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Topic: Macrosomia

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	eMedicine - Macrosomia : Article by Allahyar Jazayeri, MD, PhD
		Macrosomia may be associated with birth trauma for the neonate and birth canal lacerations, eg, perineal, vaginal, and cervical (McFarland, 1986), or cesarean delivery for the mother.
		Maternal: Macrosomia is associated with a higher incidence of cesarean delivery (double that of control subjects) and with birth canal lacerations associated with vaginal delivery.
		Cesarean delivery to reduce the risk associated with macrosomia places the mother at risk, and subsequent pregnancies are at risk of uterine dehiscence before or during the onset of labor.
	www.emedicine.com /med/topic3279.htm (4461 words)

	MedlinePlus Medical Encyclopedia: Macrosomia
		Macrosomia is a term used to describe an oversized fetus.
		The most common cause of macrosomia is maternal diabetes.
		Macrosomia can lead to trauma during birth and a greater chance of a cesarean delivery.
	www.nlm.nih.gov /medlineplus/ency/article/002251.htm (174 words)

	Can Shoulder Dystocia Be Prevented?
		Maternal diabetes – it was difficult to eliminate DM as a confounder of macrosomia in estimating the risk of SD.
		Avoiding macrosomia – since macrosomia cannot be diagnosed accurately by clinical or sonographic means, there is no accurate way to predict the assumingly preventable cases of SD, and therefore studies failed to prove the benefit of labor induction for suspected macrosomia.
		The use of liberal CS for suspected macrosomia is a matter of dispute since maternal risks of CS are concomitantly increased.
	www.obgyn.net /firstcontroversies/prague1999blickstein.htm (1090 words)

	macrosomia (Site not responding. Last check: )
		Macrosomia as it is used in pediatrics refers to the fetus and newborn.
		Most infants with macrosomia are infants of diabetic mothers, although of course some are just plain genetically big babies.
		Macrosomia is often given as the reason for caesarian section delivery.
	www.drhull.com /EncyMaster/M/macrosomia.html (81 words)

	Volume 100, Number 5, Part 1, November 2002
		Fetal macrosomia, defined as an estimated weight of at least 4000 g or a weight for gestational age greater than the 90th percentile, is associated with increased maternal and perinatal morbidity.
		Macrosomia was generally defined as birth weight of at least 4000 g or above the 90th percentile for gestational age.
		Macrosomia was defined as an estimated fetal weight of at least 4000 g in six studies, 4000 g or 90th percentile in three studies, at least 4500 g in one study, and at least 3600 g or 90th percentile in a single study.
	www.acog.org /from_home/publications/green_journal/2002/ong13782fla.htm (2490 words)

	Can Macrosomia Be Prevented
		Macrosomia is permanent and has been associated with an increased risk of birth trauma and cesarean delivery rate.
		Macrosomia rates declined gradually from 17.9% to 8.8% and 4.5% in 1985-1992, 1992-1995 and 1998, respectively.
		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.
	www.comtecmed.com /cogi/cogibook1999/Can_Macrosomia_Be_Prevented.html (1013 words)

	Detecting and managing fetal macrosomia - Modern Medicine
		Fetal macrosomia affects between 3% and 15% of all pregnancies, depending upon the racial and socioeconomic composition of the population under study.
		Only a handful of studies have directly compared the different methods for predicting fetal macrosomia by using the same patient population; thus, comparisons of overall measures of accuracy may be somewhat misleading due to the varying racial compositions and underlying prevalences of macrosomia in the different populations studied by different authors.
		Once evolving fetal macrosomia is suspected, the best strategy is to ensure that the patient's glucose tolerance is normal, minimize additional pregnancy weight gain, and deliver the fetus as early as possible once fetal maturity is assured.
	www.contemporaryobgyn.net /obgyn/article/articleDetail.jsp?id=139048 (5302 words)

