European Journal of Cardiovascular Medicine

MACROSOMIA: The term macrosomia is a foetal growth abnormality is defined on basis of weight above 4000g.Other weight cut offs like 4100g,4500g are also used. Large for gestational age (LGA): is defined as one whose weight is above the 90th percentile for gestational age. Incidence of Macrosomia in general population is 8 to 10% of all the newborns while it is 10 to 50% in infants of diabetic mothers. Risk Factors for Macrosomia in general population: Maternal obesity, history of a previous LGA infant, excess pregnancy weight gain, prolonged pregnancy (>40 weeks), multiparity and advanced maternal age. The incidence of macrosomia has been overall rising affecting 10% of all pregnancies.Non Diabetic macrosomia is still an obstetric dilemma as there is no clear consensus regarding its antepartum prediction and management as accurate diagnosis is made only retrospectively Macrosomia may be related to constitutional factors (familial trait, male sex, ethnicity), environmental factors (Gestational diabetes mellitus (GDM), diabetes, gestational weight gain, maternal obesity, post-term gestation, multiparty and large placenta in early pregnancy), or heritable genetic. Common pathogenesis for macrosomia is maternal, and fetal, hyperglycemia. then release of insulin, insulin-like growth factors, and growth hormone that leads to increased fetal glycogen and fat deposition. Although there are no test highly sensitive and specific for diagnosis of macrosomia but two-dimensional ultrasound examination is the standard modality used for diagnosis of macrosomia. For women with diabetes mellitus, avoiding hyperglycemia is a proven means of reducing the frequency of macrosomia. For obese women, pre-pregnancy weight loss can reduce the risk of delivering a macrosomic infant. For women of normal weight, avoidance of excessive gestational weight gain can reduce the risk of macrosomia. Infants of both diabetic and nondiabetic mothers who were macrosomia may have longterm metabolic effects that increase the risk of obesity and insulin resistance. Ongoing studies will be needed to see whether effects increase the incidence of adult diseases such as obesity, diabetes, and cardiovascular disease.

The Aim is to study the correlation of fetal weight with gestational age in Non diabetic mothers. The Aim is to study the causes causing fetal macrosomia in non-diabetic mothers. The Aim is to study the various delivery outcomes of fetal macrosomia in non-diabetic mothers. The Aim is to study the causes of perinatal morbidity and perinatal mortality of macrosomic babies in non-diabetic mothers.

Sonographic measurements of fetal body parts provide a direct way of sessing fetal weight and are used mainly in the third trimester.

A retrospective study analysis was done from 2019 to 2022

Fetal growth curve charts, fetal weight prediction formulas using various fetal body parts like HEAD (BPD or HC), ABDOMEN (AD or AC) and FEMUR (FL) have been used.

Weight Prediction is more accurate in non-diabetic than in diabetic mothers.

An attempt to image all the three key anatomic regions-head, abdomen and femur at appropriate anatomic levels was made.

Many sonographic parameters including measurements, formulas, ratios have higher sensitivities and positive predictive value in diagnosing macrosomia in foetus of diabetic mothers than in non-diabetic mothers because of higher prevelance of large foetuses in diabetic mothers.

Inclusion Criteria: Babies weighing 4 kg or more in non-diabetic mothers

Exclusion Criteria: Diabetic mothers

Data were entered into Excel and analyzed using SPSS and Graph Pad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

• Majority of the primigravida with EFW more than 90 percentile had undergone elective lscs
• Few multipara females went into spontaneous labor
• Induction of labor was done in latent labor cases, episiotomy was required owing to large head size in few cases. Instrumental delivery was also done.
• Women with oligohydroamnios and LGA had normal vaginal delivery.
• Pregnant women with neural tube defects like meningocele, hydrocephalus on previous scan should be planned for elective lscs beforehand.
• Perineal laceration, postpartum hemorrahge, maternal infection occurred in women delivering overgrown babies
• Few macrosomic babies had poor APGAR score and needed NICU admissions
• Rarely cases of brachial plexus injury and shoulder dystocia were noted
• Cases of shoulder dystocia needed McRoberts manoeuvre.

Table 1: Baseline characteristics in pregnant women who had GDM compared with pregnant women without the disease.

Quantitative variables presented as mean ± SD, nominal variables as number (percent), P < 0.05 = Significant, P < 0.001 =highly significant, P > 0.05 = Not significant

Table 2: Neonatal outcome of macrocosmic babies for diabetic mothers compared with macrocosmic babies of non-diabetic mothers.

Quantitative variables presented as mean ± SD, nominal variables as number (percent), P < 0.05 = Significant, P < 0.001 =highly significant, P > 0.05 = Not significant

Fetal macrosomia continues to be an obstetric challenge. This is due to the inaccuracy of clinical or sonographic diagnosis also because of the difficulty in prediction of its complications, especially shoulder dystocia. In our study there were significantly more macrosomic infants in non-diabetic women compared to diabetic women, similar data reported in one study. However in one study showed more macrocosmic newborns in diabetic women than non-diabetic women. In term of baseline characteristics.

A retrospective analysis was done from June 2020 to June 2022 at DUPMC, JALGAON.

There were 7 such macrosomic babies of non-diabetic mothers.

A 35 year old G3P2A0L2 OF 38 weeks GA, went into spontaneous labor and was delivered by NVD

A 25 yr. old G2P1L1A0 with 40 weeks +4 days GA was in latent labor, had oligohydroamnios was delivered by NVD

A 26 yr. old G2P1A0L1 of 38 weeks GA was in latent labor , had to be induced ,lscs was done ,condition of baby was poor after birth APGAR SCORE was less and was shifted to NICU. {BABY HAD MENINGOCELE AND HYDROCEPHALUS, WAS DIAGNOSED AT 27 WEEKS ON USG}

A 27 year old G2P1A0L1 of 39 weeks GA 2DAYS had a previous macrosomic baby (male baby 4 kg), delivered by lscs had male baby of 4 kg again.

A 27 yr. old G2P1A0L1 of 39 weeks GA with labor pain delivered a baby weighing 4.4 kg by NVD required episiotomy and had few perineal lacerations.

Head, brain, fetal trunk and abdominal organs grow at normal rate in foetuses of non-diabetic mothers while there is overgrowth of fetal trunk and abdominal organ in diabetic mothers.

Perinatal complications less frequent in babies of non-diabetic mothers than in diabetic mothers.

Good history taking and examination: older age of women, previous LGA infant, h/o pregestational diabetes, maternal obesity, excess weight gain should alert the obstetrician of chances of macrosomia

Usg Monitoring: fetal growth curve should be plotted against the gestational age, fetal parameters should be correlated with the gestational age, hydrops fetalis, congenital hypothyroidism can also cause macrosomia

Planning Of Delivery: Prolonged labor with failure or arrest of descent should alarm the obstetrician. Elective caesarean section can be planned to avoid shoulder dystocia, brachial plexus injury which usually occurs in NVD

Both macrosomic infants of diabetic and non-diabetic mothers are at risk for neonatal complications especially infants of diabetic mothers and male babies in the short term period, especially hypoglycemia, respiratory morbidity, caesarean section delivery, and NICU admission. Future studies need to study the effectiveness of glycemic control on improving neonatal outcomes.

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