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The macrosomic fetus: a challenge in current obstetrics

Acta obstetricia et gynecologica Scandinavica, 2008-01, Vol.87 (2), p.134-145 [Peer Reviewed Journal]

2008 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted 2008 ;Acta Obstet Gynecol Scand 2008 ;2008 INIST-CNRS ;ISSN: 0001-6349 ;EISSN: 1600-0412 ;DOI: 10.1080/00016340801899289 ;PMID: 18231880 ;CODEN: AOGSAE

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Title:
The macrosomic fetus: a challenge in current obstetrics
Author: Henriksen, Tore
Subjects: Biological and medical sciences ; Body Composition ; Body Mass Index ; caesarean delivery ; Delivery, Obstetric ; Delivery. Postpartum. Lactation ; diabetes ; Diabetes Mellitus, Type 2 - complications ; Diabetes, Gestational ; Diabetes. Impaired glucose tolerance ; Diseases of mother, fetus and pregnancy ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Fetal Macrosomia - diagnostic imaging ; Fetal Macrosomia - etiology ; Fetal Macrosomia - prevention & control ; Gynecology. Andrology. Obstetrics ; Humans ; Macrosomia ; Medical sciences ; Metabolic Syndrome - complications ; Motor Activity ; Obstetric Labor Complications - etiology ; Obstetric Labor Complications - prevention & control ; Overweight - complications ; Preconception Care ; Pregnancy ; pregnancy outcome ; Pregnancy. Fetus. Placenta ; Prenatal Care ; Ultrasonography
Is Part Of: Acta obstetricia et gynecologica Scandinavica, 2008-01, Vol.87 (2), p.134-145
Description: Background. There has been a rise in the prevalence of large newborns over a few decades in many parts of the world. There is ample evidence that fetal macrosomia is associated with increased risk of complications both for the mother and the newborn. In current obstetrics, the macrosomic fetus represents a frequent clinical challenge. Evidence is emerging that being born macrosomic is also associated with future health risks. Objective. To provide a review of causes and risks, prevention, prediction and clinical management of suspected large fetus/fetal macrosomia, primarily aimed at clinical obstetricians. Methods. Medline and EMBASE were searched between 1980 and 2007 by combining either 'fetal macrosomia' or 'large for gestational age' with other relevant terms. The Cochrane Database of Systematic Reviews was searched for the term 'fetal macrosomia'. Results and conclusions. Although the causes of high birthweight include both genetic and environmental factors, the rapid increase in the prevalence of large newborns has environmental causes. The evidence is extensive that maternal overweight and associated metabolic changes, including type 2 and gestational diabetes, play a central role. There is a paucity of studies of the effect of intervention before and/or during pregnancy on the risk of having an 'overweight newborn'. It appears rational, however, that preventive measures should primarily be implemented before pregnancy and should include guidance about nutrition and physical activity in order to reduce the prevalence of overweight. In pregnancy, limited weight gain, especially in obese women, seems to reduce the risk of macrosomia, as do good control of plasma glucose among those with diabetes. Prediction of fetal macrosomia remains an inaccurate task even with modern ultrasound equipment. There is little evidence that routine elective delivery (induction or caesarean section) for the mere reason of suspected macrosomia should be employed in a general population. Vaginal delivery of a macrosomic fetus requires considered attention by an experienced obstetrician and preparedness for operative delivery, shoulder dystocia and newborn asphyxia.
Publisher: Oxford, UK: Informa UK Ltd
Language: English
Identifier: ISSN: 0001-6349
EISSN: 1600-0412
DOI: 10.1080/00016340801899289
PMID: 18231880
CODEN: AOGSAE
Source: Journals@Ovid Open Access Journal Collection Rolling
MEDLINE
Alma/SFX Local Collection

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The macrosomic fetus: a challenge in current obstetrics

2008 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted 2008 ;Acta Obstet Gynecol Scand 2008 ;2008 INIST-CNRS ;ISSN: 0001-6349 ;EISSN: 1600-0412 ;DOI: 10.1080/00016340801899289 ;PMID: 18231880 ;CODEN: AOGSAE

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