# Fetal Macrosomia: Ultrasonographic Parameters and Associated Risk Factors in Pregnancies with and without Gestational Diabetes Mellitus

## Authors

- Simten Genc ([ORCID](https://orcid.org/0000-0003-4446-4467)) — Obstetrics and Gynecology, Okmeydani Training and Research Hospital, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
- Orhan Sahin ([ORCID](https://orcid.org/0000-0002-7216-3816)) — Obstetrics and Gynecology, Okmeydani Training and Research Hospital, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 7, Issue 3 (2021), pages 172–180
- **Article type:** Original Article
- **Published online:** 2021-09-26
- **DOI:** [10.5455/umj.20210710071617](https://doi.org/10.5455/umj.20210710071617)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=95158
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/95158.pdf

## Abstract

Introduction: Fetal macrosomia is a clinical condition that significantly affects maternal and fetal health. The objective of this study is to determine the frequency and the associated risk factors of fetal macrosomia in pregnant women with and without gestational diabetes mellitus (GDM). Materials and Methods: Our study was carried out by retrospectively examining the records of pregnant women who delivered babies with birth weights of ≥4000 g, after the 37th gestational week in the Gynecology Department of Okmeydani Training and Research Hospital between January 1, 2014, and December 31, 2020. Pregnant women were divided into 2 groups as those did not receive (Group 1, n:311) and did (Group 2, n:98) the diagnosis of GDM during their pregnancy. Results: Frequencies of preeclampsia, polyhydramnios, and shoulder dystocia were statistically significantly higher in the GDM(+) group relative to the GDM(-) group (p=0.007, p=0.006, and p=0.004, respectively). Receiver operator characteristic (ROC) curves were formed to determine cut-off values for age, parity, BPD, FL, and AC. Age (>35 years), FL (≤77 mm), AC (>356 mm), polyhydramnios, and shoulder dystocia were determined as effective factors on fetal macrosomia (p=0.0001, p=0.025, p=0.023, p=0.045, and p=0.009, respectively). Conclusion: Polyhydramnios, shoulder dystocia, preeclampsia, and an increase in AC but a decrease in BPD and FL values are more common in macrosomia associated with GDM compared to the non-GDM patient group.

## Keywords

Adverse obstetric outcomes; Gestational diabetes mellitus; Macrosomia; Polyhydramnios

## How to cite

Genc S, Sahin O. Fetal Macrosomia: Ultrasonographic Parameters and Associated Risk Factors in Pregnancies with and without Gestational Diabetes Mellitus. Ulutas Med J. 2021;7(3):172-180. doi:10.5455/umj.20210710071617

