Podcast
Questions and Answers
What is identified as the most significant factor in the pathogenesis of fetal macrosomia?
What is identified as the most significant factor in the pathogenesis of fetal macrosomia?
- Maternal nutrition
- Fetal genetic factors
- Maternal hyperglycemia (correct)
- Maternal exercise levels
Which hormones are associated with the increase in maternal insulin resistance during the second trimester?
Which hormones are associated with the increase in maternal insulin resistance during the second trimester?
- Cortisone, HPL, and prolactin (correct)
- Oxytocin and relaxin
- Testosterone and DHEA
- Estrogen and progesterone
What relationship was shown by the Hyperglycemia and Adverse Pregnancy Outcomes study?
What relationship was shown by the Hyperglycemia and Adverse Pregnancy Outcomes study?
- A linear relationship exists between maternal glucose and LGA fetuses. (correct)
- Maternal glucose has no impact on fetal adiposity.
- Higher maternal glucose correlates with smaller for gestational age fetuses.
- Maternal glucose concentrations are inversely related to fetal growth.
What is the association of fasting blood glucose levels with macrosomia in women without diabetes?
What is the association of fasting blood glucose levels with macrosomia in women without diabetes?
What risk increase is seen for macrosomia in women diagnosed with gestational diabetes mellitus (GDM)?
What risk increase is seen for macrosomia in women diagnosed with gestational diabetes mellitus (GDM)?
What percentage of women with GDM A1 had LGA newborns in the study mentioned?
What percentage of women with GDM A1 had LGA newborns in the study mentioned?
What physiological response counteracts maternal insulin resistance during pregnancy?
What physiological response counteracts maternal insulin resistance during pregnancy?
Which group of women had the highest percentage of LGA newborns according to the research findings?
Which group of women had the highest percentage of LGA newborns according to the research findings?
What is the mechanism through which glucose transfer occurs from mother to fetus?
What is the mechanism through which glucose transfer occurs from mother to fetus?
How does maternal hyperglycemia affect the fetal pancreas?
How does maternal hyperglycemia affect the fetal pancreas?
What weight gain is recommended for a pregnant patient with a BMI of 26?
What weight gain is recommended for a pregnant patient with a BMI of 26?
Which of the following is NOT a recommended laboratory evaluation for maternal health during pregnancy?
Which of the following is NOT a recommended laboratory evaluation for maternal health during pregnancy?
Which statement accurately reflects a risk factor for macrosomic fetuses?
Which statement accurately reflects a risk factor for macrosomic fetuses?
Which method is insufficient for diagnosing macrosomia on its own, according to ACOG guidelines?
Which method is insufficient for diagnosing macrosomia on its own, according to ACOG guidelines?
What electrolyte levels should be monitored immediately after the delivery of neonates born to diabetic mothers?
What electrolyte levels should be monitored immediately after the delivery of neonates born to diabetic mothers?
Which maternal condition requires screening during the evaluation process?
Which maternal condition requires screening during the evaluation process?
Which complication is NOT commonly associated with macrosomic infants?
Which complication is NOT commonly associated with macrosomic infants?
What is the first step in understanding a patient’s obstetric history?
What is the first step in understanding a patient’s obstetric history?
What medical condition is related to polyhydramnios in pregnant patients?
What medical condition is related to polyhydramnios in pregnant patients?
Which physical examination practice is crucial for monitoring pregnant patients?
Which physical examination practice is crucial for monitoring pregnant patients?
What is a significant maternal risk factor for fetal macrosomia among the following?
What is a significant maternal risk factor for fetal macrosomia among the following?
Which term is generally associated with a birth weight that is at or above the 90th percentile for a given gestational age?
Which term is generally associated with a birth weight that is at or above the 90th percentile for a given gestational age?
A prolonged gestation period greater than 42 weeks is associated with which outcome in pregnancy?
A prolonged gestation period greater than 42 weeks is associated with which outcome in pregnancy?
Which genetic disorder has NOT been associated with macrosomia or large for gestational age fetuses?
Which genetic disorder has NOT been associated with macrosomia or large for gestational age fetuses?
Which factor contributes to fetal macrosomia through maternal obesity?
Which factor contributes to fetal macrosomia through maternal obesity?
What is the historical definition weight of macrosomia regardless of gestational age?
What is the historical definition weight of macrosomia regardless of gestational age?
In terms of fetal gender, what significant difference is noted in relation to macrosomia?
In terms of fetal gender, what significant difference is noted in relation to macrosomia?
What percentage of infants exhibited a birth weight greater than 4000 grams in 2017?
What percentage of infants exhibited a birth weight greater than 4000 grams in 2017?
What is a lesser-known maternal risk factor contributing to macrosomia?
What is a lesser-known maternal risk factor contributing to macrosomia?
Which of the following does NOT affect the risk of macrosomia?
Which of the following does NOT affect the risk of macrosomia?
