Macrosomia

Publication Date: December 31, 2019
Last Updated: March 14, 2022

Recommendations

The prediction of birth weight is imprecise by ultrasonography or clinical measurement. For suspected macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with abdominal palpation.
574
Women without contraindications should be encouraged to engage in aerobic and strength-conditioning exercises during pregnancy to reduce the risk of macrosomia.
574
Control of maternal hyperglycemia reduces the risk of macrosomia. Therefore, maternal glucose management is recommended for pregnancies complicated by diabetes.
574
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.
574

Given the health benefits, particularly for pregnancy outcomes, prepregnancy counseling of morbidly obese patients regarding the benefits and risks of bariatric surgery is recommended.

574
Suspected fetal macrosomia or LGA fetus is not an indication for induction of labor before 39 0/7 weeks of gestation because there is insufficient evidence that benefits of reducing shoulder dystocia risk would outweigh the harms of early delivery.
574
Although the prediction of macrosomia is imprecise, scheduled cesarean birth may be beneficial for newborns with suspected macrosomia who have an estimated fetal weight of at least 5,000 g in women without diabetes and an estimated fetal weight of at least 4,500 g in women with diabetes.
574
Pregnant women with suspected macrosomia should be provided individualized counseling about the risks and benefits of vaginal births and cesarean births based on the degree of suspected macrosomia, accounting for their relevant clinical considerations.
574
It is appropriate for patients, obstetrician–gynecologists, and other obstetric care providers to consider past and predicted birth weights when making decisions regarding labor after cesarean however, suspected macrosomia is not a contraindication to labor after cesarean.
574

The term “macrosomia” implies growth beyond an absolute birth weight, historically 4,000 g or 4,500 g, regardless of the gestational age, although establishing a universally accepted definition for macrosomia is challenging.

574

Recommendation Grading

Overview

Title

Macrosomia

Authoring Organization

American College of Obstetricians and Gynecologists

Publication Month/Year

December 31, 2019

Last Updated Month/Year

April 1, 2024

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Hospital

Intended Users

Physician, nurse nurse midwife, nurse certified nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Prevention, Management

Diseases/Conditions (MeSH)

D005320 - Fetal Macrosomia

Keywords

macrosomia