Many mothers feel anxious about their pregnancy, especially if it is their first pregnancy or if they have some diseases, whether genetic or chronic such as diabetes. Their anxiety also increases when they receive unclear information from the doctor, such as increased amniotic fluid or fetal gigantism. What is fetal gigantism? And does a cesarean section always require a fetal increase in size? We will answer these questions in our article in Dalili Medical.

What is fetal gigantism?

 

Fetal gigantism, also known as large baby syndrome, is a medical condition that indicates an increase in the normal growth rate of the fetus before birth, as its weight exceeds 4000 grams. Giving birth to a baby with an excess weight may lead to some complications for the mother.

What is the percentage of newborns who weigh more than the normal weight?

 

About 9% of newborns worldwide are born weighing more than 4 kilograms. According to the 2015 National Vital Statistics Report on Newborns in the United States, about 7% of infants were born weighing more than 4 kg, 1% were born weighing more than 4.5 kg, and 0.1% of infants were born weighing more than 5 kg.

**What is the normal birth weight for a baby?**

 

More than 90% of babies born between 37 and 40 weeks weigh between 2.5 kg and 4.5 kg. If your baby weighs 4.5 kg or more at birth, he or she is considered large, a condition known as fetal macrosomia. If your baby weighs less than 5 kg, he or she is considered small.

**Why is my baby so large?**

 

A baby may be large at birth due to genetic factors or the mother’s health. In rare cases, it may be due to a medical condition that causes the baby to grow too quickly. There are several factors that may contribute to increased birth weight, such as:

Factors that affect a child's height and birth weight:

 

- The height and stature of the child's parents.

- If the child is a boy, as young boys tend to be larger than girls.

- Having older siblings, as the likelihood of giving birth to a large child increases with each new pregnancy.

- If there was a previous pregnancy that resulted in a large child.

- The due date was delayed for more than two weeks.

- The mother had diabetes during pregnancy.

- The mother gained a lot of weight during pregnancy or if she suffers from obesity.

- If the mother is 30 years old or older.

In some cases, there may be no clear reason for the birth weight to be higher than normal, making it inexplicable.

What are the signs that indicate a large fetus?

 

It may be difficult to determine the condition of fetal macrosomia during pregnancy, but there are some signs that may indicate that the fetus is large, including:

1. **Fundamental height**: Abnormal measurements of the uterus indicate that the fetus is likely to be large. The doctor measures the distance from the top of the uterus to the pubic bone.

2. **Polyhydramnios**: Also known as excessive amniotic fluid, which is the fluid surrounding the fetus. If a large amount of this fluid is found, this may indicate that the baby is larger than average.

3. **Urine production**: Amniotic fluid reflects the amount of urine produced by the fetus. A larger fetus produces a larger amount of urine, which leads to an increase in the amount of amniotic fluid surrounding it.

What are the causes of an increase in the size of the fetus compared to its age?

 

The hormones secreted by the pituitary gland are responsible for regulating growth. When a tumor forms in this gland, it may produce larger amounts of growth hormone, which leads to an increase in the size of the fetus. These hormones also play a role in a range of other functions, such as:

- Sexual development.

- Metabolism.

- Growth.

- Temperature regulation.

- Urine production.

- Gestational diabetes in the mother during or before pregnancy.

- Maternal weight gain.

- Pregnancy at an advanced age (over 35 years).

- Pregnancy lasting more than two weeks after the due date.

- Repeated pregnancies (where the baby's weight increases by 113 grams with each successive pregnancy until the fifth pregnancy).

- Having a family history of gigantism in one of the children.

McCune-Albright syndrome causes abnormal growth of bone tissue and leads to glandular abnormalities.

Multiple endocrine neoplasia type 1 (MEN1) is a genetic disorder that causes tumors to appear in the pituitary gland, parathyroid glands, or pancreas.

Neurofibromatosis is a genetic disorder that causes tumors to form in the nervous system.

Carney syndrome is a genetic condition that causes non-cancerous tumors in connective tissue, in addition to dark skin spots, and cancerous and non-cancerous tumors in the endocrine glands.

**Risk Factors**

There are several factors that can increase the risk of fetal macrosomia, some of which can be controlled, while others may be out of your control.

**Maternal Diabetes:** Fetal macrosomia is more likely to occur if you had a history of diabetes before pregnancy or if you were diagnosed with diabetes during pregnancy (gestational diabetes). If your diabetes is not well controlled, your baby is likely to be born with larger shoulders and more fat than a baby whose mother does not have diabetes.

**History of Fetal Macrosomia:** If you have had a large baby in the past, you are more likely to have another baby of the same size. Also, having a birth weight greater than 8 pounds 13 ounces (about 4 kilograms) increases your risk of having a large baby.

**Maternal Obesity:** Your risk of fetal macrosomia is higher if you are overweight.

**Excessive Weight Gain During Pregnancy:** Gaining too much weight during pregnancy increases your risk of fetal macrosomia.

**Previous pregnancies:** The risk of fetal macrosomia increases with each pregnancy, and up until the fifth pregnancy, this risk increases significantly.

Having a male child.Boys are usually slightly heavier than girls. Most babies who weigh more than 9 pounds, 15 ounces (4.5 kilograms) are boys.

Late pregnancy. If the pregnancy lasts more than two weeks past the due date, the baby is at higher risk for fetal macrosomia.

Maternal age. Women over age 35 are more likely to have a baby with fetal macrosomia.

Fetal macrosomia is more likely to be the result of the mother having diabetes, obesity, or being overweight during pregnancy than other causes. If these factors are not present and fetal macrosomia is suspected, the baby may have a rare medical condition that is affecting his or her growth.

