Macrosomia Group Research Articles

Levels of insulin-like growth factors and their receptors in placenta in relation to macrosomia.

To investigate the associations between mRNA levels that encodes for insulin-like growth factors (IGFS) and their receptors in term placenta, and the risk of macrosomia. Term placentas were collected from 37 neonates with macrosomia and 37 neonates with normal birth weight in Changzhou Women and Children Health Hospital from March 1 to June 30, 2008. The IGF mRNA levels and their receptors in those placentas were measured by Real-time PCR. The placental weight was positively correlated with the birth weight both in the macrosomia group (r=0.550, p=0.004) and the control group (r=0.678, p=0.000). After adjusting for potential confounders, multivariable adjusted ORs of neonates with macrosomia for those in the increasing two tertiles were 17.3 (95%CI: 2.50-19.2) and 5.94 (95%CI: 0.96, 36.8), respectively, compared with those in the lowest tertile in terms of IGF-IImRNA level. Similarly, multivariable adjusted ORs of neonates with macrosomia for those in the increasing two tertiles of IGF-IR mRNA were 25.3 (95%CI: 3.43-187) and 43.0 (95%CI: 4.89, 378), respectively. These results indicate that the levels of placental IGF-IIand IGF-IR mRNA may be involved in the development of macrosomia.

Relationship of adiponectin and visfatin with fetus intrauterine growth

To explore the correlation between adipocyte factors (adiponectin and visfatin) and fetus intrauterine growth. Enzyme immunoassay was used to measure the adiponectin and visfatin levels in maternal and umbilical serum from 14 women with fetal growth restriction (FGR group), 14 women with macrosomia (macrosomia group) and 14 normal pregnant women (control group). The correlations of cord serum adiponectin and visfatin with maternal serum adiponectin and visfatin were analyzed. (1) Serum visfatin levels in FGR mothers [(41.4 +/- 5.5)] microg/L were significantly higher than that in control women [(34.7 +/- 4.9) microg/L] and macrosomia mothers [(37.3 +/- 4.4) microg/L; P < 0.01, P < 0.05]. Serum adiponectin levels in macrosomia mothers [(4.1 +/- 1.3) mg/L] were significantly lower than that in control women [(6.6 +/- 1.5) mg/L] and FGR mothers [(6.4 +/- 1.3) mg/L; P < 0.01]. (2) Serum visfatin levels in FGR babies [(58.1 +/- 7.6) microg/L] were significantly increased than that in control newborns [(42.6 +/- 7.8) microg/L] and macrosomia babies [(48.5 +/- 9.1) microg/L; P < 0.01, P < 0.05]. Serum adiponectin levels in macrosomia babies [(6.5 +/- 1.3) mg/L] were significantly decreased than that in control newborns [(7.7 +/- 1.5) mg/L] and FGR babies [(7.7 +/- 1.0) mg/L; P < 0.05, P < 0.05]. (3) Maternal serum visfatin levels were positively correlated with umbilical serum visfatin levels (r = 0.720, P < 0.01). Umbilical serum adiponectin levels were higher than that in maternal serum, but there were no relationship between them (r = 0.301, P > 0.05). The changes of visfatin and adiponectin levels may be related to the occurrence of FGR and fetal macrosomia.

Use of the Amniotic Fluid Index Combined With Estimated Fetal Weight Within 10 Days of Delivery for Prediction of Macrosomia at Birth

The purpose of this study was to assess the value of combining the sonographically estimated fetal weight (EFW) and amniotic fluid index (AFI) measured within 10 days of term delivery for prediction of macrosomia at birth. Prospective sonographic fetal biometric measurements and delivery ward data of a single center, uploaded separately over a 4-year period, were retrospectively linked to yield an unselected sample of nondiabetic pregnancies with live-born term neonates. Of the 1925 pregnancies evaluated, 140 (7.2%) were macrosomic (birth weight > or =4000 g). The AFI was significantly higher in the macrosomic group (P < .001). On receiver operating characteristic curve analysis, the area under the curve was larger for predictions based on the EFW alone than on the AFI. An EFW of 4000 g or higher had a positive predictive value of 46.6% for macrosomia at birth. Use of the previously suggested combined EFW and AFI cutoffs of 3689 g and 119 mm, respectively, yielded a positive predictive value of 30.3%. Combined use of the EFW and AFI rather than the EFW alone does not improve prediction of macrosomia at birth.

