There's also an increased risk of stillbirth and macrosomia when a baby is overdue.
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For this reason, a C-section is often recommended for pregnant people with fetal macrosomia, which could explain Khloé's preoccupation.
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In addition to gestational diabetes, excess weight gain during pregnancy can lead to other health problems for the mother, like fetal macrosomia or difficult delivery.
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People with gestational diabetesPeople who are obese and/or have gained over 50 pounds throughout pregnancyPeople with larger than average babies, also known as fetal macrosomia, especially if the baby is expected to be over 10 pounds.
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"We have known for a while that children born to women with diabetes, including both diabetes before pregnancy as well as gestational diabetes, have a higher rate of important complications early in life including macrosomia (babies that are too large sometimes resulting in difficult deliveries), a higher rate of congenital malformations, more frequent admission to NICU because of babies having difficulties regulating their own blood sugar levels, to name a few," said Dr. Jorge Chavarro of the Harvard T.H. Chan School of Public Health in Boston.
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Certain maternal health issues can cause birth injuries. Gestational diabetes can cause premature birth, macrosomia, or stillbirth.
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Maternal complications in pregnancies with macrosomia include emergency cesarean section, postpartum hemorrhage and obstetric anal sphincter injury. The risk of maternal complications in pregnancies with newborns weighing between 4,000 g and 4,500 g is two-fold greater than in pregnancies without macrosomia. In pregnancies with newborns weighing over 4,500 g, the risk is approximately three-fold greater.
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Doctors disagree whether women should be induced for suspected macrosomia and more research is needed to find out what is best for women and their babies. Elective cesarean section has also been presented as a potential delivery method for infants of suspected macrosomia, as it can serve to prevent possible birth trauma. However, the American College of Obstetricians and Gynecologists recommends that cesarean delivery should only be considered if the fetus is an estimated weight of at least 5,000 grams in non-diabetic mothers and at least 4,500 grams in diabetic mothers. A number needed to treat analysis determined that approximately 3,700 women with suspected fetal macrosomia would have to undergo an unnecessary cesarean section in order to prevent one incident of brachial plexus injuries secondary to shoulder dystocia.
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Diabetes mellitus and pregnancy deals with the interactions of diabetes mellitus (not restricted to gestational diabetes) and pregnancy. Risks for the child include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), polyhydramnios and birth defects.
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Genetics plays a role in having an LGA baby. Taller, heavier parents tend to have larger babies. Genetic disorders of overgrowth (e.g. Beckwith–Wiedemann syndrome, Sotos syndrome, Perlman syndrome, Simpson-Golabi- Behmel syndrome ) are often characterized by macrosomia.
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Induction of labor at or near term for women with a baby of suspected macrosomia has been proposed as a treatment method, as it stops fetal growth and results in babies with a lower birth weight, fewer bone fractures, and less incidence of shoulder dystocia. However, this method could increase the number of women with perineal tears, and failed inductions can prompt the need for emergency cesarean sections. LGA babies are more than two times likely to be delivered by Cesarean section, compared to infants under 4000 grams (below the threshold of macrosomia). Predicting a baby’s weight can be inaccurate and women could be worried unnecessarily, and request their labor to be induced without a medical reason.
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In healthy pregnancies without pre-term or post-term health complications, large for gestational age, or fetal macrosomia have been observed to affect around 12% of newborns. By comparison, women with gestational diabetes are at an increased risk of giving birth to LGA babies, where ~15-45% of neonates may be affected. In 2017, the National Center of Health Statistics found that 7.8% of live-born infants born in the United States meet the definition of macrosomia, where their birth weight surpasses the threshold of 4000 grams (above ~8.8 pounds). Women in Europe and the United States tend to have higher pre-term body weight and have increased gestational weight during pregnancy compared to women in east Asia.
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Carolinians from Saipan have the same lineages with Remathau on the outer islands of Yap. Some of the people on the islands are Chamolinians which are a mixture of Chamorro and Carolinian heritage. The Carolinians in the CNMI have a high rate of macrosomia which is where the infant is born abnormally large.
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Risk factors for fetal birth injury include fetal macrosomia (big baby), maternal obesity, the need for instrumental delivery, and an inexperienced attendant. Specific situations that can contribute to birth injury include breech presentation and shoulder dystocia. Most fetal birth injuries resolve without long term harm, but brachial plexus injury may lead to Erb's palsy or Klumpke's paralysis.
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Risk factors for fetal birth injury include fetal macrosomia (big baby), maternal obesity, the need for instrumental delivery, and an inexperienced attendant. Specific situations that can contribute to birth injury include breech presentation, conduplicato corpore and shoulder dystocia. Most fetal birth injuries resolve without long term harm, but brachial plexus injury may lead to Erb's palsy or Klumpke's paralysis.
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Such interventions can help mothers achieve the recommended gestational weight and lower the incidence of fetal macrosomia in obese and overweight women. The World Health Organization also recommends that mothers aim for their recommended BMI prior to conception. In general, obese mothers or women with excessive gestational weight gain may have higher risk of pregnancy complications (ranging from LGA, shoulder dystocia, etc.).
