Birth - Macrosomia

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Introduction

Historic model of birth

Large gestational age (LGA) or macrosomia is a term used to describe a newborn with an excessive birth weight due to a range of known and unknown causes. There are many different definitions that have been used for to this term, generally a birth weight of 4000 to 4500 g (8 lb 13 oz to 9 lb 15 oz) or greater than 90% for gestational age after correcting for neonatal sex and ethnicity.


A recent study of USA data[1] suggests adverse perinatal outcomes of birthweight exceeded the 97th percentile. Their definition was a "birthweight greater than 4500 g in Whites, or 4300 g in Blacks and Hispanics regardless of gestational age is the optimal threshold to define macrosomia. A birthweight greater than the 97th percentile for a given gestational age, irrespective of race is also reasonable to define macrosomia."

  1. Duration of gestation - growth past the due date.
  2. maternal diabetes - presence of gestational diabetes; and class A, B, and C diabetes mellitus.
  3. Genetic Syndromes and Tumours - a range of overgrowth syndromes associated with developmental delay, tumors, and other anomalies with genetic causes and syndromes (Pallister-Killian, Beckwith-Wiedemann, Sotos, Perlman, and Simpson-Golabi-Behmel) rarely diagnosed prenatally.


Currently there is clinical research looking into the best mathematical formula, based upon ultrasound measurements, to estimate the possibility of macrosomia occurring.


Birth Links: birth | Lecture - Birth | caesarean | preterm birth | birth weight | macrosomia | Birth Statistics | Australian Birth Data | Developmental Origins of Health and Disease (DOHAD) | Neonatal Diagnosis | Apgar test | Guthrie test | neonatal | stillbirth and perinatal death | ICD-10 Perinatal Period | Category:Birth
Historic Birth links  
1921 USA Birth Mortality

Some Recent Findings

  • Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight[2] "Medical nutrition therapy is a mainstay of gestational diabetes mellitus (GDM) treatment. However, data are limited regarding the optimal diet for achieving euglycemia and improved perinatal outcomes. This study aims to investigate whether modified dietary interventions are associated with improved glycemia and/or improved birth weight outcomes in women with GDM when compared with control dietary interventions. RESEARCH DESIGN AND METHODS: Data from published randomized controlled trials that reported on dietary components, maternal glycemia, and birth weight were gathered from 12 databases. Data were extracted in duplicate using prespecified forms. CONCLUSIONS: Modified dietary interventions favorably influenced outcomes related to maternal glycemia and birth weight. This indicates that there is room for improvement in usual dietary advice for women with GDM."
  • Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population[3] "To investigate the association between the mode of birth and adverse neonatal outcomes of macrosomia (birth weight ≥4000 g) and non-macrosomic (birth weight <4000 g) live-born term singletons in vertex presentation (TSV) born to mothers with diabetes (pre-existing and gestational diabetes mellitus (GDM)). ...Pregnant women with diabetes, particularly those with suspected fetal macrosomia, need to be aware of the increased likelihood of adverse neonatal outcomes following instrumental vaginal birth and intrapartum CS when planning mode of birth." maternal diabetes
  • Searching for the Definition of Macrosomia through an Outcome-Based Approach[1] "Macrosomia has been defined in various ways by obstetricians and researchers. The purpose of the present study was to search for a definition of macrosomia through an outcome-based approach. In a study of 30,831,694 singleton term live births and 38,053 stillbirths in the U.S. Linked Birth-Infant Death Cohort datasets (1995-2004), we compared the occurrence of stillbirth, neonatal death, and 5-min Apgar score less than four in subgroups of birthweight (4000-4099 g, 4100-4199 g, 4200-4299 g, 4300-4399 g, 4400-4499 g, 4500-4999 g vs. reference group 3500-4000 g) and birthweight percentile for gestational age (90th-94th percentile, 95th-96th, and ≥97th percentile, vs. reference group 75th-90th percentile). There was no significant increase in adverse perinatal outcomes until birthweight exceeded the 97th percentile. A birthweight greater than 4500 g in Whites, or 4300 g in Blacks and Hispanics regardless of gestational age is the optimal threshold to define macrosomia. A birthweight greater than the 97th percentile for a given gestational age, irrespective of race is also reasonable to define macrosomia. The former may be more clinically useful and simpler to apply."
More recent papers  
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This table shows an automated computer PubMed search using the listed sub-heading term.

  • Therefore the list of references do not reflect any editorial selection of material based on content or relevance.
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References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability.

