Materiały źródłowe

• #1 Fetal Macrosomia | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4612-2482-2_8

  Macrosomia, arbitrarily defined as a birthweight of more than 4000 g at term, complicates about 10% and 25% of term and postterm pregnancies, respectively. It remains an important cause of perinatal morbidity and mortality and maternal morbidity, which arise mainly from birth injury and asphyxia and increased rate of cesarean section, respectively. […] The major obstacle in reducing the perinatal morbidity and mortality associated with fetal macrosomia has been the inability to predict with certainly which fetuses will sustain birth injury before delivery.

• #2 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. […] Fetal macrosomia is difficult to predict, and clinical and ultrasonographic estimates of fetal weight are prone to error. […] Elective cesarean section for suspected macrosomia results in a high number of unnecessary procedures, and early induction of labor to limit fetal growth may result in a substantial increase in the cesarean section rate because of failed inductions. […] The most clinically useful definition of macrosomia is a weight below which macrosomic complications, such as shoulder dystocia, do not occur. […] The delivery of a macrosomic infant has potentially serious consequences for the infant and the mother.

• #3 Fetal Macrosomia | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4612-2482-2_8

  Macrosomia, arbitrarily defined as a birthweight of more than 4000 g at term, complicates about 10% and 25% of term and postterm pregnancies, respectively. It remains an important cause of perinatal morbidity and mortality and maternal morbidity, which arise mainly from birth injury and asphyxia and increased rate of cesarean section, respectively. […] The major obstacle in reducing the perinatal morbidity and mortality associated with fetal macrosomia has been the inability to predict with certainly which fetuses will sustain birth injury before delivery.

• #4 Nomogram-based risk prediction of macrosomia: a case-control study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04706-y

  Macrosomia is closely associated with poor maternal and fetal outcome. […] The prevalence of macrosomia was 6.13% (95/1549) in our hospital. […] The nomogram model provides an effective method for clinicians to predict macrosomia in the first trimester. […] Recent studies have shown that macrosomia increases adverse maternal and fetal outcomes. […] For pregnant women, delivery of macrosomia is associated with significantly elevated risks of cesarean section, prolonged labor, postpartum hemorrhage, chorioamnionitis, soft birth canal injury, even uterus and bladder rupture. […] For the newborns, macrosomia increases the risks of shoulder dystocia, clavicle fractures, brachial plexus injury, respiratory distress, meconium aspiration, perinatal infection, hypoglycemia, polycythemia, hypoxic-ischemic encephalopathy and increases the need for admission to neonatal intensive care unit.

• #5 Fetal macrosomia – UpToDate

  https://www.uptodate.com/contents/fetal-macrosomia

  Fetal macrosomia refers to growth beyond a specific threshold, regardless of gestational age. In high income countries, the most commonly used threshold is weight above 4500 g (9 lb 15 oz), but weight above 4000 g (8 lb 13 oz) is also commonly used. A grading system has been suggested: grade 1 for infants 4000 to 4499 g, grade 2 for 4500 to 4999 g, and grade 3 for over 5000 g. This system may be useful at term for decision-making regarding forceps- or vacuum-assisted vaginal birth. […] Macrosomia is associated with an increased risk of several complications, particularly maternal and/or fetal trauma during birth and neonatal hypoglycemia and respiratory problems. Long-term adverse effects in these offspring include increased risks for obesity and insulin resistance.

• #6 Early Prediction of Fetal Macrosomia Through Maternal Lipid Profiles

  https://www.mdpi.com/1422-0067/26/3/1149

  The prevalence of fetal macrosomia is steadily increasing worldwide, reaching up to 20%. Fetal macrosomia complicates pregnancy and delivery. Current prediction strategies are inaccurate, and most patients with fetal macrosomia go into labor with an “unknown status”. The aim of this study was to develop a system for predicting fetal macrosomia based on the lipid profiles of pregnant women’s blood serum. […] The risk of perinatal loss in fetal macrosomia is higher than in children with normal birth weight. In pregnancies complicated by diabetes, fetuses with macrosomia develop a unique pattern of excessive growth characterized by central subcutaneous fat deposition around the abdomen and between the shoulder blades. This results in an increase in the shoulder circumference relative to the head, which, in 5–9% of cases, significantly increases the risk of shoulder dystocia, Erb’s palsy, brachial plexus injuries, fractures of tubular bones, and neonatal asphyxia.