If a rare medical condition is suspected, your health care provider may recommend diagnostic tests during your pregnancy and may refer you to a genetic counselor based on the test results.

**Birth Risks**

Possible complications for the mother as a result of fetal macrosomia can include:

**Labor problems:** Fetal macrosomia can cause the baby to become stuck in the birth canal (shoulder dystocia), which can cause birth injuries or require the use of forceps or a vacuum (operative vaginal delivery). In some cases, a cesarean delivery may be necessary.

**Reproductive tract tears:** During childbirth, fetal macrosomia can cause injury to the birth canal, such as tearing of the vaginal tissues and the muscles between the vagina and anus (perineal muscles).

Bleeding after childbirth: A large fetus increases the risk that the muscles of the uterus will not contract properly after birth, known as uterine atony. This can lead to severe bleeding after childbirth.

Uterine rupture: If you have had a cesarean delivery or major uterine surgery, a large fetus increases the risk of uterine rupture during labor. This condition, although rare, is serious, as the uterus can rupture along the scar line resulting from a cesarean section or any previous surgery. In this case, an emergency cesarean section may be necessary to avoid life-threatening complications.

What is the preferred method of delivery in cases of fetal macrosomia?

 

Cesarean section is the preferred option in cases of fetal macrosomia, especially in the following cases:

1. A previous history of difficulty in delivering the shoulders during a previous vaginal delivery.

2. The fetal weight exceeds 5000 grams.

3. The fetal weight exceeds 4500 grams if the mother suffers from diabetes.

Despite the high rate of complications associated with vaginal delivery, the possibility of vaginal delivery can be considered in some cases after discussing the risks with the mother. This requires close monitoring of the progress of labor and the condition of the fetus, in addition to the possibility of performing a deep episiotomy if necessary.

**Newborn and Childhood Risks**

Possible complications of fetal macrosomia that may affect your baby include:

- **Low blood sugar**: Babies diagnosed with fetal macrosomia are more likely to be born with blood sugar levels that are lower than normal.

- **Childhood obesity**: Studies suggest that the risk of childhood obesity increases with increased birth weight.

- **Metabolic syndrome**: If your baby is diagnosed with fetal macrosomia, he or she is at risk of developing metabolic syndrome during childhood.

Metabolic syndrome is a group of health conditions, such as high blood pressure, high blood sugar levels, excess fat around the waist, and abnormal changes in cholesterol levels. These conditions occur together, increasing the risk of heart disease, stroke, and diabetes.

**Prevention**

You may not be able to prevent fetal macrosomia, but you can have a healthy pregnancy. Research suggests that exercising during pregnancy and following a low-glycemic diet can help reduce the risk of macrosomia.

**For example:**

- Make an appointment with your health care provider before you become pregnant. If you’re thinking about becoming pregnant, talk to your health care provider. If you’re overweight, he or she may refer you to another professional, such as a registered dietitian or obesity specialist, to help you reach a healthy weight before you become pregnant.

- Monitor your weight. It’s important to gain a healthy amount of weight during pregnancy, usually between 25 and 35 pounds (11 to 16 kilograms), to support your baby’s growth and development. Women who gain more weight during pregnancy are often advised to gain less weight, so it’s important to work with your health care provider to determine what’s right for you.

- Manage your diabetes. If you had diabetes before pregnancy or developed gestational diabetes, you should work with your health care provider to manage your condition. Controlling your blood sugar levels is important.

* Is there a treatment for fetal macrosomia?

 

If your doctor suspects fetal macrosomia, a vaginal birth isn’t necessarily out of the question. However, you will need to give birth in a hospital if forceps or a vacuum device is needed during labor, or if a cesarean delivery becomes necessary. In general, labor induction — which is the stimulation of uterine contractions — is not recommended until labor starts on its own. Research suggests that induction does not reduce the risk of complications related to fetal macrosomia, and may increase the need for a cesarean delivery. In some cases, your doctor may recommend a cesarean delivery. For example:

- If you had diabetes before pregnancy or developed gestational diabetes, and your doctor estimates your baby weighs 9 pounds 15 ounces (4,500 grams) or more, a cesarean delivery may be the safest way to deliver your babyL.

- If your baby weighs 11 pounds or more and you have no history of maternal diabetes, and your doctor estimates your baby's weight at 11 pounds (5,000 grams) or more, a cesarean delivery may be recommended.

- If you've had one baby and had shoulder dystocia, you're at increased risk of having the problem again. A cesarean delivery may be recommended to avoid risks associated with shoulder dystocia, such as a broken collarbone.

**How ​​to Manage Your Baby's Excess Weight Loss or Weight Gain**

 

If your baby is gaining much less than the recommended 113 grams per week, it's important to have some tests to find out what's holding him back and how to address this problem. Here are some common problems you may encounter:

1. **Inadequate nutrition**: If you're not feeding him enough, you can improve his weight gain by increasing the number of meals to 8-10 times a day. Make sure that the gap between feedings does not exceed three hours during the day and four hours at night.

2. **Not emptying the breast**: Make sure that your baby empties at least one breast at each feeding, as hindmilk is high in fat. He should nurse for 10 to 15 minutes before switching to the other breast.

3. **Difficulty feeding**: If your baby is having difficulty feeding due to issues such as tongue or lip tie, or if he gets tired or frustrated while eating, supplements such as breast milk bottles or formula may be helpful in increasing his weight. Working with a lactation consultant can help solve some of these issues. If your baby is sucking on a pacifier or drinking supplemental water, this may be a sign that he needs more support.