Macrosomía fetal. Resultados obstétricos y neonatales

Objective A longitudinal descriptive retrospective study was performed of neonates weighing more than 3,999 g born in the Obste trics and Gynecology Service of the University Maternity Hospital of the Canary Islands (Spain) from January 1 st, 1992 to December 31 st, 2002. Subjects and methods Data were taken from the medical records of mothers and newborn infants. Statistical analysis was performed of 2,037 newborns weighing 4,000 g or more. Subsequently, the following variables were analyzed: age at delivery, parity, gestational age, pregnancy-related conditions, onset and route of delivery, sex of the infant, Apgar score, fetal artery pH, intensive care unit admission, fetal and neonatal mortality, hemorrhagic complications, and birth canal trauma. These data were compared with those in a control group of infants weighing less than 4,000 g at birth and delivered in the same period. Results The incidence of macrosomia was 5.3%. Most of the mothers (79.4%) were aged between 17 and 34 years old and 54.4% were multiparous. Three-quarters (74.6%) of deliveries were at term, with spontaneous onset in 66.7% and normal delivery in 64.1%. Most of the newborns were boys (67.3%) with good perinatal outcomes. In the macrosomic group, birth canal trauma was found in 74.07%, pregnancy-related conditions in 25.97%, hemorrhagic complications in 2.95%, and shoulder dystocia in 2.061%. Conclusions In tables 1, 2, 3 and 4 are related the final data. Statistically significant differences with p less than 0.001 are demonstrated in the following data: older age of 34 years at the time of delivery, multiparity, gestation chronological prolonged, male fetal gender, delivery induction, rates of cesaran section, neonatal income in intensive care unit, and extended perinatal mortality.

Macrosomic Births at Mostar Clinical Hospital: A 2-Year Review

The aim of this research was to determine the incidence, risk factors and perinatal outcome of the macrosomic infants (birth weight > or = 4000 g). The retrospective research was performed using a case-control study conducted at Mostar Clinical Hospital. Total of 379 women gave singleton term births to macrosomic newborn in the period from January 1st, 2004 to December 31st, 2005 (observed group). Another 379 singleton normal birthweight term newborns (birth weight < 4000 g, but not small for gestational age), of the same maternal parity and age, who were delivered in the same period, formed the control group. The incidence of macrosomic births was 13, 1%. In the study group, significantly higher number of cases of postdatism (> 42 weeks of gestation) (P<0,001), maternal obesity (prepregnancy BMI> 26 kg/m2) (P<0,001), gestational diabetes mellitus (P=0,033), hypertension (P=0,025) and male infant (P<0,001) were observed. Cesarean delivery (P<0,001), intrapartal complications (cephalopelvic disproportion P<0.001, perineal trauma P=0,042) and newborn birth trauma (clavicular fracture P=0,038, brachial palsy P=0,021) occurred significantly more often in the macrosomic group. There was only one fetal death in the macrosomic group. In the control group there were no cases of perinatal deaths. To conclude, it is important to emphasize the significance of proper diagnosis of fetal macrosomia and management of macrosomic birth, since we have seen a growing number of macrosomic births during the last decades, and have faced a problem of increased risks of adverse perinatal outcome.

Fetal Macrosomia – A Continuing Obstetric Challenge

Background: Macrosomic fetuses represent a continuing challenge in obstetrics. Objectives: We studied maternal risk factors of fetal macrosomia and maternal and infant outcome in such cases. Methods: A retrospective cohort study was carried out with a total of 26,961 singleton pregnancies between 1989 and 2001. Records of 886 mothers who gave birth to live born infants weighing ≧4,500 g were compared to those of 26,075 mothers with normal weight (<4,500 g) infants. Multiple regression analysis was used to identify independent reproductive risk factors. Perinatal complications were also assessed. Results: The incidence of fetal macrosomia was 3.4%. Diabetes, previous macrosomic birth, postdatism (>42 weeks of gestation), obesity (BMI > 25 before pregnancy), male infant, gestational diabetes mellitus, and non-smoking were independent risk factors of fetal macrosomia, with adjusted risks of 4.6, 3.1, 3.1, 2.0, 1.9, 1.6, 1.4, respectively. In the macrosomic group, birth and maternal traumas occurred significantly more often than in the control group. However, records of subsequent pregnancies (n = 250) after the study period showed that a previous uncomplicated birth appeared to decrease complication risks. Conclusions: Most cases of fetal macrosomia occur in low-risk pregnancies and evaluation of maternal risks cannot accurately predict which women will eventually give birth to an overweight newborn. After an uncomplicated birth of a macrosomic infant, vaginal delivery may be a safe option for the infant and mother.