• #7 Management of Suspected Fetal Macrosomia | AAFP

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

  The most feared result of macrosomia is shoulder dystocia, and up to one fourth of infants with shoulder dystocia experience brachial plexus or facial nerve injuries, or fractures of the humerus or clavicle. […] The mother is at increased risk for cesarean section, which occurs more commonly in pregnancies complicated by macrosomia. […] Elective cesarean section for suspected macrosomia has been proposed as a way to spare the parturient an unproductive labor and to prevent birth trauma. […] 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. […] 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.

• #8 Nomogram-based risk prediction of macrosomia: a case-control study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04706-y

  Macrosomia is closely associated with poor maternal and fetal outcome. […] The prevalence of macrosomia was 6.13% (95/1549) in our hospital. […] The nomogram model provides an effective method for clinicians to predict macrosomia in the first trimester. […] Recent studies have shown that macrosomia increases adverse maternal and fetal outcomes. […] For pregnant women, delivery of macrosomia is associated with significantly elevated risks of cesarean section, prolonged labor, postpartum hemorrhage, chorioamnionitis, soft birth canal injury, even uterus and bladder rupture. […] For the newborns, macrosomia increases the risks of shoulder dystocia, clavicle fractures, brachial plexus injury, respiratory distress, meconium aspiration, perinatal infection, hypoglycemia, polycythemia, hypoxic-ischemic encephalopathy and increases the need for admission to neonatal intensive care unit.

• #9 Nomogram-based risk prediction of macrosomia: a case-control study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04706-y

  Macrosomia is closely associated with poor maternal and fetal outcome. […] The prevalence of macrosomia was 6.13% (95/1549) in our hospital. […] The nomogram model provides an effective method for clinicians to predict macrosomia in the first trimester. […] Recent studies have shown that macrosomia increases adverse maternal and fetal outcomes. […] For pregnant women, delivery of macrosomia is associated with significantly elevated risks of cesarean section, prolonged labor, postpartum hemorrhage, chorioamnionitis, soft birth canal injury, even uterus and bladder rupture. […] For the newborns, macrosomia increases the risks of shoulder dystocia, clavicle fractures, brachial plexus injury, respiratory distress, meconium aspiration, perinatal infection, hypoglycemia, polycythemia, hypoxic-ischemic encephalopathy and increases the need for admission to neonatal intensive care unit.

• #10 Nomogram-based risk prediction of macrosomia: a case-control study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04706-y

  Macrosomia is closely associated with poor maternal and fetal outcome. […] The prevalence of macrosomia was 6.13% (95/1549) in our hospital. […] The nomogram model provides an effective method for clinicians to predict macrosomia in the first trimester. […] Recent studies have shown that macrosomia increases adverse maternal and fetal outcomes. […] For pregnant women, delivery of macrosomia is associated with significantly elevated risks of cesarean section, prolonged labor, postpartum hemorrhage, chorioamnionitis, soft birth canal injury, even uterus and bladder rupture. […] For the newborns, macrosomia increases the risks of shoulder dystocia, clavicle fractures, brachial plexus injury, respiratory distress, meconium aspiration, perinatal infection, hypoglycemia, polycythemia, hypoxic-ischemic encephalopathy and increases the need for admission to neonatal intensive care unit.

• #11 Nomogram-based risk prediction of macrosomia: a case-control study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04706-y

  Macrosomia is closely associated with poor maternal and fetal outcome. […] The prevalence of macrosomia was 6.13% (95/1549) in our hospital. […] The nomogram model provides an effective method for clinicians to predict macrosomia in the first trimester. […] Recent studies have shown that macrosomia increases adverse maternal and fetal outcomes. […] For pregnant women, delivery of macrosomia is associated with significantly elevated risks of cesarean section, prolonged labor, postpartum hemorrhage, chorioamnionitis, soft birth canal injury, even uterus and bladder rupture. […] For the newborns, macrosomia increases the risks of shoulder dystocia, clavicle fractures, brachial plexus injury, respiratory distress, meconium aspiration, perinatal infection, hypoglycemia, polycythemia, hypoxic-ischemic encephalopathy and increases the need for admission to neonatal intensive care unit.

