Fetal macrosomia: causes, consequences for mother and child

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Some expectant mothers on ultrasound in conclusion write "tendency to macrosomia of the fetus." What it is, not every woman knows. But it is important to monitor all indicators during pregnancy.

The weight of a pregnant woman, the balance of hormonal levels and intrauterine weight are monitored by doctors. They evaluate pregnancy week by week, the development of the fetus and the feelings of the expectant mother. And one of the important indicators is the intrauterine weight of the fetus, it directly affects labor activity.

Macrosomia: what is it?

Fetal macrosomia is the overweight of the newborn. An accurate diagnosis can only be made after the baby is born. It is generally accepted that macrosomia is when the weight of the newborn is more than 4 kg. According to statistics, approximately 7% of babies are born weighing more than 4 kg, 1% - 4.5 kg, and only 0.1% - more than 5 kg.

In medicine, the pathology code is indicated: ICD 10: O33.5 (a large fetus that provokes a disproportion that requires emergency medical care). Typically, this iscesarean.

Often this pathology occurs in women who are not primiparous, over the age of 30, and also who are obese and diabetic. Large babies require careful medical supervision.

Possible causes of pathology

The development, weight and height of the baby increases in the presence of at least one of the provoking factors directly related to the he alth, nutrition of the mother, as well as the course of the previous and current pregnancies.

The following are common causes of fetal macrosomia:

1. Metabolic imbalance. Problems of fat and carbohydrate metabolism affect the acceleration of negative processes in the body of the fetus. Often such a diagnosis is made in women who are insulin dependent, obese and diabetic.
2. Fetal macrosomia in gestational diabetes occurs in 15-45% of women in labor. A future mother should monitor her he alth and visit a doctor regularly, because macrosomia in GDM occurs only in case of delayed diagnosis and treatment.
3. Failure to eat. A rapid increase in body weight is observed in women who eat high-calorie foods in the diet that violate the ratio between the main nutrients. The risk of developing pathology increases if carbohydrates and fats are abused, as well as with a lack of copper, phosphorus, calcium and vitamins, which favorably affect the bearing of a child and its development.
4. Overwearing. If the gestation periodincreases, then it continues to develop and grow further, gaining body weight, and increase in height. This is one of the factors that women who are not nulliparous should pay attention to, since each subsequent pregnancy is usually longer than the previous one.
5. Heredity. This is about the factors that affect the pathology due to genetic predisposition, are not fully understood, and the relationship is not traced. There is an opinion that heavy babies are born to large and tall women (height 1.70, weighing more than 70 kg).
6. Large fetus from a previous pregnancy. Given the statistics, the weight of the second child is more than the first by about 25-30%. There is a hypothesis that this is due to the fact that the woman's body is already ready for all the processes that occur to her during pregnancy.
7. Anabolic drugs. A connection has been established for an increase in the growth of an infant if a woman takes drugs that accelerate anabolism. Hormone-based drugs (gestagens) and other components.

Mechanism of development of pathology

The main cause of occurrence is an increase in blood sugar levels during gestation. This happens with diabetes, overweight and obesity. In this case, a high concentration of glucose in the blood is observed in the unborn child. This provokes stimulation of the production of insulin and growth hormone in his body. Then they activate the growth of the fetus due to the deposition of glycogen and fat in the tissues. The process is rapidly accelerated during the overwear.

Studies have shown that macrosomia is common in women with low glucose tolerance before pregnancy, regardless of body weight. Another factor is the level of triglycerides in the blood. Given this mechanism of development, we can conclude that a biochemical imbalance in the female body, even before pregnancy, can provoke macrosomia. There is a risk of not only maternal, birth trauma, but also the death of the fetus in the womb.

Types of macrosomia

There are two types of macrosomia:

1. Constitutional type. Influence of hereditary factors. The fetus is large, but intrauterine development occurs normally without deviations. A potential problem is trauma during childbirth.
2. Asymmetric type. Enlargement of internal organs, in which functions and their work are impaired. This type is considered pathological. Characterized by a large circumference of the chest and abdomen compared to the head. Visually, such children are proportionately different from others. Asymmetric macrosomia has consequences for the child in the form of obesity, the development of cardiovascular disease, diabetes and hypertension.

How to recognize danger?

The attending physician can detect pathology during ultrasound using the fetal biometric labeling path. Quite often, pathology is determined only after childbirth, when accurate measurements of the baby were taken. A large belly of a pregnant woman may indicate the active growth of the fetus or polyhydramnios.

Signs of illness

Signs of disease:

• abdominal circumference over 100cm;
• bottom height from 40 cm.

It is possible to identify a large fetus for a period of 36-38 weeks, during each visit to the doctor, the weight of the woman in labor increases by 500 grams. A reliable method is ultrasound.

Consequences of the disease for mother and baby

Macrosomia is a dangerous pathology for both mother and fetus. During labor with the process of intrauterine hypertrophy, the risk of complications increases:

• protracted labor;
• heavy bleeding;
• damage to the passage channels of the uterus;
• atony;
• stop labor activity;
• postpartum infections.

Complications for the baby are also possible. At birth with excess body weight, the risk, first of all, of injuring the child increases. These include: dislocation of the humerus, fracture of the collarbone, damage to the facial nerve, as well as paralysis of the shoulder joint. A complication may be hypoxia, which will lead to encephalopathy (developmental retardation and even death).

Children with this pathology may face various disorders that will occur after childbirth: underdevelopment of the respiratory system, hypertrophy of the heart channels or metabolic disorders.

Consequences may occur later in a child's life. Various carbohydrate disorders (diabetes, glucose tolerance), overweight and hypertension are possible.

Delivery with macrosomia

Many mothers who have a large fetus are interested in how long a planned caesarean section is scheduled. With a large fetus, a woman is recommended to be under the supervision of doctors before the onset of labor, and at about 39 weeks, an operation is scheduled.

Birth can be natural or operative (emergency, planned caesarean section).

Indications for caesarean section:

• narrow pelvis;
• age peak before 18, after 30;
• contraindications to pushing;
• entanglement of the umbilical cord of the fetus;
• overwearing;
• uterine pathology;
• diabetes;
• amniotic fluid broke prematurely;
• preeclampsia;
• complications of history.

You can also prepare for independent childbirth. It is necessary to keep the body in physical shape (yoga, fitness, swimming), you need to work with the muscles of the vagina according to the method of A. Kegel, as well as attend courses for pregnant women, they will teach you proper breathing, show exercises and much more. This is all allowed only if there are no contraindications.

There is no method that will help to completely avoid pathology. But you can apply prevention methods: monitor your he alth, diet, visit a gynecologist on time, take the necessary tests. It is necessary to evaluate the development of the fetus and sensations during pregnancy week by week, especially if you are at risk. And, most importantly, preparing in advance to become a mother is a big responsibility.