What is the primary cause of postpartum hemorrhage (PPH) influencing maternal mortality?
What is the primary cause of postpartum hemorrhage (PPH) influencing maternal mortality?
Which of the following is NOT commonly associated with congenital anomalies in infants of diabetic mothers?
Which of the following is NOT commonly associated with congenital anomalies in infants of diabetic mothers?
What is the likely risk of developing shoulder dystocia in a newborn weighing 4200 g?
What is the likely risk of developing shoulder dystocia in a newborn weighing 4200 g?
What complication is particularly linked to the prolonged second phase of labor?
What complication is particularly linked to the prolonged second phase of labor?
Which management strategy for pregnancies with macrosomia has been discouraged due to lack of clear evidence?
Which management strategy for pregnancies with macrosomia has been discouraged due to lack of clear evidence?
What is the expected blood loss threshold defining postpartum hemorrhage after a vaginal delivery?
What is the expected blood loss threshold defining postpartum hemorrhage after a vaginal delivery?
In cases of fetal macrosomia, what can help reduce the risk of perinatal complications?
In cases of fetal macrosomia, what can help reduce the risk of perinatal complications?
Which condition occurs as a mechanical inability during birth, specifically after the delivery of the fetal head?
Which condition occurs as a mechanical inability during birth, specifically after the delivery of the fetal head?
Which of the following electrolyte imbalances is linked with newborns of diabetic mothers?
Which of the following electrolyte imbalances is linked with newborns of diabetic mothers?
What is a common complication of macrosomic pregnancies that poses challenges to healthcare providers?
What is a common complication of macrosomic pregnancies that poses challenges to healthcare providers?
Flashcards
Macrosomia Definition
Macrosomia Definition
Excessive fetal growth, typically a birth weight above a certain threshold (e.g., 4000g or 4500g), regardless of gestational age.
Large for Gestational Age (LGA)
Large for Gestational Age (LGA)
A birth weight at or above the 90th percentile for a given gestational age.
Maternal Diabetes & Macrosomia
Maternal Diabetes & Macrosomia
Poorly controlled maternal diabetes (gestational, type 1, or type 2) significantly increases risk of macrosomia.
Obesity & Macrosomia Risk
Obesity & Macrosomia Risk
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Multiparity & Macrosomia
Multiparity & Macrosomia
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Previous LGA Infants & Macrosomia Risk
Previous LGA Infants & Macrosomia Risk
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Post-date Pregnancy & Macrosomia
Post-date Pregnancy & Macrosomia
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Male-Fetal Gender & Macrosomia
Male-Fetal Gender & Macrosomia
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Congenital Disorders & Macrosomia
Congenital Disorders & Macrosomia
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Macrosomia Prevalence
Macrosomia Prevalence
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Type A2 GDM
Type A2 GDM
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Prenatal Weight Monitoring
Prenatal Weight Monitoring
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Macrosomia
Macrosomia
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Maternal Hyperglycemia Screening
Maternal Hyperglycemia Screening
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Pre-eclampsia Screening
Pre-eclampsia Screening
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Fetal Hypoglycemia
Fetal Hypoglycemia
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Neonatal Hypocalcemia
Neonatal Hypocalcemia
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Neonatal Hypomagnesemia
Neonatal Hypomagnesemia
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Metabolic Derangements
Metabolic Derangements
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Meconium Aspiration
Meconium Aspiration
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Macrosomia risk in pregnancy
Macrosomia risk in pregnancy
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Macrosomia pathophysiology
Macrosomia pathophysiology
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Maternal insulin resistance
Maternal insulin resistance
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Hyperinsulinemia
Hyperinsulinemia
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Hyperglycemia risk factors
Hyperglycemia risk factors
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Fetal pancreas hyperplasia
Fetal pancreas hyperplasia
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Maternal glucose & LGA fetuses
Maternal glucose & LGA fetuses
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Macrosomia & abnormal glucose
Macrosomia & abnormal glucose
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GDM & macrosomia risk
GDM & macrosomia risk
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Postpartum Hemorrhage (PPH)
Postpartum Hemorrhage (PPH)
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Uterine Atony
Uterine Atony
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Macrosomic Pregnancy
Macrosomic Pregnancy
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Perineal Trauma
Perineal Trauma
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Shoulder Dystocia
Shoulder Dystocia
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Fetal Distress
Fetal Distress
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Congenital Anomalies
Congenital Anomalies
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Induction of Labor (IOL)
Induction of Labor (IOL)
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Macrosomia Management
Macrosomia Management
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Diabetes & Macrosomia
Diabetes & Macrosomia
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Study Notes
Macrosomia Definition
- Macrosomia refers to excessive fetal growth, characterized by a birth weight equal to or greater than the 90th percentile for a given gestational age.
- A universally accepted definition of macrosomia is challenging, often using an absolute birth weight threshold of 4,000g or 4,500g, regardless of gestational age.