• #12 Macrosomia – StatPearls – NCBI Bookshelf

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

  A patient who delivers a macrosomic infant should be screened very carefully for previously undiagnosed diabetes. If such screening is negative, they should be monitored carefully in subsequent pregnancies. The goal of scheduled cesarean birth for suspected macrosomia is to reduce fetal morbidity or maternal morbidity, or both. Although fetal and maternal morbidity increases with birth weights 4,000 g, most births of macrosomic newborns are uncomplicated.[10] […] Pregnancies complicated by macrosomia are inherently at an increased risk of adverse outcomes depending on the degree of macrosomia. At 5000g, an increased risk of stillbirth or neonatal death is present.[22][10] Macrosomia and its complications can be subdivided into the following broad categories: […] The prediction of birth weight by ultrasonography or clinical measurement is imprecise; however, emerging evidence using a 2 stage screening strategy based on ultrasonographic examination in the third trimester shows a modest positive screen rate in identifying pregnancies at risk of macrosomia.[30] For suspected macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained via abdominal palpation. Women without contraindications should be encouraged to engage in aerobic and strength-conditioning exercises during pregnancy to reduce the risk of macrosomia. Control of maternal hyperglycemia reduces the risk of macrosomia. Therefore, maternal glucose optimization is recommended for pregnancies complicated by diabetes.

• #13 Fetal macrosomia – UpToDate

  https://www.uptodate.com/contents/fetal-macrosomia

  Fetal macrosomia refers to growth beyond a specific threshold, regardless of gestational age. In high income countries, the most commonly used threshold is weight above 4500 g (9 lb 15 oz), but weight above 4000 g (8 lb 13 oz) is also commonly used. A grading system has been suggested: grade 1 for infants 4000 to 4499 g, grade 2 for 4500 to 4999 g, and grade 3 for over 5000 g. This system may be useful at term for decision-making regarding forceps- or vacuum-assisted vaginal birth. […] Macrosomia is associated with an increased risk of several complications, particularly maternal and/or fetal trauma during birth and neonatal hypoglycemia and respiratory problems. Long-term adverse effects in these offspring include increased risks for obesity and insulin resistance.

• #14 Early Prediction of Fetal Macrosomia Through Maternal Lipid Profiles

  https://www.mdpi.com/1422-0067/26/3/1149

  The prevalence of fetal macrosomia is steadily increasing worldwide, reaching up to 20%. Fetal macrosomia complicates pregnancy and delivery. Current prediction strategies are inaccurate, and most patients with fetal macrosomia go into labor with an “unknown status”. The aim of this study was to develop a system for predicting fetal macrosomia based on the lipid profiles of pregnant women’s blood serum. […] The risk of perinatal loss in fetal macrosomia is higher than in children with normal birth weight. In pregnancies complicated by diabetes, fetuses with macrosomia develop a unique pattern of excessive growth characterized by central subcutaneous fat deposition around the abdomen and between the shoulder blades. This results in an increase in the shoulder circumference relative to the head, which, in 5–9% of cases, significantly increases the risk of shoulder dystocia, Erb’s palsy, brachial plexus injuries, fractures of tubular bones, and neonatal asphyxia.

• #15 Nomogram-based risk prediction of macrosomia: a case-control study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04706-y

  Predicting macrosomia and taking proper interventions during early stage of pregnancy can avoid or decrease adverse complications. […] In this study, we attempted to set up a predictive model of macrosomia based on clinical indicators in first trimester, which enables early identification and prevention of macrosomia. […] The AUC of the nomogram model for macrosomia was 0.807 (95% CI: 0.7550.859). The sensitivity and specificity were 0.716 and 0.777, respectively. […] Given the increased morbidity and mortality for infants and mothers caused by macrosomia, predicting macrosomia and taking effective interventions in early pregnancy were both crucial. […] The nomogram model enables visual and personalized prediction, which can help obstetricians to more easily access the risk of macrosomia according to the score of each pregnant woman, then provide personalized healthcare service.

• #16 The Role of Maternal Weight in the Hierarchy of Macrosomia Predictors; Overall Effect of Analysis of Three Prediction Indicators

