducing macrosomia, birth trauma and C/S rates. […] The maintenance of strict metabolic control in the GDM patients combined with the early induction of labor protocol was accompanied by rates of macrosomia, LGA fetuses, shoulder dystocia, and cesarean births not significantly higher than those for the non-GDM subjects.

• #42 Can Macrosomia Be Prevented?

  https://www.contemporaryobgyn.net/view/can-macrosomia-be-prevented

  Macrosomia rates declined gradually from 17.9% to 8.8% and 4.5% in 1985-1992, 1992-1995 and 1998, respectively. […] We hypothesized that in the management of pregnancies with GDM combining early detection and strict metabolic control with early induction of labor near term- to avoid excessive fetal growth in utero, could lead to more favorable perinatal outcome. […] The main perinatal complication of GDM is accelerated fetal growth. It increases the risk of birth trauma and the likelihood of performing a cesarean delivery. […] Contrary to the conflicting results regarding management of fetal macrosomia, our study clearly demonstrates that although it might not be sufficient to pursue one of the two approaches, by combining the two management protocols and strictly implementing them together, the problem of macrosomia can be overcome, achieving rates similar to the healthy non-diabetic pregnant population. […] This has been attainable at low cost and minimal clinical recourses, without increasing the rate of cesarean or instrumental deliveries, but merely by adhering and strictly implementing tight glycemic control together with early induction of labor.

• #43 Fetal macrosomia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/diagnosis-treatment/drc-20372584

  If you don’t have pre-gestational or gestational diabetes and your health care provider estimates that your baby weighs 11 pounds (5,000 grams) or more, a C-section might be recommended. […] If you’ve delivered one baby with shoulder dystocia, you’re at increased risk of the problem occurring again. A C-section might be recommended to avoid the risks associated with shoulder dystocia, such as a fractured collarbone. […] If your health care provider recommends an elective C-section, be sure to discuss the risks and benefits. […] After your baby is born, he or she will likely be examined for signs of birth injuries, abnormally low blood sugar (hypoglycemia) and a blood disorder that affects the red blood cell count (polycythemia). He or she might need special care in the hospital’s neonatal intensive care unit.

• #44 Mayo Clinic Health Library – Fetal macrosomia | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20372561

  If you don’t have pre-gestational or gestational diabetes and your health care provider estimates that your baby weighs 11 pounds (5,000 grams) or more, a C-section might be recommended. […] If you’ve delivered one baby with shoulder dystocia, you’re at increased risk of the problem occurring again. A C-section might be recommended to avoid the risks associated with shoulder dystocia, such as a fractured collarbone. […] If your health care provider recommends an elective C-section, be sure to discuss the risks and benefits. […] After your baby is born, he or she will likely be examined for signs of birth injuries, abnormally low blood sugar (hypoglycemia) and a blood disorder that affects the red blood cell count (polycythemia). He or she might need special care in the hospital’s neonatal intensive care unit.

• #45 Treating Fetal Macrosomia | Delivery Error | Stern Law, PLLC| The CP Lawyer

  https://www.thecplawyer.com/birth-injury/injury-pregnancy/fetal-macrosomia/treating/

  After your child is born, he or she should be assessed for birth injuries, low blood sugar, and a certain blood disorder known as polycythemia which affects a baby’s red blood cell count. In the event of complications during labor and delivery, your child may be kept for monitoring and treatment in the neonatal intensive care unit. Additionally, as your child progresses in age, he or she should be regularly monitored for insulin resistance, obesity and other macrosomia-related complications that may arise.

• #46 Large-for-Gestational-Age (LGA) Infant – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/perinatal-problems/large-for-gestational-age-lga-infant

  Infants whose weight is the 90th percentile for gestational age are classified as large for gestational age. […] Treatment is directed at managing birth and postnatal complications, which are more common among neonates who are large for gestational age. […] Treatment of hypoglycemia can range from enteral feeding orally or via nasogastric tube to IV administration of dextrose-containing fluids. Oral treatment with 40% glucose gel may prevent the need to separate the neonate from the mother for IV placement, but if hypoglycemia is persistent, parenteral dextrose-containing fluids are given IV. […] Good control of maternal glucose levels minimizes risk of complications.