	Can shoulder dystocia be anticipated accurately?
		One of the most important factors about macrosomia is the differential rate of growth of the fetal head, chest, and trunk as gestation proceeds, both in the babies of diabetic and of nondiabetic mothers.
		Levine in 1992 showed that if macrosomia was defined as the 90th percentile of fetal weight for a given gestational age, then sonographic prediction of macrosomic was wrong 50% of the time both in underestimating and overestimating fetal weight.
		The bottom line is that macrosomia is as difficult to predict in diabetic mothers as it is in the nondiabetic population.
	www.shoulderdystociainfo.com /anticipated.htm (6684 words)

	Factors associated with Macrosomia - Pregnancy and Nutrition - Brief Article Nutrition Research Newsletter - Find ...
		Macrosomia, elevated birth weight or more specifically birth weight for a full-term infant greater than the 90th percentile for gestational age or higher than 4000 gram, is the most common of these complications and can cause delivery complications for neonates, including shoulder dystocia, clavicle fractures, and brachial plexus injury.
		Macrosomia was significantly associated with a history of gestational diabetes and an elevated BMI, but not with any other factors.
		Macrosomia in neonates of mothers with gestational diabetes is associated with body mass index and previous gestational diabetes.
	www.findarticles.com /p/articles/mi_m0887/is_3_21/ai_84209266 (653 words)

	Bioline International Official Site (site up-dated regularly)
		The principal risk of fetal macrosomia is trauma, both to the mother and fetus, during vaginal delivery.
		Macrosomia is generally defined as birth weight of at least 4000g.
		Post term pregnancy is a risk factor for macrosomia and is associated with maternal and perinatal morbidity and mortality.
	www.bioline.org.br /request?am05018 (2162 words)

	ACOG Issues Guidelines on Fetal Macrosomia - American College of Obstetrics and Gynecologists American Family Physician ...
		The term fetal macrosomia implies fetal growth beyond a specific weight, usually 4,000 g (8 lb, 13 oz) or 4,500 g (9 lb, 4 oz), regardless of the fetal gestational age.
		Weighing the newborn after delivery is the only way to accurately diagnose macrosomia, because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise.
		Excessive weight gain during pregnancy is associated with fetal macrosomia, and results from large cohort studies confirm this.
	www.findarticles.com /p/articles/mi_m3225/is_1_64/ai_76414064 (850 words)

	NEJM -- Transplacental passage of insulin in pregnant women with insulin-dependent diabetes mellitus. Its role in fetal ...
		We examined the hypothesis that it may be caused by insulin transferred as an insulin-antibody complex from the mother to her fetus.
		Considerable amounts of antibody-bound insulin are transferred from mother to fetus during pregnancy in some women with insulin-dependent diabetes mellitus; the extent of transfer correlates with the maternal concentration of anti-insulin antibody.
		The correlation between macrosomia and the concentrations of animal insulin in cord serum indicates that the transferred insulin has biologic activity and suggests that the formation of antibody to insulin in the mother is a determinant of fetal outcome independent of maternal blood glucose levels.
	content.nejm.org /cgi/content/abstract/323/5/309 (660 words)

	The Association Between Glucose Challenge Test, Obesity and Pregnancy Outcome in 6390 Non-Diabetic Women - Health - ... (Site not responding. Last check: )
		An increase in the rate of macrosomia, LGA and cesarean section was identified in both obese and non-obese women in relation to increased GCT severity categories (by 10 mg/dl increments) (Table III).
		Macrosomia occurred more often in infants of obese mothers and significantly more often in those who were obese and had abnormal GCT results.
		For obese subjects, a significant increase in the rate of macrosomia was identified from the GCT category of 130-140 mg/dl, for LGA in the GCT category of 120-130 mg/dl and for cesarean section above the GCT category of 110-120 mg/dl (Table III).
	www.redorbit.com /news/display?id=146013&source=r_health (2600 words)

	Screening for Gestational Diabetes Mellitus: Recommendations and Rationale
		Macrosomia is associated with an increased risk for neonatal adverse effects, such as brachial plexus injuries (most of which are temporary) and clavicular fracture.
		A retrospective analysis that found similar rates of macrosomia in screened and unscreened populations cannot rule out an effect of screening, because screened women may have been at higher risk for GDM than unscreened women, and the study may not have been large enough to detect a benefit.
		Modeling done for the USPSTF, which assumed that treatment with insulin would reduce the risk of having an infant with macrosomia in mothers with GDM by 75 percent, calculated that nearly 7,000 women at high risk, and 9,000 women at average risk, would need to be screened to prevent 1 case of brachial plexus injury.
	www.ahrq.gov /clinic/3rduspstf/gdm/gdmrr.htm (3039 words)