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8000437/

  So far it has not been established which maternal features play the most important role in newborn macrosomia. The aim of this study is to provide assessment of a hierarchy of twenty six (26) maternal characteristics in macrosomia prediction. Results. The macrosomia risk was the highest for prior macrosomia (AOR = 7.53, 95%CI: 3.1518.00, p 0.001). A few maternal characteristics were associated with more than three times higher macrosomia odds ratios, e.g., maternal obesity and gestational age 38 weeks. A different hierarchy was shown by the prediction study. Compared to the basic prediction model (AUC = 0.564 (0.5010.627), p = 0.04), AUC increased most when pre-pregnancy weight (kg) was added to the base model (AUC = 0.706 (0.6490.764), p 0.001). The values of IDI and NRI were also the highest for the model with maternal weight (IDI = 0.061 (0.0390.083), p 0.001), and (NRI = 0.538 (0.330.746), p 0.001). After summing up the effects of NRI, IDI and AUC, the probability of macrosomia was most strongly improved (in order) by: pre-pregnancy weight, body mass index (BMI), excessive gestational weight gain (GWG) and BMI 25 kg/m2. The main conclusions: newer prediction indicators showed that (among 26 features) excessive pre-pregnancy weight/BMI and excessive GWG played a much more important role in macrosomia prediction than other maternal characteristics. These indicators more strongly highlighted the differences between predictors than the results of commonly used odds ratios.

• #17 The Role of Maternal Weight in the Hierarchy of Macrosomia Predictors; Overall Effect of Analysis of Three Prediction Indicators

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8000437/

  The goal of this study is to establish the significance hierarchy of 26 maternal characteristics as potential macrosomia predictors (in the literature referred to as macrosomia risk factors). Hierarchy of predictor significance was determined based on three prediction indicators (NRI, IDI and AUC) calculated after adding one (test) predictor to the base multifactorial prediction model. […] In this assessment of the significance hierarchy of 26 maternal characteristics as potential macrosomia predictors, excessive pre-pregnancy weight/BMI and excessive GWG played the most important role in macrosomia prediction. This analysis based on newer prediction indices (NRI, IDI and AUC) showed that the importance of BMI and GWG was much higher than that of other maternal characteristics and this difference was stronger than the odds ratio results showed.

• #18 The Role of Maternal Weight in the Hierarchy of Macrosomia Predictors; Overall Effect of Analysis of Three Prediction Indicators

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8000437/

  The goal of this study is to establish the significance hierarchy of 26 maternal characteristics as potential macrosomia predictors (in the literature referred to as macrosomia risk factors). Hierarchy of predictor significance was determined based on three prediction indicators (NRI, IDI and AUC) calculated after adding one (test) predictor to the base multifactorial prediction model. […] In this assessment of the significance hierarchy of 26 maternal characteristics as potential macrosomia predictors, excessive pre-pregnancy weight/BMI and excessive GWG played the most important role in macrosomia prediction. This analysis based on newer prediction indices (NRI, IDI and AUC) showed that the importance of BMI and GWG was much higher than that of other maternal characteristics and this difference was stronger than the odds ratio results showed.

• #19 Nomogram-based risk prediction of macrosomia: a case-control study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04706-y

  Predicting macrosomia and taking proper interventions during early stage of pregnancy can avoid or decrease adverse complications. […] In this study, we attempted to set up a predictive model of macrosomia based on clinical indicators in first trimester, which enables early identification and prevention of macrosomia. […] The AUC of the nomogram model for macrosomia was 0.807 (95% CI: 0.7550.859). The sensitivity and specificity were 0.716 and 0.777, respectively. […] Given the increased morbidity and mortality for infants and mothers caused by macrosomia, predicting macrosomia and taking effective interventions in early pregnancy were both crucial. […] The nomogram model enables visual and personalized prediction, which can help obstetricians to more easily access the risk of macrosomia according to the score of each pregnant woman, then provide personalized healthcare service.

• #20 Nomogram-based risk prediction of macrosomia: a case-control study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04706-y

  Predicting macrosomia and taking proper interventions during early stage of pregnancy can avoid or decrease adverse complications. […] In this study, we attempted to set up a predictive model of macrosomia based on clinical indicators in first trimester, which enables early identification and prevention of macrosomia. […] The AUC of the nomogram model for macrosomia was 0.807 (95% CI: 0.7550.859). The sensitivity and specificity were 0.716 and 0.777, respectively. […] Given the increased morbidity and mortality for infants and mothers caused by macrosomia, predicting macrosomia and taking effective interventions in early pregnancy were both crucial. […] The nomogram model enables visual and personalized prediction, which can help obstetricians to more easily access the risk of macrosomia according to the score of each pregnant woman, then provide personalized healthcare service.

