Macrosomia
Publication Date: January 1, 2020
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
January 1, 2020
Last Updated Month/Year
October 2, 2023
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