• #47 Mayo Clinic Health Library – Fetal macrosomia | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20372561

  If you don’t have pre-gestational or gestational diabetes and your health care provider estimates that your baby weighs 11 pounds (5,000 grams) or more, a C-section might be recommended. […] If you’ve delivered one baby with shoulder dystocia, you’re at increased risk of the problem occurring again. A C-section might be recommended to avoid the risks associated with shoulder dystocia, such as a fractured collarbone. […] If your health care provider recommends an elective C-section, be sure to discuss the risks and benefits. […] After your baby is born, he or she will likely be examined for signs of birth injuries, abnormally low blood sugar (hypoglycemia) and a blood disorder that affects the red blood cell count (polycythemia). He or she might need special care in the hospital’s neonatal intensive care unit.

• #48 Fetal Macrosomia: What it Means for Your Baby | Birth Injury Guide

  https://www.birthinjuryguide.org/causes/fetal-macrosomia/

  Doctors will generally recommend a c-section if you have suspected fetal macrosomia and: […] After delivery, your doctor will assess the baby for any signs of a birth injury. Depending on the baby’s health, gestational age, birth weight etc. they may need to spend some time in the neonatal intensive care unit (NICU).

• #49 Large-for-Gestational-Age (LGA) Infant – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/perinatal-problems/large-for-gestational-age-lga-infant

  Infants whose weight is the 90th percentile for gestational age are classified as large for gestational age. […] Treatment is directed at managing birth and postnatal complications, which are more common among neonates who are large for gestational age. […] Treatment of hypoglycemia can range from enteral feeding orally or via nasogastric tube to IV administration of dextrose-containing fluids. Oral treatment with 40% glucose gel may prevent the need to separate the neonate from the mother for IV placement, but if hypoglycemia is persistent, parenteral dextrose-containing fluids are given IV. […] Good control of maternal glucose levels minimizes risk of complications.

• #50 Fetal macrosomia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/diagnosis-treatment/drc-20372584

  Keep in mind that your baby might be at risk of childhood obesity and insulin resistance and should be monitored for these conditions during future checkups. […] Also, if you haven’t previously been diagnosed with diabetes and your health care provider is concerned about the possibility of diabetes, you may be tested for the condition. During future pregnancies, you’ll be closely monitored for signs and symptoms of gestational diabetes a type of diabetes that develops during pregnancy.

• #51 Mayo Clinic Health Library – Fetal macrosomia | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20372561

  Keep in mind that your baby might be at risk of childhood obesity and insulin resistance and should be monitored for these conditions during future checkups. […] Also, if you haven’t previously been diagnosed with diabetes and your health care provider is concerned about the possibility of diabetes, you may be tested for the condition. During future pregnancies, you’ll be closely monitored for signs and symptoms of gestational diabetes a type of diabetes that develops during pregnancy.

• #52 Treating Fetal Macrosomia | Delivery Error | Stern Law, PLLC| The CP Lawyer

  https://www.thecplawyer.com/birth-injury/injury-pregnancy/fetal-macrosomia/treating/

  After your child is born, he or she should be assessed for birth injuries, low blood sugar, and a certain blood disorder known as polycythemia which affects a baby’s red blood cell count. In the event of complications during labor and delivery, your child may be kept for monitoring and treatment in the neonatal intensive care unit. Additionally, as your child progresses in age, he or she should be regularly monitored for insulin resistance, obesity and other macrosomia-related complications that may arise.

• #53 Mayo Clinic Health Library – Fetal macrosomia | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20372561

  Keep in mind that your baby might be at risk of childhood obesity and insulin resistance and should be monitored for these conditions during future checkups. […] Also, if you haven’t previously been diagnosed with diabetes and your health care provider is concerned about the possibility of diabetes, you may be tested for the condition. During future pregnancies, you’ll be closely monitored for signs and symptoms of gestational diabetes a type of diabetes that develops during pregnancy.