• #21 Early Prediction of Fetal Macrosomia Through Maternal Lipid Profiles

  https://www.mdpi.com/1422-0067/26/3/1149

  A key challenge remains the development of early methods for predicting fetal macrosomia to reduce the occurrence of this complication both among pregnant women with metabolic disorders such as gestational diabetes and obesity and women without these risk factors. […] Our research has identified clinical and experimental predictive markers for fetal macrosomia based on mass spectrometry analysis of blood samples. Key clinical risk factors include maternal age, pre-pregnancy obesity, excessive weight gain before and during pregnancy, and gestational diabetes (GDM) that has not progressed to insulin therapy. […] In this study, we aimed to predict fetal macrosomia regardless of whether GDM is present, starting as early as the first trimester. Our analysis of the lipid profiles in the serum of women with fetal macrosomia, compared to those with normal fetal weights, revealed significant differences throughout pregnancy (at 11–13 weeks, 24–26 weeks, and 30–32 weeks). We hypothesize that the lipid groups we identified, particularly phosphatidylcholines and sphingomyelins, play a critical role in the development of fetal macrosomia and could serve as laboratory markers for this complication.

• #22 Early Prediction of Fetal Macrosomia Through Maternal Lipid Profiles

  https://www.mdpi.com/1422-0067/26/3/1149

  A key challenge remains the development of early methods for predicting fetal macrosomia to reduce the occurrence of this complication both among pregnant women with metabolic disorders such as gestational diabetes and obesity and women without these risk factors. […] Our research has identified clinical and experimental predictive markers for fetal macrosomia based on mass spectrometry analysis of blood samples. Key clinical risk factors include maternal age, pre-pregnancy obesity, excessive weight gain before and during pregnancy, and gestational diabetes (GDM) that has not progressed to insulin therapy. […] In this study, we aimed to predict fetal macrosomia regardless of whether GDM is present, starting as early as the first trimester. Our analysis of the lipid profiles in the serum of women with fetal macrosomia, compared to those with normal fetal weights, revealed significant differences throughout pregnancy (at 11–13 weeks, 24–26 weeks, and 30–32 weeks). We hypothesize that the lipid groups we identified, particularly phosphatidylcholines and sphingomyelins, play a critical role in the development of fetal macrosomia and could serve as laboratory markers for this complication.

• #23 Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003190

  The effectiveness of screening for macrosomia is not well established. […] The objective of this study is to investigate the diagnostic effectiveness of universal ultrasonic fetal biometry in predicting the delivery of a macrosomic infant, shoulder dystocia, and associated neonatal morbidity in low- and mixed-risk populations. […] In this study, we found that suspected LGA is strongly predictive of the risk of delivering a large infant in low- and mixed-risk populations. However, it is only weakly (albeit statistically significantly) predictive of the risk of shoulder dystocia. […] Universal third-trimester ultrasound screening will identify more pregnancies with macrosomia. However, it will not have a clinically significant effect at predicting shoulder dystocia. […] We conclude that ultrasonically suspected LGA in the general population has quite good diagnostic effectiveness for macrosomic birth weight. However, it is not strongly predictive of the risk of associated complications, such as shoulder dystocia.

• #24 Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003190

  The effectiveness of screening for macrosomia is not well established. […] The objective of this study is to investigate the diagnostic effectiveness of universal ultrasonic fetal biometry in predicting the delivery of a macrosomic infant, shoulder dystocia, and associated neonatal morbidity in low- and mixed-risk populations. […] In this study, we found that suspected LGA is strongly predictive of the risk of delivering a large infant in low- and mixed-risk populations. However, it is only weakly (albeit statistically significantly) predictive of the risk of shoulder dystocia. […] Universal third-trimester ultrasound screening will identify more pregnancies with macrosomia. However, it will not have a clinically significant effect at predicting shoulder dystocia. […] We conclude that ultrasonically suspected LGA in the general population has quite good diagnostic effectiveness for macrosomic birth weight. However, it is not strongly predictive of the risk of associated complications, such as shoulder dystocia.