Outcome of Second Delivery After Prior Macrosomic Infant in Women With Normal Glucose Tolerance

Our aim was to estimate the obstetric outcome of second delivery in women with normal glucose tolerance whose first fetus was macrosomic (fetal weight >/= 4,500 g). Primiparas delivering a macrosomic infant during the years 1997-2000 were identified from a hospital computer database, and the obstetric outcome of a second delivery was analyzed up until June 2003. A control group (birth weight 3,000-3,500 g) served for comparison. Among 13,020 first pregnancies, 301 (2.3%) were macrosomic. A similar proportion in the macrosomic group, 156 of 301 (52%), and control group, 171 of 300 (57%), returned for second delivery (P = .252). Compared with controls, first macrosomic deliveries were characterized by higher rates of operative delivery, anal sphincter injury, and shoulder dystocia. At second delivery, 32% of neonates in the macrosomic group and 0.3% in the control group weighed 4,500 g or more (P < .001). More prelabor cesareans were performed in the macrosomic group compared with controls (27 of 156, 17.3%, compared with 8 of 171, 4.7%; P < .001). Among 104 women in the macrosomic group who labored after first vaginal delivery, 99% (103 of 104) delivered vaginally again compared with 44% (11 of 25) who labored after primiparous cesarean delivery (P < .001), which compares with 97% (146 of 150) and 77% (10 of 13), respectively, in the control group. Despite a one-third recurrence of macrosomia, first vaginal delivery of a macrosomic infant was associated with a high incidence of second vaginal delivery. Conversely, primiparous macrosomic cesarean delivery conveyed a high risk (56%) for repeat intrapartum cesarean whether macrosomia recurred or not. II-2.

Identification of Macrosomic, Normal and Intrauterine Growth Retarded Neonates Using the Modified Neonatal Growth Assessment Score

Objective: Separation of Macrosomic, normal and intrauterine growth retarded (IUGR) neonates using the modified Neonatal Growth Assessment Score (NGAS). Methods: A sample of 23 neonates with evidence of growth acceleration and 74 neonates classified as normal or IUGR in a previous study was used in this investigation. The prenatal growth of all neonates had been studied longitudinally with ultrasound. From the data collected, Rossavik models describing the growth trajectories of head circumference (HC), abdominal circumference (AC), thigh circumference (ThC), femur diaphysis length, head cube (A) and abdominal cube (B) were specified. These models were used to predict birth weight (WT), crown-heel length (CHL), HC, AC and ThC at birth. Actual birth measurements of WT, CHL, HC, AC and ThC were evaluated using age-specific normal size curves and compared to predicted measurements by means of the growth potential realization index (GPRI). GPRI values were evaluated by comparison to previously established normal ranges and used to calculate Neonatal Growth Assessment Scores (NGAS₅). NGAS₅ values, together with assessments of anatomical measurements and GPRI values, were used to establish macrosomic, normal and IUGR groups. Principal components analysis was applied to the sets of GPRI values available for each neonate to provide a principal component score for separating macrosomic and normal neonates (m₂NGAS₅₁) or one to separate macrosomic, normal and IUGR neonates (m₃NGAS₅₁) using linear discriminant analysis. The groups identified by these multivariate methods were compared to the original classification and their characteristics evaluated. Results: The m₂NGAS₅₁ and a boundary value of 207.5% separated macrosomic and normal neonates with an accuracy of 97.3%. The m₃NGAS₅₁ and boundary values of 210.0 and 182.5% separated macrosomic, normal and IUGR neonates with an accuracy of 96.9%. No single GPRI value or anatomical measurement could achieve these levels of accuracy. All normal infants were AGA but only 45.5% of the IUGR group were SGA and only 60.9% of the macrosomic group were LGA. Thirteen different types of IUGR and eleven different types of macrosomia were identified based on GPRI values. Conclusion: The modified NGAS accurately separates macrosomic, normal and IUGR neonates although growth abnormalities are expressed in different ways in different individuals.