• #54 Treating Fetal Macrosomia | Delivery Error | Stern Law, PLLC| The CP Lawyer

  https://www.thecplawyer.com/birth-injury/injury-pregnancy/fetal-macrosomia/treating/

  After your child is born, he or she should be assessed for birth injuries, low blood sugar, and a certain blood disorder known as polycythemia which affects a baby’s red blood cell count. In the event of complications during labor and delivery, your child may be kept for monitoring and treatment in the neonatal intensive care unit. Additionally, as your child progresses in age, he or she should be regularly monitored for insulin resistance, obesity and other macrosomia-related complications that may arise.

• #55 Mayo Clinic Health Library – Fetal macrosomia | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20372561

  Keep in mind that your baby might be at risk of childhood obesity and insulin resistance and should be monitored for these conditions during future checkups. […] Also, if you haven’t previously been diagnosed with diabetes and your health care provider is concerned about the possibility of diabetes, you may be tested for the condition. During future pregnancies, you’ll be closely monitored for signs and symptoms of gestational diabetes a type of diabetes that develops during pregnancy.

• #56 Macrosomia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557577/

  Preventative measures such as exercise during pregnancy, a low-glycemic diet for women with gestational diabetes, and prepregnancy bariatric surgery for individuals with severe obesity have shown promise in reducing macrosomia risk. […] Induction of labor (IOL), which was widely recommended until recently, has been discouraged due to the lack of clear evidence on its significance in the management of macrosomia. […] The role of cesarean delivery for suspected macrosomia remains controversial. While cesarean birth may reduce the risk of severe birth trauma in cases of extreme macrosomia, its use for estimated fetal weights below specific thresholds, particularly in women without diabetes, is not supported by current evidence due to the inaccuracy of prenatal weight estimates and the associated maternal risks. […] Ultimately, for pregnancies complicated by suspected macrosomia, management decisions should balance maternal and neonatal risks, consider the limitations of diagnostic tools, and prioritize patient-centered discussions to guide choices regarding induction, vaginal delivery, or cesarean birth.

• #57 Fetal Macrosomia (Large Baby) & Birth Injuries

  https://browntrialfirm.com/birth-injury-lawyer/fetal-macrosomia-birth-injury/

  Maternal health complications and doctors use of assistive tools can result in birth injuries that make what would have otherwise been an uneventful childbirth a life-altering one. Fetal macrosomia is 1 of many conditions that can result in long-lasting injuries or impairments for mother and child. […] The best way to prevent fetal macrosomia is to receive adequate prenatal care. Pregnant mothers who remain active during their pregnancies and have their weight gain and blood sugar monitored can greatly reduce their risk of having a baby with fetal macrosomia. […] A pregnant mother who receives adequate monitoring and prenatal care from her OB-GYN can significantly reduce her babys chances of being born with fetal macrosomia.

• #58

  https://journals.lww.com/mfm/fulltext/2023/01000/maternal_obesity,_gestational_diabetes,_and_fetal.5.aspx

  A commonly used approach is to directly address maternal obesity as a way of reducing risk of GDM. […] In fact, studies have shown that lifestyle changes reduce the risk of GDM in obese women. […] On the other hand, a meta-analysis by Horvath et al. showed that treating gestational diabetes (with diet or insulin) was associated with a lower risk of macrosomia. […] What is certain is that the combination has a multiplier effect most likely mechanistically.

• #59 Macrosomia and Birth Trauma in Infants of Diet Treated Gestational Diabetic Women | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-7091-8925-2_15

  It is well recognized that untreated gestational diabetes is associated with an excess rate of stillbirths and a high frequency of large for dates (macrosomic) infants. […] Treatment of gestational diabetes should be designed to prevent these complications. Standard treatment has consisted of a well balanced diabetic diet. […] Management by diet alone with good control of blood glucose values has been shown to result in normal perinatal mortality. […] However, perinatal morbidity may remain excessive with just dietary therapy. For example, in Gabbes series the incidence of fetal macrosomia in the well controlled diet treated women was 20%.