- "Large for gestational age" (LGA) is another term used for excessive fetal growth.
Etiology - Maternal Causes
- Maternal Diabetes: Poorly controlled diabetes during pregnancy (including gestational, insulin-dependent, or drug-induced) significantly increases the risk of fetal macrosomia.
- Obesity: Maternal obesity is linked to a 4-12 fold increased risk of fetal macrosomia. This is a significant global concern.
- Multiparity: While not inherently a major risk factor, it can contribute to macrosomia due to an association with conditions like maternal diabetes and obesity.
- Previous LGA Infants: Women who have delivered previous LGA infants are at a 5-10 fold increased risk for a subsequent LGA infant.
- Post-date Pregnancy: Prolonged gestation (over 42 weeks) increases the risk of macrosomia.
Etiology - Fetal Causes
- Fetal Gender: Male fetuses are typically 150 grams heavier than female fetuses overall, although not always.
- Genetic and Congenital Disorders: Certain congenital disorders (e.g., Beckwith-Wiedemann syndrome, Sotos syndrome, Fragile X syndrome, Weaver syndrome) are associated with macrosomia and LGA fetuses.
Epidemiology
- In 2017, approximately 7.8% of infants had a birth weight exceeding 4,000 grams, and 0.1% exceeded 5,000 grams.
- Other factors like race, ethnicity, and genetics play a role in contributing to macrosomia.
- Hispanic pregnant women are observed to be at a higher risk.
Pathophysiology
- Pregnancy involves a complex interplay of physiological and endocrine changes to support fetal growth.
- Maternal hyperglycemia is a key factor in macrosomia pathogenesis.
- Increased maternal stress hormones (cortisone, human placental lactogen, prolactin) contribute to insulin resistance during pregnancy.
- Maternal hyperglycemia results in fetal hyperglycemia and hyperplasia of fetal beta islet cells. This overstimulates glucose metabolism in the infant.
- Glucose crosses the placenta through facilitated diffusion.
Associated with Macrosomia
- Hyperglycemia in pregnant women is strongly associated with macrosomia.
- In gestational diabetes mellitus (GDM) cases, even with treatment, the risk of macrosomia is 2-3 times greater.
History
- Essential maternal history includes the first day of last menstrual period (LMP), gestational age, parity, pre-pregnancy weight.
- Other information such as previous pregnancies (especially if with macrosomic infants) previous medical conditions, immunizations, and family history are particularly important.
Physical Examination
- Patient weight should be correlated with standard guidelines based on pre-pregnancy BMI (e.g., 11.5 - 16 kg for BMI between 18.5 to 24.9.)
- Specific weight gain recommendations are given according to pre-pregnancy BMI (for patients with low BMI weight gain should be 12 to 18kg).
- Physical exam can exclude other possible conditions.
Maternal Evaluation
- Maternal hyperglycemia screening is crucial.
- Complete blood count (CBC), urinalysis, BUN, creatinine, and lipid profiles, liver function tests (LFTs), and blood pressure monitoring is important.
- Routine fetal imaging studies (abdominal ultrasound) are important.
Fetal Evaluation
- Macrosomic fetuses are at risk of various metabolic derangements, and frequent monitoring, lab work (glucose, calcium, magnesium, bilirubin, complete blood count) are essential.
- Fetal glucose levels are assessed immediately after delivery and compared to baseline values.
- Potential complications from polycythemia, hypocalcemia, or hypomagnesemia should be addressed.
- Fetal condition should be carefully monitored given the risk of complications.
Complications - Maternal
- Excessive blood loss (postpartum hemorrhage, PPH) is a major maternal complication.
- Uterine atony and over-distention of the uterus contributes to this issue.
- Perineal trauma due to prolonged labor and operative deliveries is also a risk.
Complications - Fetal
- Shoulder dystocia, a difficulty birthing, can result in injury, and brachial plexus problems.
- Congenital anomalies (heart problems, caudal regression syndrome, small left colon syndrome, spinal bifida,etc), and metabolic (such as electrolyte imbalances like hypocalcemia, hypomagnesemia, hyperinsulinemia, hypoglycemia) issues in the newborn are possible.
- Fetal distress is another possible problem.
- Polycythemia (high red blood cell count) and hyperbilirubinemia (high bilirubin level) can potentially occur.
Management
- Induction of labor (IOL) is often discouraged due to a lack of clear evidence.
- Improved glycemic control can reduce risk in pregnancies complicated with diabetes.
- Pregnancies with macrosomia and no underlying diabetes require careful management, possibly electing a Cesarean delivery.
- Assisted vaginal deliveries (forceps, vacuum) require significant caution.
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Description
This quiz explores the definition of macrosomia, characterized by excessive fetal growth, and examines its maternal causes, including diabetes and obesity. Understanding these factors can help in managing and preventing macrosomia during pregnancy.