	Fetal Macrosomia - New Treatments, January 2, 2007 (Site not responding. Last check: )
		Excessive birth weight is associated with an increased risk of maternal and neonatal injury.
		Macrosomia refers to a fetus with an estimated weight of more than 4,500 grams, regardless of gestational age.
		Diagnosis of macrosomia requires ultrasound evaluation; however, estimation of fetal weight based on ultrasound is associated with a large margin of error.
	www.ccspublishing.com /journals2a/macrosomia.htm (247 words)

	EFFECT OF GESTATIONAL DIABETES AND MAERNAL HYPERTENSION ON GROSS MORPHOLOGY OF PLACENTA
		However, macrosomia continuous to be a problem in higher than average proportions of such cases.
		Macrosomia also involves placenta within the chronic hypertensive disease, the most common diagnosis is essential vascular hypertension.
		Due to macrosomia affecting the fetal part of placenta, the weight, diameter and central thickness of placentae in diabetic mothers increases as compared to normal placenta.
	www.ayubmed.edu.pk /JAMC/PAST/17-1/Ashfaq.htm (1885 words)

	Relation of enteroinsular hormones at birth to macrosomia and neonatal hypoglycemia in infants of diabetic mothers.
		Relation of enteroinsular hormones at birth to macrosomia and neonatal hypoglycemia in infants of diabetic mothers.
		Moreover, the observed discrepancy in the relative increase of free IRI and C-peptide, combined with the low molar ratio of C-peptide to IRI, suggests a decreased metabolic clearance of insulin or transplacental passage of insulin from the maternal circulation in infants of mothers with insulin-treated diabetes.
		To study the role of enteroinsular hormones in fetal macrosomia and neonatal hypoglycemia in infants of diabetic mothers, we measured plasma concentrations of free and total immunoreactive insulin, C-peptide, pancreatic glucagon, enteroglucagon, and gastric inhibitory polypeptide at birth in 35 IDMs and 35 infants of normal mothers.
	www.ihop-net.org /UniPub/iHOP/gp/4461963.html (346 words)

	The Journal of Family Practice
		The definition of macrosomia is fetal weight of 4000 to 4500 g or greater, regardless of gestational age.
		The purpose of induction for fetal macrosomia would be to prevent maternal and neonatal morbidities.
		Mention macrosomia, and knuckles whiten; the dread of shoulder dystocia is palpable.
	www.jfponline.com /Pages.asp?AID=2325 (755 words)

	Induction of labour for suspected fetal macrosomia
		The objective of this review was to assess the effects of a policy of labour induction for suspected fetal macrosomia on method of delivery and maternal or perinatal morbidity.
		Compared to expectant management, induction of labour for suspected macrosomia has not been shown to reduce the risk of caesarean section (relative risk (RR) 0.88, 95% confidence interval (CI) 0.59 to 1.34) or instrumental delivery (RR 0.98, 95% CI 0.53 to 1.82).
		Induction of labour for suspected fetal macrosomia in non-diabetic women has not been shown to alter the risk of maternal or neonatal morbidity, but the power of the included studies to show a difference in rare events is limited.
	www.cochrane.org /reviews/en/ab000938.html (397 words)

	Fetal Macrosomia and the Oral Glucose Tolerance Test
		We used receiver operating characteristics (ROC) curve analysis to correlate macrosomia (more than or equal to 4000g) with varying thresholds for the 2 hour 75 gm oral glucose tolerance test (OGTT) results in pregnant women screened at our hospital from 1998-2001.
		Defining macrosomia as 4500 grammes resulted in no significant change in sensitivity or specificity.
		The macrosomia rate in patients with a 2 hour value >7.8mmol per litre (25%) is comparable to 20-30% found by others.
	www.endocrine-abstracts.org /ea/0004/ea0004dp8.htm (329 words)