• #60 Macrosomia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557577/

  Preventative measures such as exercise during pregnancy, a low-glycemic diet for women with gestational diabetes, and prepregnancy bariatric surgery for individuals with severe obesity have shown promise in reducing macrosomia risk. […] Induction of labor (IOL), which was widely recommended until recently, has been discouraged due to the lack of clear evidence on its significance in the management of macrosomia. […] The role of cesarean delivery for suspected macrosomia remains controversial. While cesarean birth may reduce the risk of severe birth trauma in cases of extreme macrosomia, its use for estimated fetal weights below specific thresholds, particularly in women without diabetes, is not supported by current evidence due to the inaccuracy of prenatal weight estimates and the associated maternal risks. […] Ultimately, for pregnancies complicated by suspected macrosomia, management decisions should balance maternal and neonatal risks, consider the limitations of diagnostic tools, and prioritize patient-centered discussions to guide choices regarding induction, vaginal delivery, or cesarean birth.

• #61 Cerebral Palsy from Macrosomia | Michigan Cerebral Palsy Attorneys

  https://www.michigancerebralpalsyattorneys.com/causes-and-risk-factors-of-cerebral-palsy/incorrect-size-position-presentation/cerebral-palsy-macrosomia/

  In pregnancies dealing with macrosomia, it is most important to manage the underlying causes of the condition. For instance, obese women should be instructed to gain as little weight as possible and see a dietician or nutritionist. […] While vaginal delivery is still possible for macrosomic babies, the baby will risk certain injuries. Vaginal deliveries for macrosomic babies often require the use of vacuum extractors or forceps, and instrument delivery is a risk factor associated with a number of traumatic head injuries. Furthermore, the physician should be prepared to deal with shoulder dystocia, a situation in which the baby’s shoulders cannot pass through the birth canal. In all situations, the physician should be prepared to perform an emergency C-section. Most importantly, the physician should inform the patient of the risks of vaginally delivering a macrosomic baby.

• #62 Fetal Macrosomia: Symptoms and Care

  https://www.medicoverhospitals.in/diseases/fetal-macrosomia/

  Effective management of fetal macrosomia begins with comprehensive prenatal care. Regular monitoring of maternal and fetal health is essential to identify potential risks and intervene when necessary. Healthcare providers may recommend lifestyle modifications, such as dietary changes and exercise, to mitigate risk factors. […] In cases where fetal macrosomia is suspected, healthcare providers may discuss delivery options with the expectant mother. Depending on the estimated fetal weight and other factors, a planned cesarean delivery may be recommended to reduce the risk of complications during labour. […] Following delivery, both the mother and the newborn require careful monitoring and follow-up care. Newborns with macrosomia may be at an increased risk for hypoglycemia, jaundice, and other complications. Early intervention and appropriate medical management are crucial to ensure the well-being of both mother and baby. […] Treatment may involve careful monitoring and planning for delivery to prevent complications.

• #63 Macrosomia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557577/

  Preventative measures such as exercise during pregnancy, a low-glycemic diet for women with gestational diabetes, and prepregnancy bariatric surgery for individuals with severe obesity have shown promise in reducing macrosomia risk. […] Induction of labor (IOL), which was widely recommended until recently, has been discouraged due to the lack of clear evidence on its significance in the management of macrosomia. […] The role of cesarean delivery for suspected macrosomia remains controversial. While cesarean birth may reduce the risk of severe birth trauma in cases of extreme macrosomia, its use for estimated fetal weights below specific thresholds, particularly in women without diabetes, is not supported by current evidence due to the inaccuracy of prenatal weight estimates and the associated maternal risks. […] Ultimately, for pregnancies complicated by suspected macrosomia, management decisions should balance maternal and neonatal risks, consider the limitations of diagnostic tools, and prioritize patient-centered discussions to guide choices regarding induction, vaginal delivery, or cesarean birth.

