Macrosomia & Risk Factors

Macrosomia (????????????) is also known as ‘Large for gestational age’ (LGA) is an indication of high prenatal growth rate. It is often defined as a weight, length, or head circumference that lies above the 90th percentile for that gestational age. However, it has been suggested that the definition be restricted to infants with birth weights greater than the 97th percentile as this more accurately describes infants who are at greatest risk for perinatal morbidity and mortality. It is being a unique problem, Siddha Spirituality of Swami Hardas Life System considers that our readers should be aware of.

Macrosomia Definition (???????????? ???????)

Macrosomia, which literally means “large body”, is sometimes used for ‘Large for gestational age’. Some experts consider a baby to be big when it weighs more than 8 pounds 13 ounces (4,000 g) at birth, and others say a baby is big if it weighs more than 9 pounds 15 ounces (4,500 g). A baby is also called macrosomia or large for gestational age if its weight is greater than the 90th percentile at birth.

Macrosomia Symptoms (???????????? ?? ?????)

Common risks in LGA babies include:

• Shoulder dystocia
• Hypoglycemia
• Metatarsus adductus
• Hip subluxation
• Talipes calcaneovalgus due to intrauterine deformation

Shoulder dystocia can result from the anterior shoulder becoming impacted on the maternal symphysis pubis. The doctor or midwife will try to push the baby’s anterior shoulder downward to pass through the birth canal and clear the woman’s symphysis pubis.

Birth canal (???? ???? ???? ?????)

This can be difficult if the child is macrosomia since the birth canal is 10 cm when fully dilated for most women. If shoulder dystocia occurs, there are various maneuvers which can be performed by the birth attendant to try to deliver the shoulders.

These generally involve trying to turn the shoulders into the oblique, using suprapubic pressure to disimpact the anterior shoulder from above the symphysis pubis, or delivering the posterior arm first.

If the situation does not resolve, the provider may intentionally snap the baby’s clavicle (the bone that holds the shoulder in place) in order to displace the shoulder and allow the child to be delivered.

The bone should heal spontaneously, and most babies will make a full recovery from this birth injury. There is still a risk of temporary or permanent nerve damage to the baby’s arm or other injuries such as a humeral fracture.

Risk (?????)

Although big babies are at higher risk for shoulder dystocia, most cases of shoulder dystocia happen in smaller babies because there are many more small and normal-size babies being born than big babies. Researchers have found that it is impossible to predict who will have shoulder dystocia and who will not.

Induction of labor for women with a baby with suspected macrosomia leads to babies being born at lower birth weight, with fewer bone fractures and less shoulder dystocia, but could increase the number of women with perineal tears.

Prediction (??????????)

Predicting a baby’s weight can be inaccurate. Women could be worried unnecessarily, and request their labor to be induced for no reason. Doctors disagree whether women should be induced for suspected macrosomia and more research is needed to find out what this is best for women and their babies.

Big babies are at higher risk of hypoglycemia in the neonatal period, independent of whether the mother has diabetes.

Macrosomia Risk factors (???????????? ????? ????)

One of the primary risk factors of macrosomia is poorly-controlled diabetes, particularly gestational diabetes (GD), as well as pre-existing diabetes mellitus (DM) (pre-existing DM type 2 is associated more with macrosomia, while pre-existing DM type 1 can be associated with macrosomia).

This increases maternal plasma glucose levels as well as insulin, stimulating fetal growth. The macrosomia newborn exposed to maternal Diabetes Mellitus usually only has an increase in weight. Macrosomia newborns that have complications other than exposure to maternal Diabetes Mellitus present with universal measurements above the 90th percentile.

Genetics (?????????)

Genetics plays a role in having a baby born with macrosomia. Taller, heavier parents tend to have larger babies. Babies born to an obese mother have greatly increased chances of large for gestational age.

Probably, as a consequence of increasing BMI among pregnant women, more children are born macrosomia.

Others (???? ???)

• Gestational age; pregnancies that go beyond 40 weeks increase incidence
• Fetal sex; male infants tend to weigh more than female infants
• Excessive maternal weight gain
• Multiparity (having two to three times the number of LGA infants vs prima paras)
• Congenital anomalies
• Erythroblastosis fetalis – Hydrops fetalis
• Use of some antibiotics during pregnancy 
• Genetic disorders of overgrowth 

If one has excessive amniotic fluid, microsomia is more likely, since there is no room for the baby to grow. Preterm labor is also highly likely for polyhydramnios.

Macrosomia Diagnosis (???????????? ?? ?????)

LGA and macrosomia cannot be diagnosed until after birth, as it is impossible to accurately estimate the size and weight of a child in the womb.

Babies that are large for gestational age throughout the pregnancy may be suspected because of an ultrasound, but fetal weight estimations in pregnancy are quite imprecise.

For non-diabetic women, ultrasounds and care providers are equally inaccurate at predicting whether or not a baby will be big. If an ultrasound or a care provider predicts a big baby, they will be wrong half the time.

Big baby birth ratio (???? ????? ?? ???? ??????)

The big babies are born to only 1 out of 10 women. It is however found that 1 out of 3 American women was told that their babies were too big. In the end, the average birth weight of these suspected “big babies” was only 7 pounds 13 ounces (3,500 g).

In the end, care provider concerns about a suspected big baby were the fourth-most common reason for induction (16% of all inductions), and the fifth-most common reason for a C-section (9% of all C-sections). This treatment is not based on current best evidence.

When a care provider “suspected” a big baby, this tripled the C-section rates and made mothers more likely to experience complications, without improving the health of babies.

Reference: https://en.wikipedia.org/wiki/Large_for_gestational_age