• #25 Macrosomia – StatPearls – NCBI Bookshelf

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

  A patient who delivers a macrosomic infant should be screened very carefully for previously undiagnosed diabetes. If such screening is negative, they should be monitored carefully in subsequent pregnancies. The goal of scheduled cesarean birth for suspected macrosomia is to reduce fetal morbidity or maternal morbidity, or both. Although fetal and maternal morbidity increases with birth weights 4,000 g, most births of macrosomic newborns are uncomplicated.[10] […] Pregnancies complicated by macrosomia are inherently at an increased risk of adverse outcomes depending on the degree of macrosomia. At 5000g, an increased risk of stillbirth or neonatal death is present.[22][10] Macrosomia and its complications can be subdivided into the following broad categories: […] The prediction of birth weight by ultrasonography or clinical measurement is imprecise; however, emerging evidence using a 2 stage screening strategy based on ultrasonographic examination in the third trimester shows a modest positive screen rate in identifying pregnancies at risk of macrosomia.[30] For suspected macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained via abdominal palpation. Women without contraindications should be encouraged to engage in aerobic and strength-conditioning exercises during pregnancy to reduce the risk of macrosomia. Control of maternal hyperglycemia reduces the risk of macrosomia. Therefore, maternal glucose optimization is recommended for pregnancies complicated by diabetes.

• #26 Macrosomia – StatPearls – NCBI Bookshelf

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

  A patient who delivers a macrosomic infant should be screened very carefully for previously undiagnosed diabetes. If such screening is negative, they should be monitored carefully in subsequent pregnancies. The goal of scheduled cesarean birth for suspected macrosomia is to reduce fetal morbidity or maternal morbidity, or both. Although fetal and maternal morbidity increases with birth weights 4,000 g, most births of macrosomic newborns are uncomplicated.[10] […] Pregnancies complicated by macrosomia are inherently at an increased risk of adverse outcomes depending on the degree of macrosomia. At 5000g, an increased risk of stillbirth or neonatal death is present.[22][10] Macrosomia and its complications can be subdivided into the following broad categories: […] The prediction of birth weight by ultrasonography or clinical measurement is imprecise; however, emerging evidence using a 2 stage screening strategy based on ultrasonographic examination in the third trimester shows a modest positive screen rate in identifying pregnancies at risk of macrosomia.[30] For suspected macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained via abdominal palpation. Women without contraindications should be encouraged to engage in aerobic and strength-conditioning exercises during pregnancy to reduce the risk of macrosomia. Control of maternal hyperglycemia reduces the risk of macrosomia. Therefore, maternal glucose optimization is recommended for pregnancies complicated by diabetes.

• #27 Fasting plasma glucose and fetal ultrasound predict the occurrence of neonatal macrosomia in gestational diabetes mellitus | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05594-6

  The cause of fetal overgrowth during pregnancy is still unclear. This study aimed to analyze and predict the risk of macrosomia in pregnant women with gestational diabetes mellitus (GDM). […] The data of perinatal outcomes of 322 GDM and 353 NGT who had given birth to single live babies at term were analyzed. We found that significant cut-off values for the prediction of macrosomia are 5.13mmol/L in fasting plasma glucose (FPG), 12.25kg in gestational weight gain (GWG), 3,605g in ultrasound fetal weight gain (FWG) and 124mm in amniotic fluid index (AFI). The area under the ROC curve of this predictive model combined all variables reached 0.953 (95% CI: 0.914~0.993) with a sensitivity of 95.0% and a specificity of 85.4%. […] FPG is positively associated with newborn birth weight. An early intervention to prevent macrosomia may be possible by combining maternal GWG, FPG, FWG, and AFI in gestational diabetes.

• #28 Fasting plasma glucose and fetal ultrasound predict the occurrence of neonatal macrosomia in gestational diabetes mellitus | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05594-6

  The cause of fetal overgrowth during pregnancy is still unclear. This study aimed to analyze and predict the risk of macrosomia in pregnant women with gestational diabetes mellitus (GDM). […] The data of perinatal outcomes of 322 GDM and 353 NGT who had given birth to single live babies at term were analyzed. We found that significant cut-off values for the prediction of macrosomia are 5.13mmol/L in fasting plasma glucose (FPG), 12.25kg in gestational weight gain (GWG), 3,605g in ultrasound fetal weight gain (FWG) and 124mm in amniotic fluid index (AFI). The area under the ROC curve of this predictive model combined all variables reached 0.953 (95% CI: 0.914~0.993) with a sensitivity of 95.0% and a specificity of 85.4%. […] FPG is positively associated with newborn birth weight. An early intervention to prevent macrosomia may be possible by combining maternal GWG, FPG, FWG, and AFI in gestational diabetes.

