LONG TERM FOLLOW UP NEEDED SINCE MANY OF THESE INFANTS TURN DIABETIC OR OBESE.
MEDICAL TREATMENT :
Risks associated with macrosomia can be divided into 3 groups: maternal risks, fetal risks, and neonatal risks.
Maternal risks include risks associated with the passage of a large fetus through the birth canal. Macrosomic fetuses place the mother at increased risk of birth canal (eg, perineal, vaginal, cervical) lacerations. In addition, the risk of cesarean delivery is higher in pregnancies complicated by macrosomia (Spellacy, 1985). Cesarean delivery places the mother at risk for problems associated with major abdominal surgery, which include infections, bleeding, and damage to adjacent organs (eg, bladder, uterus, fallopian tubes, ovaries, intestines, ureter). It also places the mother at risk for complications associated with regional and general anesthesia.
Fetal risks associated with macrosomia include birth trauma (3-7%), including shoulder dystocia (9.2-24%); brachial plexus injuries (1-4%); and death (0.4%) (Mondestin, 2002).
Neonatal risks associated with macrosomia include hypoglycemia (50%), hematological disturbances (ie, polycythemia), and electrolyte disturbances (up to 50%).
A consensus has not been reached regarding management strategies to reduce the risk of macrosomia. 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. Not all cases of nerve injuries can be prevented by cesarean delivery because some occur in utero. Estimates indicate that as many as 3700 cesarean deliveries must be performed to prevent a single permanent nerve injury in macrosomic infants (Rouse, 1996).
Induction of labor for probable macrosomia has not been shown to significantly change outcomes. Some studies have shown increased rates of cesarean delivery when labor induction was attempted because of macrosomia (Combs, 1993).
Diet:
Maternal obesity and maternal weight gain in pregnancy are 2 of the strongest predictors of macrosomia at birth; therefore, a reasonable belief is that appropriate dietary education in pregnancy may help prevent prepregnancy obesity and excessive maternal weight gain in pregnancy. Intuitively, this type of intervention, if successful, may reduce the risks of macrosomia in those women who are obese prior to pregnancy or who may gain excessive weight in pregnancy. However, this has not been tested in clinical trials.
No studies have been performed on maternal dietary intervention and the risk of macrosomia in pregnancy in nondiabetic women. In diabetic patients, maternal diet alone, without the use of insulin, did not alter rates of macrosomia (Buchanan, 1994; Walkinshaw, 2000).
Excessive maternal weight gain can double the risk of macrosomia; thus, a reasonable suggestion is careful weight control for women who exceed the recommended weight gain in pregnancy (Parker, 1992; Cogswell, 1995; Bianco, 1998).
In diabetic patients, diet control and the addition of insulin therapy has been shown to significantly reduce the incidence of birth weight greater than the 90th percentile for gestational age.
Because maternal obesity in pregnancy is associated with fetal macrosomia, gestational diabetes, increased risk of cesarean deliveries, and preeclampsia, appropriate dietary education in pregnancy should be provided to all patients who are at risk of obesity and excessive weight gain in pregnancy. Such intervention poses no harm to the pregnancy and may potentially reduce maternal and neonatal risks. At the present time, clinical trials are lacking support of the effectiveness of such intervention.