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Search term: Macrosomia

Junwei Zhang, Mingze Du, Zhe Li, Lulu Wang, Jijun Hu, Bei Zhao, Yingying Feng, Xiaolin Chen, Lijun Sun Fresh versus frozen embryo transfer for full-term singleton birth: a retrospective cohort study. J Ovarian Res: 2018, 11(1);59 PubMed 30012201

Amy R Goetz, Constance A Mara, Lori J Stark Greater Breastfeeding in Early Infancy Is Associated with Slower Weight Gain among High Birth Weight Infants. J. Pediatr.: 2018; PubMed 30007772

Timothy O Ihongbe, Jordyn T Wallenborn, Sylvia Rozario, Saba W Masho Short interpregnancy interval and adverse birth outcomes in women of advanced age: a population-based study. Ann Epidemiol: 2018; PubMed 30006251

Necati Hancerliogullari, Hatice Kansu Celik, Burcu Kisa Karakaya, Aytekin Tokmak, Yasemin Tasci, Salim Erkaya, Yaprak Engin-Ustun, A Seval Ozgu-Erdinc Effect of Prolonged Fasting Duration on 50 Gram Oral Glucose Challenge Test in the Diagnosis of Gestational Diabetes Mellitus. Horm. Metab. Res.: 2018; PubMed 30001567

Andrew J Spiro, Katherine N Vu, Alicia Lynn Warnock An Atypical HNF4A Mutation Which Does Not Conform to the Classic Presentation of HNF4A-MODY. Case Rep Endocrinol: 2018, 2018;1560472 PubMed 29998026

Older papers  
  • Maternal serum adiponectin at 11 to 13 weeks of gestation in the prediction of macrosomia[4] "Maternal serum adiponectin concentration was measured in a case-control study of singleton pregnancies at 11 to 13 weeks' gestation, which included 50 cases that subsequently delivered macrosomic neonates with birth weight above the 95th percentile for gestation at delivery and 300 controls who delivered appropriate for gestational age neonates. In the macrosomic group the median serum adiponectin [0.82, interquartile range (IQR): 0.56-1.02 MoM] was significantly lower than in the non-macrosomic controls (1.02, IQR: 0.70-1.29 MoM; p = 0.001). The estimated detection rate of macrosomia, at fixed false positive rate of 10%, from maternal characteristics and obstetric history was 34.6% and this increased to 38.2% with the addition of serum adiponectin. Maternal serum adiponectin at 11 to 13 weeks is a useful biomarker for early prediction of macrosomia."
  • Birth-weight prediction by two- and three-dimensional ultrasound imaging[5] "To compare the accuracies of birth-weight predicting models derived from two-dimensional (2D) ultrasound parameters and from total fetal thigh volumes measured by three-dimensional (3D) ultrasound imaging; and to compare the performances of these formulae with those of previously published equations. ...We believe that the greatest sources of discrepancy in estimation of birth weight are the phenotypic differences among patients used to create each of the formulae mentioned in this study. Our data reinforce the need for customized birth-weight prediction formulae, regardless of whether 2D or 3D measurements are employed."
  • Genetic considerations in the prenatal diagnosis of overgrowth syndromes[6] "Large (>90%) for gestational age (LGA) fetuses are usually identified incidentally. Detection of the LGA fetus should first prompt the provider to rule out incorrect dates and maternal diabetes. Once this is done, consideration should be given to certain overgrowth syndromes, especially if anomalies are present. The overgrowth syndromes have significant clinical and molecular overlap, and are associated with developmental delay, tumors, and other anomalies. Although genetic causes of overgrowth are considered postnatally, they are infrequently diagnosed prenatally. Here, we review prenatal sonographic findings in fetal overgrowth syndromes, including Pallister-Killian, Beckwith-Wiedemann, Sotos, Perlman, and Simpson-Golabi-Behmel. We also discuss prenatal diagnosis options and recurrence risks."

Birth Weight Classification

Human Birth Weight Classifications
no colour
Birth weight (grams) less 500 500 – 999 1,000 – 1,499 1,500 – 1,999 2,000 – 2,499 2,500 – 2,999 3,000 – 3,499 3,500 – 3,999 4,000 – 4,499 4,500 – 4,999 5,000 or more
Classification
Extremely Low Birth Weight
Very Low Birth Weight
Low Birth Weight
Normal Birth Weight
High Birth Weight


Korea

Birth statistics of high birth weight infants (macrosomia) in Korea.[7]

We used 2 data sources, namely, the hospital units (1960's to 1990's) and Statistics Korea (1993 to 2010). The analyses include the incidence of high birth weight infants (HBWIs), birth weight distribution, sex ratio, and the relationship of HBWI to maternal age. The incidence of HBWIs for the past 50 years has been dropping in Korea. The older the mother, the higher was the risk of a HBWI and LBWI. We hope that these findings would be utilized as basic data that will aid those managing HBWIs.