## References

1. Asplund CA, Seehusen DA, Callahan TL, Olsen C. Percentage change in antenatal body mass index as a predictor of neonatal macrosomia. Ann Fam Med. 2008;6(6): 550-4 https://doi.org/10.1370/afm.903
2. Ng SK, Olog A, Spinks AB, Cameron CM, Searle J, McClure RJ. Risk factors and obstetric complications of large for gestational age births with adjustments for community effects: results from a new cohort study. BMC Public Health. 2010;6; 10:460 https://doi.org/10.1186/1471-2458-10-460
3. Abolfazl M, Hamidreza TS, Narges M, Maryam Y. Gestational diabetes and its association with unpleasant outcomes of pregnancy. Pak J Med Sci 2008;24(4):566-70
4. Ahmed SR, Ellah MA, Mohamed OA, Eid HM. Prepregnancy obesity and pregnancy outcome. Int J Health Sci (Qassim). 2009;3(2):203-8
5. Bamberg C, Hinkson L, Henrich W. Prenatal detection and consequences of fetal macrosomia. Fetal Diagn Ther. 2013;33 (3):143-8 https://doi.org/10.1159/000341813
6. Hermann GM, Dallas LM, Haskell SE, Roghair RD. Neonatal macrosomia is an independent risk factor for adult metabolic syndrome. Neonatology. 2010;98(3):238-44 https://doi.org/10.1159/000285629
7. Strehlow S, Uzelac P. Complications of labour and delivery. Current Obstetrics and Gynecology, Diagnosis and Treatment. New York: The McGraw-Hill Companies Inc; 2007. pp. 432–40
8. Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49 -e64 https://doi.org/10.1097/aog.0000000000002501
9. Brown MA, Lindheimer MD, de Swiet M,etal.The classification and diagnosis of the hypertensive disorders of pregnancy: Statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 2001;20:9 -14 https://doi.org/10.3109/10641950109152635
10. Vinturache AE, Chaput KH, Tough SC. Pre-pregnancy body mass index (BMI) and macrosomia in a Canadian birth cohort. J Matern Fetal Neonatal Med. 2017;30(1):109-116 https://doi.org/10.3109/14767058.2016.1163679
11. Oral E, Cağdaş A, Gezer A, Kaleli S, Aydinli K, Oçer F. Perinatal and maternal outcomes of fetal macrosomia. Eur J Obstet Gynecol Reprod Biol. 2001;99(2):167-71 https://doi.org/10.1016/s0301-2115(01)00416-x
12. Nkwabong E, Nzalli Tangho GR. Risk Factors for Macrosomia. J Obstet Gynaecol India. 2015;65(4):226-9 https://doi.org/10.1007/s13224-014-0586-4
13. Fuchs F, Bouyer J, Rozenberg P, Senat MV. Adverse maternal outcomes associated with fetal macrosomia: what are the risk factors beyond birthweight? BMC Pregnancy Childbirth. 2013;8;13:90 https://doi.org/10.1186/1471-2393-13-90
14. Kraïem J, Chiha N, Bouden S, Ounaïssa F, Falfoul A. L'accouchement du macrosome de 4500 g et plus. A propos de 61 cas -The delivery of macrosomic infants weighing 4500g and more. A report of 61 cases. Tunis Med. 2004;82(7):656-61 180 77 Fetal Macrosomia Genc et al.
15. Ju H, Chadha Y, Donovan T, O'Rourke P. Fetal macrosomia and pregnancy outcomes. Aust N Z J Obstet Gynaecol. 2009; 49(5):504-9 https://doi.org/10.1111/j.1479-828x.2009.01052.x
16. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991-2002 https://doi.org/10.1097/01.aoa.0000344706.95925.dc
17. Mohammadbeigi A, Farhadifar F, Soufi Zadeh N, Mohammad salehi N, Rezaiee M, Aghaei M. Fetal macrosomia: risk factors, maternal, and perinatal outcome. Ann Med Health Sci Res. 2013;3(4):546-50 https://doi.org/10.4103/2141-9248.122098
18. Shi P, Yang W, Yu Q, Zhao Q, Li C, Ma X, Jin L, Han X, Zhang Y, Yan W. Overweight, gestational weight gain and elevated fasting plasma glucose and their association with macrosomia in chinese pregnant. Matern Child Health J. 2014;18(1):10-15 https://doi.org/10.1007/s10995-013-1253-6
19. Biri A, Korucuoglu U, Ozcan P, Aksakal N, Turan O, Himmetoglu O. Effect of different degrees of glucose intolerance on maternal and perinatal outcomes. J Matern Fetal Neonatal Med. 2009;22(6):473-8 https://doi.org/10.1080/14767050802610344
20. Navti OB, Ndumbe FM, Konje JC. The peri -partum management of pregnancies with macrosomic babies weighing > or =4,500 g at a tertiary University Hospital. J Obstet Gynaecol. 2007;27(3):267-70 https://doi.org/10.1080/01443610701195074
21. Friesen CD, Miller AM, Rayburn WF. Influence of spontaneous or induced labor on delivering the macrosomic fetus. Am J Perinatol. 1995;12(1):63-6 https://doi.org/10.1055/s-2007-994404
22. Combs CA, Rosenn B, Miodovnik M, Siddiqi TA. Sonographic EFW and macrosomia: is there an optimum formula to predict diabetic fetal macrosomia? J Matern Fetal Med. 2000;9(1):55- https://doi.org/10.1002/(sici)1520-6661(200001/02)9:1<55::aid-mfm12>3.0.co;2-9
23. Lee BH, Park TC, Lee HJ. Association between fetal abdominal circumference and birthweight in maternal hyperglycemia. Acta Obstet Gynecol Scand. 2014;93(8):786-93 https://doi.org/10.1111/aogs.12420
24. Bethune M, Bell R. Evaluation of the measurement of the fetal fat layer, interventricular septum and abdominal circumference percentile in the prediction of macrosomia in pregnancies affected by gestational diabetes. Ultrasound Obstet Gynecol. 2003;22(6):586-90 https://doi.org/10.1002/uog.885
25. Stanirowski PJ, Majewska A, Lipa M, Bomba-Opoń D, Wielgoś M. Ultrasound evaluation of the fetal fat tissue, heart, liver and umbilical cord measurements in pregnancies complicated by gestational and type 1 diabetes mellitus: potential application in the fetal birth-weight estimation and prediction of the fetal macrosomia. Diabetol Metab Syndr. 2021;13(1):22 https://doi.org/10.1186/s13098-021-00634-7
26. Zhang X, Decker A, Platt RW, Kramer MS. How big is too big? The perinatal consequences of fetal macrosomia. Am J Obstet Gynecol. 2008;198(5):517.e1-6 https://doi.org/10.1016/j.ajog.2007.12.005
27. Weissmann-Brenner A, Simchen MJ, Zilberberg E, Kalter A, Weisz B, Achiron R, Dulitzky M. Maternal and neonatal outcomes of macrosomic pregnancies. Med Sci Monit. 2012; 18(9):77-81 https://doi.org/10.12659/msm.883340
28. Esakoff TF, Cheng YW, Sparks TN, Caughey AB. The association between birthweight 4000g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am J Obstet Gynecol. 2009;200(6):672-4 https://doi.org/10.1016/j.ajog.2009.02.035
29. Opati P, Zheng R, Wang J, Xin Y, Zhao H, Bi D. Comparison of neonatal outcomes in macrosomic infants of diabetic and non-diabetic mothers. J Neonatal Perinatal Med. 2015 Mar 10 https://doi.org/10.3233/npm-15814037
30. Hermann GM, Dallas LM, Haskell SE, Roghair RD. Neonatal macrosomia is an independent risk factor for adult metabolic syndrome. Neonatology. 2010;98(3):238-44 https://doi.org/10.1159/000285629