• #29 Fasting plasma glucose and fetal ultrasound predict the occurrence of neonatal macrosomia in gestational diabetes mellitus | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05594-6

  Prediction of macrosomia remains a challenge. Macrosomia is more common in women with gestational diabetes or pre-pregnancy diabetes than in women without diabetes, which may sometimes be associated with maternal glycemic control. […] The results showed GWG, FPG, AFI, and EFW were the influencing factors for the occurrence of macrosomia. Every 1 kg of weight gain during pregnancy increases the risk of macrosomia by 1.221 times (95%CI:1.0451.425). An increase in FPG of 0.1mmol/L increases macrosomia risk by 1.391 times (95%CI:1.122~1.724). […] In conclusion, this study indicated that abnormally elevated FPG is an independent risk factor for macrosomia in pregnant women with GDM. In addition, when macrosomia is possible but cannot be diagnosed, a combination of maternal GWG, FPG, FWG, and AFI can predict macrosomia in gestational diabetes mellitus, which might be a new target for early intervention to prevent macrosomia.

• #30 Macrosomia – StatPearls – NCBI Bookshelf

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

  A patient who delivers a macrosomic infant should be screened very carefully for previously undiagnosed diabetes. If such screening is negative, they should be monitored carefully in subsequent pregnancies. The goal of scheduled cesarean birth for suspected macrosomia is to reduce fetal morbidity or maternal morbidity, or both. Although fetal and maternal morbidity increases with birth weights 4,000 g, most births of macrosomic newborns are uncomplicated.[10] […] Pregnancies complicated by macrosomia are inherently at an increased risk of adverse outcomes depending on the degree of macrosomia. At 5000g, an increased risk of stillbirth or neonatal death is present.[22][10] Macrosomia and its complications can be subdivided into the following broad categories: […] The prediction of birth weight by ultrasonography or clinical measurement is imprecise; however, emerging evidence using a 2 stage screening strategy based on ultrasonographic examination in the third trimester shows a modest positive screen rate in identifying pregnancies at risk of macrosomia.[30] For suspected macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained via abdominal palpation. Women without contraindications should be encouraged to engage in aerobic and strength-conditioning exercises during pregnancy to reduce the risk of macrosomia. Control of maternal hyperglycemia reduces the risk of macrosomia. Therefore, maternal glucose optimization is recommended for pregnancies complicated by diabetes.

• #31 Management of Suspected Fetal Macrosomia | AAFP

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

  The most feared result of macrosomia is shoulder dystocia, and up to one fourth of infants with shoulder dystocia experience brachial plexus or facial nerve injuries, or fractures of the humerus or clavicle. […] The mother is at increased risk for cesarean section, which occurs more commonly in pregnancies complicated by macrosomia. […] Elective cesarean section for suspected macrosomia has been proposed as a way to spare the parturient an unproductive labor and to prevent birth trauma. […] 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. […] 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.

• #32 Management of Suspected Fetal Macrosomia | AAFP

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

  The most feared result of macrosomia is shoulder dystocia, and up to one fourth of infants with shoulder dystocia experience brachial plexus or facial nerve injuries, or fractures of the humerus or clavicle. […] The mother is at increased risk for cesarean section, which occurs more commonly in pregnancies complicated by macrosomia. […] Elective cesarean section for suspected macrosomia has been proposed as a way to spare the parturient an unproductive labor and to prevent birth trauma. […] 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. […] 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.

• #33 Management of Suspected Fetal Macrosomia | AAFP

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

  The most feared result of macrosomia is shoulder dystocia, and up to one fourth of infants with shoulder dystocia experience brachial plexus or facial nerve injuries, or fractures of the humerus or clavicle. […] The mother is at increased risk for cesarean section, which occurs more commonly in pregnancies complicated by macrosomia. […] Elective cesarean section for suspected macrosomia has been proposed as a way to spare the parturient an unproductive labor and to prevent birth trauma. […] 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. […] 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.

• #34 Management of Suspected Fetal Macrosomia | AAFP

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

  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. […] The weight estimate of the suspected macrosomic fetus should be recognized as uncertain. […] For almost all macrosomic pregnancies including diabetic mothers, previous deliveries with shoulder dystocia, or women considering VBACs, expectant management with vigilance for evidence of fetopelvic disproportion will have optimal results.