Abnormalities

Beckwith-Wiedemann syndrome

Beckwith-Wiedemann syndrome (BWS) is an overgrowth disorder caused by either a mutation or deletion of imprinted genes within the chromosome 11p15.5 region. Infants show exomphalos, macroglossia, and gigantism and also have a predisposition to tumour development. Originally described by Beckwith and separately by Wiedemann in 1969.[8]

Links: OMIM 130650 | Search PubMed

Pallister-Killian syndrome

Links: OMIM 601803

Perlman syndrome

Perlman congenital overgrowth syndrome is an autosomal recessive syndrome similar to Beckwith-Wiedemann syndrome (BWS; OMIM 130650). Children are large at birth, hypotonic, show organomegaly, and have a high neonatal mortality.

  • Facial abnormalities - inverted V-shaped upper lip, prominent forehead, deep-set eyes, broad and flat nasal bridge, and low-set ears.
  • renal abnormalities - nephromegaly and hydronephrosis.
  • neural abnormalities - neurodevelopmental delay.


Loss of function of DIS3 Like 3'-5' Exoribonuclease 2 (DIS3L2 exoribonuclease) generates a mouse model of this syndrome, following up-regulation of Insulin-like growth factor 2 (Igf2).[9] IGF2 has also been shown in other studies through microRNA miR-483-3p to contribute to macrosomia by regulating trophoblast proliferation.[10]


Links: OMIM 267000 | GHR DIS3L2 | Search PubMed

References

  1. 1.0 1.1 Ye J, Zhang L, Chen Y, Fang F, Luo Z & Zhang J. (2014). Searching for the definition of macrosomia through an outcome-based approach. PLoS ONE , 9, e100192. PMID: 24941024 DOI.
  2. Yamamoto JM, Kellett JE, Balsells M, García-Patterson A, Hadar E, Solà I, Gich I, van der Beek EM, Castañeda-Gutiérrez E, Heinonen S, Hod M, Laitinen K, Olsen SF, Poston L, Rueda R, Rust P, van Lieshout L, Schelkle B, Murphy HR & Corcoy R. (2018). Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight. Diabetes Care , 41, 1346-1361. PMID: 29934478 DOI.
  3. Zeki R, Wang AY, Lui K, Li Z, Oats JJN, Homer CSE & Sullivan EA. (2018). Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study. BMJ Paediatr Open , 2, e000224. PMID: 29637191 DOI.
  4. Nanda S, Akolekar R, Sarquis R, Mosconi AP & Nicolaides KH. (2011). Maternal serum adiponectin at 11 to 13 weeks of gestation in the prediction of macrosomia. Prenat. Diagn. , 31, 479-83. PMID: 21394735 DOI.
  5. Bennini JR, Marussi EF, Barini R, Faro C & Peralta CF. (2010). Birth-weight prediction by two- and three-dimensional ultrasound imaging. Ultrasound Obstet Gynecol , 35, 426-33. PMID: 20069666 DOI.
  6. Vora N & Bianchi DW. (2009). Genetic considerations in the prenatal diagnosis of overgrowth syndromes. Prenat. Diagn. , 29, 923-9. PMID: 19609940 DOI.
  7. Kang BH, Moon JY, Chung SH, Choi YS, Lee KS, Chang JY & Bae CW. (2012). Birth statistics of high birth weight infants (macrosomia) in Korea. Korean J Pediatr , 55, 280-5. PMID: 22977440 DOI.
  8. WIEDEMANN HR. (1964). [FAMILIAL MALFORMATION COMPLEX WITH UMBILICAL HERNIA AND MACROGLOSSIA--A "NEW SYNDROME"?]. J Genet Hum , 13, 223-32. PMID: 14231762
  9. Hunter RW, Liu Y, Manjunath H, Acharya A, Jones BT, Zhang H, Chen B, Ramalingam H, Hammer RE, Xie Y, Richardson JA, Rakheja D, Carroll TJ & Mendell JT. (2018). Loss of Dis3l2 partially phenocopies Perlman syndrome in mice and results in up-regulation of Igf2 in nephron progenitor cells. Genes Dev. , , . PMID: 29950491 DOI.
  10. Li J, Fu Z, Jiang H, Chen L, Wu X, Ding H, Xia Y, Wang X, Tang Q & Wu W. (2018). IGF2-derived miR-483-3p contributes to macrosomia through regulating trophoblast proliferation by targeting RB1CC1. Mol. Hum. Reprod. , , . PMID: 29939354 DOI.

Reviews

Walsh JM & McAuliffe FM. (2012). Prediction and prevention of the macrosomic fetus. Eur. J. Obstet. Gynecol. Reprod. Biol. , 162, 125-30. PMID: 22459652 DOI.

Articles

De Reu PA, Smits LJ, Oosterbaan HP & Nijhuis JG. (2008). Value of a single early third trimester fetal biometry for the prediction of birth weight deviations in a low risk population. J Perinat Med , 36, 324-9. PMID: 18598122 DOI.

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Search Pubmed: Macrosomia | high birth weight

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Cite this page: Hill, M.A. (2018, July 18) Embryology Birth - Macrosomia. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Birth_-_Macrosomia

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