• #64 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  A systematic review that included 18 RCTs with 1151 women revealed that dietary changes/interventions resulted in a greater decrease in fasting and postprandial glucose values and a lower need for medication treatment for gestational diabetes. Dietary interventions were also shown to be associated with lower birth weight and lower rates of macrosomia (relative risk, 0.49 [95% CI, 0.27-0.88]; P =.02). […] […] ACOG recommends that women without any contraindications should be encouraged to participate in aerobic and strength conditioning exercises during pregnancy to reduce the risk of macrosomia. The U.S. Department of Health and Human Services Physical Activity Guidelines for Americans recommends at least 150 minutes of moderate intensity aerobic exercise per week during pregnancy and postpartum. […] […] Several potentially useful strategies may be helpful in prevention of macrosomia. 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. […]

• #65 Fetal Macrosomia | Birth Injury Center

  https://birthinjurycenter.org/delivery-complications/fetal-macrosomia/

  Fetal macrosomia refers to a baby with a birth weight that is particularly high. The exact definition varies, but medical sources usually use 4000g (approximately 8 pounds, 13 ounces) or 4500g (approximately 9 pounds, 15 ounces) as the cutoff point. […] The management of fetal macrosomia may involve two main steps. During the pregnancy, treatments may be helpful to manage risk factors and decrease the risk of macrosomia. […] In pregnant women with diabetes, keeping blood sugar under control helps to avoid fetal macrosomia. The better controlled the mother’s diabetes is, the less likely the baby is to grow too large. […] Monitoring the mother’s weight gain, and counseling her on how to stay healthy during pregnancy, is also an important part of prenatal care. […] The delivery should also be carefully managed in order to reduce the chances of significant injuries to the mother and/or the baby.

• #66

  https://link.springer.com/article/10.1007/s11892-012-0338-8

  Fetal macrosomia and maternal diabetes are independent risk factors for shoulder dystocia, an obstetrical emergency that may cause permanent neonatal injury. […] Randomized trials of glycemic control in pregnancies complicated by gestational diabetes reveal decreased rates of macrosomia and shoulder dystocia among those treated. […] This randomized blinded controlled trial demonstrated that glycemic control in mild gestational diabetes decreased risks of macrosomia, shoulder dystocia, cesarean delivery, and hypertensive disorders. […] This large multicenter, international trial evaluating 23,000 women found positive correlations of maternal glucose levels below diagnostic thresholds for diabetes with macrosomia, cesarean delivery, fetal hyperinsulinemia, and shoulder dystocia. […] Similar to the HAPO trial, this secondary analysis of the MFMU trial 2009 revealed associations with adverse maternal and neonatal outcomes with glycemic values short of diabetic thresholds. […] The consequences of not treating gestational diabetes can lead to increased risks of macrosomia and shoulder dystocia.

• #67

  https://link.springer.com/article/10.1007/s11892-012-0338-8

  Fetal macrosomia and maternal diabetes are independent risk factors for shoulder dystocia, an obstetrical emergency that may cause permanent neonatal injury. […] Randomized trials of glycemic control in pregnancies complicated by gestational diabetes reveal decreased rates of macrosomia and shoulder dystocia among those treated. […] This randomized blinded controlled trial demonstrated that glycemic control in mild gestational diabetes decreased risks of macrosomia, shoulder dystocia, cesarean delivery, and hypertensive disorders. […] This large multicenter, international trial evaluating 23,000 women found positive correlations of maternal glucose levels below diagnostic thresholds for diabetes with macrosomia, cesarean delivery, fetal hyperinsulinemia, and shoulder dystocia. […] Similar to the HAPO trial, this secondary analysis of the MFMU trial 2009 revealed associations with adverse maternal and neonatal outcomes with glycemic values short of diabetic thresholds. […] The consequences of not treating gestational diabetes can lead to increased risks of macrosomia and shoulder dystocia.

