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Macrosomia – Again and again, one hears or reads about babies who already weigh six or seven kilos at birth. “Sumo babies” or “giant babies” are also colloquially called these above-average newborns.
Doctors speak of fetal macrosomia as soon as the birth weight of an infant exceeds 4,350 grams. A normal-weight newborn weighs an average of 3,300 to 3,500 grams. So in extreme cases, such a macrosomic baby may well weigh twice as much as a normal baby.
Macrosomia – A Difficult Birth
Everyone knows that a particularly low birth weight is a major risk factor for a variety of physical and psychological problems. However, only very few people think about a particularly high birth weight.
After all, baby fat looks quite cute. Nevertheless, an above-average weight can also be associated with major problems for mother and child, if only in terms of birth.
Giving birth to a child weighing 5, 6 or even 7 kilograms is not a pleasant thought for any mother. Often, the birth canal is too narrow for macrosomic babies because they are simply too big. Many mothers therefore opt for premature induction of labor or delivery by cesarean section.
Vaginal birth is usually not recommended, especially if the baby is particularly heavy. Due to the enormous size of a macrosomic baby, severe injuries can occur during birth if the birth canal or uterus is overstretched. Such injuries can lead to severe to life-threatening postpartum bleeding.
Perineal tears can also be more serious than in normal births. Therefore, as birth weight increases, the frequency of vaginal surgical deliveries and cesarean sections increases. However, it is not only the mother who runs the risk of injury.
The baby can also suffer serious complications during birth. If it is too big for the birth canal, it can get stuck and injured. Possible birth complications include.
Shoulder dystocia describes a dreaded birth complication in which the baby’s shoulders get stuck in the mother’s pelvis after the head is delivered. This causes the birth to stop.
The baby’s shoulders can be released by specific movements. Macrosomic babies are at increased risk of shoulder dystocia because the birth canal is often much too narrow for them. This can lead to bone fractures or plexus paresis.
If the baby bumps into the mother’s bony structures during birth, he or she may experience bone fractures themselves. This often affects the collarbone because the shoulder area of macrosomic babies is too wide for the birth canal.
Plexus Palsy (Injury To The Brachial Plexus)
If the baby gets stuck in the birth canal during delivery, the risk of nerve injury is high. This often happens with shoulder dystocia. If the baby’s shoulder gets stuck and has to be released manually, stretching and straining can injure the nerves in the arm.
This can lead to a disturbance in arm sensitivity. In some circumstances, paralysis may even result.
Because of the possible complications, early induction of labor is often considered. If the baby is delivered before the 40th week of gestation, he or she is often not quite that big yet.
How Can I Tell If My Baby Is Macrosomic?
Making the correct diagnosis of macrosomia before birth is difficult. Although clinical measurements can provide information about the child’s size, the baby’s actual weight cannot be determined until after birth.
Nevertheless, both external examinations, for example by the midwife, and ultrasound examinations can provide clues as to whether the baby is particularly large. There are various formulas that can be used to estimate birth weight.
In addition to ultrasound diagnostics, it is also useful to evaluate maternal risk factors. If conditions such as diabetes or gestational diabetes exist, the risk for macrosomia is increased. The same is true for other conditions such as obesity and extreme weight gain during pregnancy.
Although several methods exist to estimate birth weight, none of them is accurate. To date, no formulas or variables have been discovered that can accurately predict the baby’s weight. Therefore, there is always a possibility that the baby is not macrosomic at birth, although everything looked like it beforehand.
Conversely, it can also happen that the child is suddenly unexpectedly large at birth. Nevertheless, prenatal diagnosis of macrosomia is important to prevent complications at birth.
Early Induction Of Labor Or Cesarean Section?
Giving birth to a baby weighing over 4 kilos is certainly not a piece of cake. Therefore, if your child has been diagnosed with macrosomia, you should start thinking about delivery.
Caesarean section, premature induction of labor, or normal delivery? Most doctors recommend delivery by cesarean section in cases of macrosomia, especially if the baby is particularly large.
This is to avoid both maternal and infant birth trauma. As a rule, cesarean delivery is recommended from an estimated weight of 5,000 grams, and for diabetic women from a weight of 4,500 grams.