	Ch02abs
		Prevalence rates of macrosomia among infants born to women with GDM have been reported from 12% to 35%.
		Macrosomia is clearly associated with increased maternal and neonatal death rates, primary cesarean section for cephalopelvic disproportion and non-progression of labour, brachial plexus paralysis and clavicular fractures.
		The first, conducted in the late 1950s, found a reduced incidence of macrosomia in infants of women with GDM treated with insulin and diet compared to those receiving routine prenatal care (3.7% vs 13.1%).
	www.ctfphc.org /Abstracts/Ch02abs.htm (1073 words)

	Macrosomia - Health EncyclopediaNews Story - KNBC \| Los Angeles
		Macrosomia - Health EncyclopediaNews Story - KNBC
		The most common cause of macrosomia is maternal diabetes.
		Macrosomia can lead to trauma during birth and a greater chance of a cesarean delivery.
	www.nbc4.tv /encyclopedia/6862983/detail.html (321 words)

	GD: Treatment Protocols Research Citations
		Macrosomia is usually used as the excuse for higher c-section rates in gd moms, but even when macrosomia rates are reduced through treatment, most (not all) studies have found a higher c/s rate anyhow, raising the question of the benefits vs. risks of treatment.
		However, the purpose for reducing macrosomia was defeated; the c/s rate was INCREASED in the home monitoring group, despite the strong decrease in birthweight (32% c/s in home monitored group vs. 25% in weekly testing group).
		Macrosomia declined (period 1=18%, 2=15%, 3=9%), and LGA fetuses declined (1=24%, 2=21%, 3=12%).
	www.plus-size-pregnancy.org /gd/gd_treatmentresearch.htm (14969 words)

	High Rates of Infant Macrosomia: A Comparison of a Canadian Native and a Non-Native Population -- Rodrigues et al. 130 ...
		High Rates of Infant Macrosomia: A Comparison of a Canadian Native and a Non-Native Population -- Rodrigues et al.
		The prevalence of macrosomia among the Cree was 34.3% vs. 11.1%
		and GDM as a determinant of macrosomia in well-controlled analyses.
	jn.nutrition.org /cgi/content/full/130/4/806 (4873 words)

	Mutation in gene HNF4A linked to increeased birthweight and macrosomia
		Macrosomia (birthweight more than 4000g) is associated with complications for both mothers and babies; one cause of macrosomia is diabetes in the mother.
		The particular type of diabetes investigated in this study is known as maturity-onset diabetes of the young (MODY) genes; two of the genes known to be involved in this disease are HNF4A and HNF1A/TCF1 both of which have a key role in the regulation of the secretion of insulin by the pancreas.
		However, the mechanism by which the same mutation also causes diabetes (ie with decreased insulin) in later life remains to be determined in view of the increased insulin shown to be present at birth that causes the low glucose.
	www.news-medical.net /?id=23112 (461 words)

	Article by Henci Goer on the Uselessness of Standard Management of Gestational Diabetes - FROM RONNIE Falcão's ...
		The main rationale for current GD management is to reduce the incidence of birth injuries and cesarean section by reducing the incidence of macrosomia.
		No differences in perinatal mortality, morbidity, LGA or macrosomia rates were found between screened and unscreened populations, but women in the screened population were more likely to have primary cesarean sections (19 percent versus 12 percent), more clinic visits, more fetal surveillance tests, and more prenatal hospitalization (Santini et al.
		After showing that current cutoffs fail to discriminate a group of women at high risk for macrosomia, obstetricians conclude in defiance of logic that they should lower the values or that insulin should be given to more women or that cutoffs should be chosen by fiat (Sacks et al.
	www.gentlebirth.org /archives/gdhgoer.html (2893 words)

	Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of ...
		Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia.
		The purpose of this case-control study was to determine the relative importance of various predictors of newborn macrosomia, with particular reference to maternal constitutional factors and glucose intolerance of pregnancy.
		Macrosomia was defined by both absolute birthweight > or = 4,000 g and birthweight > or = 90th centile for gestational age.
	www.medscape.com /medline/abstract/9360188?src=emed_ckb_ref_0 (246 words)

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