Niños macrosómicos y de peso normal de un consultorio de atención primaria. Comparación de características propias y maternas 1997-2000

The incidence of low birth weight babies has been a concern of primary health care in Chile, with an incidence of 5.5%. In the Dr. J. Symon Ojeda outpatient clinic in the Metropolitan region between 1997 and 2000 the incidence of babies born with a weight less than 2 500 g has fluctuated between 3.5 and 4.7%. In contrast the incidence of macrosomic babies has varied between 6.6 and 13%. To determine differences between macrosomic and normal babies we compared all the 132 children weighing 4 000 g or more, born between 1997 and 2000 with a group of normal weight (3 000 - 3 999 g) babies randomly selected born during the same time period. Information was obtained using the clinical records of the mother and child. Results: in the macrosomic group, the porportion of males, assisted deliveries, height, cephalic perimeter and weeks of gestation were significantly higher than the control group. Apgar scores at 5 minutes were higher in the control group. The mothers of the macrosomic group scored higher in terms of age, schooling, mean weight at the beginning and end of pregnancy and number of altered glucose levels. The proportion of obese mothers at the first control was double that of the controls (p < 0.01). In both groups there was an importat number of mothers who weighed 80 kg or more at the end of pregnancy. We conclude that the 2 groups of babies differ significantly in the variables studied. We consider important that overweight women who are pregnant be treated from the time of their first visit by a multidisciplinary team.

Abnormal fetal growth is not associated with altered chorionic villous expression of vascular endothelial growth factor mRNA.

Altered placental and circulating levels of vascular endothelial growth factor (VEGF) and its receptor (flt-1) may be associated with pre-eclampsia and intrauterine growth restriction (IUGR). The aim of this study was to determine whether chorionic villous VEGF or flt-1 mRNA are altered at early gestation in pregnancies subsequently found to be complicated by abnormal fetal growth. Quantitative reverse transcription-polymerase chain reaction was performed on chorionic villous samples for VEGF and flt-1 using an internal RNA standard. Using the individualized birthweight ratio (IBR), the subjects (n = 51) were divided into three groups; IUGR (IBR <10th centile, n = 6), normal (IBR 10th-90th centiles, n = 41) and macrosomic (IBR >90th centile, n = 4). There was no correlation between the mRNA expression of VEGF(121) or VEGF(165) and gestational age of the normal controls. There was also no difference in the expression of either of the VEGF isoforms between the IUGR or macrosomic groups and the normal controls. Expression of flt-1 was below the detection limit of the assay. In conclusion, we have found that altered chorionic villous expression of VEGF is not associated with the initial stages of development of IUGR or macrosomia.

Elective cesarean section for macrosomia: Jau-Shon Yan; Yeing-Kuan Chang; Chang-Sheng Yin Chin Med J Taipei 1993 51/3 (231–234)

Fetal macrosomia is associated with increased risk of dystocia and birth trauma. Elective Cesarean section has been recommended for macrosomic fetus to prevent the associated complications. However, the cost/benefit ratio of such practice should be known before it can be considered appropriate.The record of 6230 women delivered consecutively at Tri-Service General Hospital were reviewed retrospectively. The occurrence rates of dystocia and birth trauma were compared between normal birthweight group (2500-3999 gm) and macrosomic group (> or = 4000 gm). The complication rates were calculated specifically among those macrosomic infants delivered vaginally.Of the 6230 singleton pregnancies, 207 had an infant weighing at least 4000 gm. One hundred and three macrosomic infants were delivered by Cesarean section. The indication for Cesarean section was dystocia in 25, estimated fetal macrosomia in 30 and other, 48. If only those pregnancies with macrosomic infant allowing an adequate trial of labor were considered, the frequency of Cesarean section for dystocia was 19.1% in the 4000-4999 gm group and 21.4% in the 4500 gm group, compared with 4.4% in the normal birthweight group. No birth trauma occurred in the macrosomic infants delivered by Cesarean section. Of those macrosomic infants delivered vaginally, the frequency of clavicle fracture was 11.8% in the 4000-4499 gm group and 18.2% in the > or = 4500 gm group, compared with 1.2% in the normal birthweight group. Two infants (18.2%) weighing greater than 4500 gm sustained brachial plexus injury.Elective Cesarean section on macrosomic infants to prevent dystocia is not recommended because most of them can be delivered vaginally. For the very macrosomic infants (> or = 4500 gm), elective Cesarean section is suggested to prevent birth trauma.

