Total 354,509 15,501
Some factors associated with fetal overgrowth are listed in
Table 44-3. Many are interrelated and thus likely are additive.
For example, advancing age is usually related to multiparity and diabetes, and obesity is related to diabetes. In one study, the incidence of macrosomia exceeded 24 percent in China among obese women, and macrosomia rates were also signiicantly higher (approximately 2.5-fold) for prolonged pregnancy and gestational diabetes (Wang, 2017). Of these, maternal diabetes is an important risk factor for fetal overgrowth (Chap. 57, p. 1100). s shown in Table 44-2, the incidence of maternal diabetes grows s birthweights >4000 g rise. It should be emphasized, however, that maternal diabetes is associated with only a small percentage of the total number of such large newborns.
The adverse consequences of excessive fetal growth are considerable. Neonates with a birthweight of at least 4000 g have cesarean delivery rates > 50 percent. This is particularly true with maternal obesity or diabetes or with birthweights >5000 g (Cordero, 2015; Crosby, 2017; Gaudet, 2014; Hehir, 2015). One study found a higher risk for traumatic neonatal morbidity in LGA neonates compared with normal-weight ones (Chauhan, 2017). Rates of shoulder dystocia vary greatly and can reach nearly 30 percent for macrosomic neonates when maternal diabetes is comorbid (Cordero, 2015). In general obstetrical populations that include diabetic mothers, dystocia rates are at least 5 percent for neonates with birthweights ::5000 g (Crosby,
TABLE 44-3. Risk Factors for Fetal Overgrowth
Large size of parents Advancing maternal age Previous macrosomic infant Racial and ethnic factors
TABLE 4-4. Maternal and Fetal Outcomes for 208,090 Pregnancies Delivered at Parkland Hospital from 1998 through 201e2 <4000 9 4000-4499 9 4500-4999 9 �5000 9 Outcomea n = 187,1 19 n = 17,750 n = 2849 n = 372 P value
Cesa rea n totaI 46,577 (25) 5,362 (30) 1204 (42) 224 (60) <0.001 Scheduled 12,564 (7) 1,481 (8) 316 (11) 65 (17) <0.001
Dystocia 7589 (4) 1388 (8) 337 (1n2) 46 (1n2) <0.001
Shou Ider dystocia 437 (0) 366 (2) 192 (7) 56 (15) <0.001 3rd-or 4th-degree laceration 7296 (4) 932 (5) 190 (7) 37 (1n0) <0.001