Those who do not wish to deliver their child by cesarean section also have the option of having an induction of labor performed before the actual due date. Early induction of labor can prevent the baby from growing even larger in the womb. If it is not quite so big and heavy yet, the birth is less complicated.
It also makes the risk of complications such as shoulder dystocia less. Induction of labor can be considered after the completion of the 37th week of pregnancy. This is done on an inpatient basis with the help of special medications that promote labor.
Note: If macrosomia is suspected in your baby, your doctor will probably recommend delivery by cesarean section. However, vaginal birth is not impossible. There is also a possibility of premature induction of labor. In any case, you should get good advice before making a decision.
What Role Does Diabetes Play?
There are several possible causes of macrosomia. Often no decisive cause can be identified. However, maternal diabetes mellitus is considered the greatest risk factor. This may already exist before pregnancy or may occur for the first time during pregnancy.
This is then also referred to as gestational diabetes. Worldwide, the incidence of diabetes and gestational diabetes is increasing. This is due to the increasing age and weight of mothers.
Maternal diabetes can harm the unborn child, especially if it is untreated. This is because it causes permanently elevated blood glucose levels in the body. The elevated blood glucose levels are passed on to the child via the placenta.
The baby responds by secreting insulin to break down the sugar. However, insulin also has a growth-promoting effect. This leads to an increase in the size of the child and to increased fat storage.
So what to do if you have diabetes? Regardless of whether diabetes is already present or gestational diabetes is present, the disease must be treated. As a rule, the first step is to provide detailed training for those affected.
Insulin injections alone are not enough to treat diabetes. A change in diet, regular exercise and regular monitoring of blood glucose levels are important therapeutic steps.
Excessive weight gain during pregnancy should be avoided. As a rule, the pregnant woman is not given insulin until she is unable to lower her sugar levels herself via the lifestyle measures mentioned above.
Pregnant women with diabetes should be managed by a team of experts before and during delivery. Delivery, whether by cesarean section or premature induction of labor, should ideally take place in a special birthing clinic.
These Causes Can Also Lead To Macrosomia
In addition to pre-existing diabetes and gestational diabetes, the following factors are also possible causes of macrosomia.
- Extreme weight gain during pregnancy.
- Maternal obesity.
- Prolonged pregnancy.
- Infantile syndromes (e.g. Sotos syndrome).
Nevertheless, even normal weight and healthy mothers can give birth to a macrosomic child. Some mothers simply have a hereditary predisposition to this, for example, if they themselves had a high birth weight. In addition, male fetuses tend to be born particularly large and heavy.
So if your baby has been diagnosed with macrosomia, this does not automatically mean that you suffer from diabetes or have put on excessive weight. Nevertheless, you should get yourself checked for diseases, especially gestational diabetes.
After all, mild gestational diabetes doesn’t always cause symptoms, but it can still lead to all kinds of problems if it’s overlooked.
How Do Macrosomic Babies Develop Later?
You may be wondering if macrosomia is associated with late effects on the affected baby. Will it develop differently than normal babies? To answer this question, you need to distinguish between long-term and short-term consequences.
After delivery, the baby may suffer from hypoglycemia for a short time. This is also called hypoglycemia and often happens when the mother has diabetes.
The cause of hypoglycemia is too much insulin production. As you already know, maternal diabetes leads to very high blood glucose levels, which also pass to the baby. The baby produces a lot of insulin to break down this sugar. Then, when it is born and the umbilical cord is clamped, it suddenly stops receiving blood sugar from the mother.
But the insulin levels are still elevated. So it can happen that the baby’s blood sugar level drops sharply. Therefore, it is important that babies born to diabetic mothers are well monitored in the first 48 hours after birth. Blood glucose levels should be checked regularly to make sure the baby is not hypoglycemic.
And what about the long-term consequences? Studies indicate that the weight problems of macrosomic babies are often permanent. They’re more likely to have problems with obesity later on, and they’re also more likely to struggle with cardiovascular disease, high blood pressure, and diabetes.
Still, you shouldn’t worry if your baby has been diagnosed with macrosomia. While fetal macrosomia is a risk factor for problems like obesity and diabetes later in life, it’s still only one of many. It is much more important than your baby is born healthy and that there are no complications.
In case of a particularly severe macrosomia, you should therefore inform yourself about the possibilities of an early induction of labor or a cesarean section.