• #35 Macrosomia – StatPearls – NCBI Bookshelf

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

  A patient who delivers a macrosomic infant should be screened very carefully for previously undiagnosed diabetes. If such screening is negative, they should be monitored carefully in subsequent pregnancies. The goal of scheduled cesarean birth for suspected macrosomia is to reduce fetal morbidity or maternal morbidity, or both. Although fetal and maternal morbidity increases with birth weights 4,000 g, most births of macrosomic newborns are uncomplicated.[10] […] Pregnancies complicated by macrosomia are inherently at an increased risk of adverse outcomes depending on the degree of macrosomia. At 5000g, an increased risk of stillbirth or neonatal death is present.[22][10] Macrosomia and its complications can be subdivided into the following broad categories: […] The prediction of birth weight by ultrasonography or clinical measurement is imprecise; however, emerging evidence using a 2 stage screening strategy based on ultrasonographic examination in the third trimester shows a modest positive screen rate in identifying pregnancies at risk of macrosomia.[30] For suspected macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained via abdominal palpation. Women without contraindications should be encouraged to engage in aerobic and strength-conditioning exercises during pregnancy to reduce the risk of macrosomia. Control of maternal hyperglycemia reduces the risk of macrosomia. Therefore, maternal glucose optimization is recommended for pregnancies complicated by diabetes.

• #36 Management of Suspected Fetal Macrosomia | AAFP

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

  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. […] The weight estimate of the suspected macrosomic fetus should be recognized as uncertain. […] For almost all macrosomic pregnancies including diabetic mothers, previous deliveries with shoulder dystocia, or women considering VBACs, expectant management with vigilance for evidence of fetopelvic disproportion will have optimal results.

• #37 Early Prediction of Fetal Macrosomia Through Maternal Lipid Profiles

  https://www.mdpi.com/1422-0067/26/3/1149

  The molecular mechanisms that contribute to fetal macrosomia are largely uncharted, and further research in this area could enhance our understanding of the impact of metabolic diseases. This knowledge could lead to effective preventive strategies, improved prognostic techniques, and early diagnosis methods to help reduce the incidence of fetal macrosomia.

• #38 Early Prediction of Fetal Macrosomia Through Maternal Lipid Profiles

  https://www.mdpi.com/1422-0067/26/3/1149

  The molecular mechanisms that contribute to fetal macrosomia are largely uncharted, and further research in this area could enhance our understanding of the impact of metabolic diseases. This knowledge could lead to effective preventive strategies, improved prognostic techniques, and early diagnosis methods to help reduce the incidence of fetal macrosomia.

• #39

  https://link.springer.com/article/10.1007/s43032-025-01833-7

  Fetal macrosomia is associated with adverse short- and long-term outcomes for the mother and the child. […] Given the potential adverse perinatal outcomes, there is a need to predict macrosomia. Early pregnancy macrosomia prediction could identify women in need of increased pregnancy surveillance and allow for interventions to decrease the risk. […] Early pregnancy maternal waist circumference can replace weight in a fetal macrosomia prediction model. […] Our model detected about 41% of women that gave birth to a newborn with macrosomia at a false-positive rate of 10%, similar to other studies of macrosomia prediction with maternal factors. […] Our finding of a positive association between early pregnancy maternal waist circumference and fetal macrosomia is consistent with prior studies. […] In summary, we demonstrate that waist circumference can replace weight for macrosomia prediction.

• #40 Nomogram-based risk prediction of macrosomia: a case-control study | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04706-y

  The predictive model of this study is established based on maternal general characteristics before pregnancy and the clinical data in early pregnancy, which can be used to screen pregnant women for macrosomia in the early pregnancy stage so that effective intervention and treatment can be earlier implemented for these gestational women.

• #41 Fasting plasma glucose and fetal ultrasound predict the occurrence of neonatal macrosomia in gestational diabetes mellitus | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05594-6

  Prediction of macrosomia remains a challenge. Macrosomia is more common in women with gestational diabetes or pre-pregnancy diabetes than in women without diabetes, which may sometimes be associated with maternal glycemic control. […] The results showed GWG, FPG, AFI, and EFW were the influencing factors for the occurrence of macrosomia. Every 1 kg of weight gain during pregnancy increases the risk of macrosomia by 1.221 times (95%CI:1.0451.425). An increase in FPG of 0.1mmol/L increases macrosomia risk by 1.391 times (95%CI:1.122~1.724). […] In conclusion, this study indicated that abnormally elevated FPG is an independent risk factor for macrosomia in pregnant women with GDM. In addition, when macrosomia is possible but cannot be diagnosed, a combination of maternal GWG, FPG, FWG, and AFI can predict macrosomia in gestational diabetes mellitus, which might be a new target for early intervention to prevent macrosomia.

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