Evaluation of Insulin Sensitivity in Obese Offspring of Diabetic Rats by Hyperinsulinemic-Euglycemic Clamp Technique

Young adult macrosomic offspring of streptozotocin-induced mildly hyperglycemic rats exhibit accelerated growth through the first 10 wk of age. At 10 wk, oral glucose loading resulted in elevated plasma insulin and glucose concentrations compared to controls. To assess the mechanism of the abnormal glucose tolerance in vivo, hyperinsulinemic-euglycemic clamp studies were performed. Ten-wk-old rats were fasted overnight, and porcine insulin was infused (2.4 mU.kg-1.min-1). Glucose was infused concurrently at varying rates to maintain euglycemia for 40-60 min. Insulin levels were raised from a baseline value of 163 +/- 57 pmol/L (23 +/- 8 microU/mL) (SD) to 476 +/- 57 pmol/L (67 +/- 8 microU/mL) at steady state for males and from 178 +/- 43 pmol/L (25 +/- 6 microU/mL) to 454 +/- 43 pmol/L (64 +/- 6 microU/mL) for females. The results showed that the macrosomic male and female animals were significantly less sensitive to the effects of insulin than were their respective controls; this was evident by a lower increment in glucose disposal rate per unit increase in insulin (0.04 +/- 0.01 versus 0.11 +/- 0.03 for males and 0.05 +/- 0.03 versus 0.18 +/- 0.07 mg.kg-1 per microU/mL for females). The endogenous glucose production by the liver in the basal (fasted) state in the macrosomic group compared to controls was higher, suggesting possible hepatic insulin resistance. However, endogenous glucose production was suppressed to the same degree between the experimental and control groups during the hyperinsulinemic period, suggesting that the hepatic insulin resistance can be overcome by high insulin levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Fetal Macrosomia in a Military Hospital: Incidence, Risk Factors, and Outcome

The purpose of this paper is to determine the incidence of fetal macrosomia, analyze risk factors, and review maternal and fetal outcome. Macrosomia occurred in 15.1% of deliveries, with very macrosomic fetuses comprising 4.1% of these pregnancies; 61.3% were male. Diabetes mellitus, post-term pregnancy, and excessive weight gain were identified as maternal risk factors. The incidence of shoulder dystocia, birth injury, and low Apgar scores was significantly higher than in controls. In addition, cesarean section rates were higher for the macrosomic groups. Fetuses delivered vaginally had more frequent birth injury than those delivered by cesarean section. Women at risk for fetal macrosomia should be screened, and liberal use of cesarean section is recommended.

Maternal hyperglycemia in pregnant rats: Its effect on growth and carbohydrate metabolism in the offspring

Mild hyperglycemia during the last half of pregnancy was achieved by administration of streptozotocin to pregnant rats on the fifth day of gestation. Citrate buffer (vehicle for streptozotocin) was administered to control rats also on the fifth day of gestation. The pups born to the streptozotocin-treated mothers had higher birth weight, pancreatic insulin content, plasma insulin, and C-peptide concentrations compared with pups born to control mothers. The plasma glucose concentrations of the pups were similar between the two groups. The pups who were identified as macrosomic (birth weight > 1.7 SD than the mean of the control pups) maintained an accelerated postnatal growth through the first 10 weeks of age in female rats and in the first 3, and at 5 and 6 weeks of age for the male rats. The accelerated growth in the female rats was associated with higher perirenal-ovarian and salpingeal fat weight at 6 weeks. At 10 weeks of age, higher plasma insulin and glucose concentrations were observed following oral glucose challenge in both male and female macrosomic rats than in the control rats. At 12 weeks of age, only the female macrosomic rats showed abnormal glucose response due to peripheral insulin resistance. In the male rats at 12 weeks of age, a higher plasma insulin concentration in the macrosomic group was associated with a normal plasma glucose response to oral glucose challenge. We conclude that mild maternal hyperglycemia in rats resulted in fetal hyperinsulinemia and accelerated fetal growth. The macrosomic newborn, particularly the females, demonstrated persistence of accelerated postnatal growth with abnormal glucose tolerance probably as a result of peripheral insulin resistance.