The macrosomic fetus: a challenge in current obstetrics
1Department of Obstetrics and Gynecology, Rikshospitalet, University of Oslo, Oslo, Norway. tore.henriksen@rikshospitalet.no
Acta Obstetricia Et Gynecologica Scandinavica
|January 31, 2008
Summary
Maternal overweight and diabetes are key environmental causes of fetal macrosomia, increasing risks for mother and infant. Prevention through pre-pregnancy lifestyle changes and in-pregnancy glucose control is recommended, though prediction remains challenging.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatology
Background:
- Rising prevalence of large newborns (fetal macrosomia) globally.
- Fetal macrosomia poses increased risks for maternal and neonatal complications.
- Born macrosomic infants face elevated future health risks.
Purpose of the Study:
- Review causes, risks, prevention, prediction, and management of fetal macrosomia.
- Target audience: clinical obstetricians.
- Provide evidence-based guidance for managing suspected large fetuses.
Main Methods:
- Comprehensive literature search of Medline, EMBASE (1980-2007).
- Included terms: 'fetal macrosomia', 'large for gestational age'.
- Searched Cochrane Database of Systematic Reviews for 'fetal macrosomia'.
Main Results:
- Environmental factors, particularly maternal overweight and metabolic changes (diabetes), drive increased macrosomia rates.
- Limited evidence on pre/during pregnancy interventions, but pre-pregnancy nutrition/activity guidance is rational.
- In-pregnancy interventions: controlled weight gain (esp. in obese women) and diabetes glucose management reduce risk.
Conclusions:
- Maternal overweight and diabetes are primary environmental drivers of fetal macrosomia.
- Pre-pregnancy lifestyle modification and in-pregnancy glucose control are key preventive strategies.
- Fetal macrosomia prediction is inaccurate; routine elective delivery is not evidence-based; vaginal delivery requires careful management.
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