• #68 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  Midpelvic operative vaginal delivery is the most important consideration for labor and delivery in the case of suspected fetal macrosomia. […] The ACOG committee provides the following recommendations for the management of fetal macrosomia: […] Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. […] With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. […] Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

• #69 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  Midpelvic operative vaginal delivery is the most important consideration for labor and delivery in the case of suspected fetal macrosomia. […] The ACOG committee provides the following recommendations for the management of fetal macrosomia: […] Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. […] With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. […] Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

• #70 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  Midpelvic operative vaginal delivery is the most important consideration for labor and delivery in the case of suspected fetal macrosomia. […] The ACOG committee provides the following recommendations for the management of fetal macrosomia: […] Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. […] With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. […] Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

• #71 The management of the macrosomic fetus and the assessment of wellbeing in gestational diabetes mellitus – hjog.org

  https://hjog.org/?p=1686

  Fetal macrosomia is defined as a birth weight above the 90th percentile for gestational age or alternatively over 4,000 g. […] The 1545% of diabetic mother babies present macrosomia, which is a 3-fold higher risk compared to normoglycemic ones. […] There are various recommendations for the management of macrosomia varying from expectant management and elective induction of labor before term to elective cesarean section for an estimated fetal weight of 4,250 g or 4,500 g depending on the study. […] The ACOG recommends prophylactic Caesarean section if fetal macrosomia with an EFW 5000 g in pregnant women without diabetes and 4500 g in those with GDM. […] After 37 weeks of gestation the fetus continues to grow 230 g/week and elective induction of labor before or near term has been proposed to prevent macrosomia and its complications.

• #72 Macrosomia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/262679-treatment

  Decision making regarding delivery should be individualized to the patient, taking into account risks and benefits of both macrosomia and other delivery factors such as surgical risks, including implications for future childbearing, and the neonatal risks of early term delivery. […] […] In patients with poorly controlled diabetes resulting in macrosomia, consultation with a maternal fetal medicine specialist to obtain better control may be useful. […] […] Pregestational obesity and excessive gestational weight gain in pregnancy are two of the strongest predictors of macrosomia at birth; therefore, a possible intervention to prevent macrosomia may be nutrition education and an exercise program. Excessive maternal weight gain can double the risk of macrosomia; thus, a reasonable suggestion is careful weight control for women who exceed the recommended weight gain in pregnancy. […]

• #73 Macrosomia: Determination of EFW and Recommendations for Delivery – The ObG Project

  https://www.obgproject.com/2017/02/07/macrosomia-role-early-delivery/

  Suspected fetal macrosomia is not a contraindication to a trial of labor after cesarean. […] No single formula based on ultrasound biometry performs significantly better than others for the detection of macrosomia more than 4,500 g. […] Similar to clinical estimates of fetal weight, ultrasonography can be used most effectively as a tool to rule out macrosomia, which may help avoid maternal and fetal morbidity.

• #74 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  Midpelvic operative vaginal delivery is the most important consideration for labor and delivery in the case of suspected fetal macrosomia. […] The ACOG committee provides the following recommendations for the management of fetal macrosomia: […] Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. […] With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. […] Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

• #75 Macrosomia: Determination of EFW and Recommendations for Delivery – The ObG Project

  https://www.obgproject.com/2017/02/07/macrosomia-role-early-delivery/

  Suspected fetal macrosomia is not a contraindication to a trial of labor after cesarean. […] No single formula based on ultrasound biometry performs significantly better than others for the detection of macrosomia more than 4,500 g. […] Similar to clinical estimates of fetal weight, ultrasonography can be used most effectively as a tool to rule out macrosomia, which may help avoid maternal and fetal morbidity.

• #76 Macrosomia: Determination of EFW and Recommendations for Delivery – The ObG Project

  https://www.obgproject.com/2017/02/07/macrosomia-role-early-delivery/

  Suspected fetal macrosomia is not a contraindication to a trial of labor after cesarean. […] No single formula based on ultrasound biometry performs significantly better than others for the detection of macrosomia more than 4,500 g. […] Similar to clinical estimates of fetal weight, ultrasonography can be used most effectively as a tool to rule out macrosomia, which may help avoid maternal and fetal morbidity.

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