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Being or becoming overweight in pregnancy increases the risk of complications for mother and fetus, including cesarean section, gestational hypertension, pre-eclampsia, macrosomia and shoulder dystocia. Excessive weight gain can make losing weight after the pregnancy difficult. Around 50% of women of childbearing age in developed countries like the United Kingdom are overweight or obese before pregnancy. Diet modification is the most effective way to reduce weight gain and associated risks in pregnancy.
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Finally, the role of GLUT3/GLUT4 transport remains speculative. If the untreated gestational diabetes fetus is exposed to consistently higher glucose levels, this leads to increased fetal levels of insulin (insulin itself cannot cross the placenta). The growth-stimulating effects of insulin can lead to excessive growth and a large body (macrosomia). After birth, the high glucose environment disappears, leaving these newborns with ongoing high insulin production and susceptibility to low blood glucose levels (hypoglycemia).
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The risks of maternal diabetes to the developing fetus include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), mild neurological deficits, polyhydramnios and birth defects.In some studies 4% to 11% of infants born to type 1 diabetic women had defects compared to 1.2% to 2.1% of infants born in the general population. The cause is, e.g., oxidative stress, by activating protein kinase CAuthor: Gäreskog, Mattias Title: Teratogenicity Involved in Experimental Diabetic Pregnancy that leads to apoptosis of some cells.
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More research is needed to find out which lifestyle interventions are best. Some women with GDM use probiotics but it is very uncertain if there are any benefits in terms of blood glucose levels, high blood pressure disorders or induction of labour. If a diabetic diet or G.I. Diet, exercise, and oral medication are inadequate to control glucose levels, insulin therapy may become necessary. The development of macrosomia can be evaluated during pregnancy by using sonography.
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The two main risks GDM imposes on the baby are growth abnormalities and chemical imbalances after birth, which may require admission to a neonatal intensive care unit. Infants born to mothers with GDM are at risk of being both large for gestational age (macrosomic) in unmanaged GDM, and small for gestational age and Intrauterine growth retardation in managed GDM. Macrosomia in turn increases the risk of instrumental deliveries (e.g. forceps, ventouse and caesarean section) or problems during vaginal delivery (such as shoulder dystocia).
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First signs of SGBS may be observed as early as 16 weeks of gestation. Aids to diagnosing might include the presence of macrosomia, polyhydramnios, elevated maternal serum-α-fetoprotein, cystic hygroma, hydrops fetalis, increased nuchal translucency, craniofacial abnormalities, visceromegaly, renal abnormalities, congenital diaphragmatic hernia, polydactyly, and a single umbilical artery. If there is a known mutation in the family, prenatal testing is available. Prenatal testing is also possible by looking for evidence of the mild SGBS phenotype in the mother and the positive SGBS phenotype in male family members.
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Thus, women in Europe and the United States, with higher gestational weight gain, tend to have higher associated risk of LGA infants, macrosomia and cesarean. In European countries, the prevalence of births of newborns weighing between 4,000 g and 4,499 g is 8% to 21%, and in Asian countries the prevalence is between 1% and 8%. In general, rates of LGA infants have increased 15-25% in many countries including the United States, Canada, Germany, Denmark, Scotland and more in the past 20-30 years, suggesting an increase in LGA births worldwide.
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MOMO syndrome is an extremely rare genetic disorder which belongs to the overgrowth syndromes and has been diagnosed in only seven cases around the world, and occurs in 1 in 100 million births. The name is an acronym of the four primary aspects of the disorder: Macrosomia (excessive birth weight), Obesity, Macrocephaly (excessive head size) and Ocular abnormalities. It is unknown if it is a life-limiting condition. MOMO syndrome was first diagnosed in 1993 by Professor Célia Priszkulnik Koiffmann, a Brazilian researcher in the Genetic and Clinical Studies of neurodevelopmental disorders.
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Macrosomia may affect 12% of normal women compared to 20% of women with GDM. However, the evidence for each of these complications is not equally strong; in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study for example, there was an increased risk for babies to be large but not small for gestational age in women with uncontrolled GDM. Research into complications for GDM is difficult because of the many confounding factors (such as obesity). Labelling a woman as having GDM may in itself increase the risk of having an unnecessary caesarean section.
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One of the primary risk factors of LGA is poorly-controlled maternal diabetes, particularly gestational diabetes (GD), as well as preexisting diabetes mellitus (DM) (preexisting type 2 is associated more with macrosomia, while preexisting type 1 can be associated with microsomia). The risk of having a macrosomic fetus is three times greater in mothers with diabetes than those without diabetes. DM increases maternal plasma glucose levels as well as insulin, stimulating fetal growth of subcutaneous fat. The LGA newborn exposed to maternal DM usually only has an increase in weight, not a change in body length or head size.
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Management of gestational diabetes through dietary modifications and anti-diabetic medications has been shown to decrease the incidence of LGA. The use of metformin to control maternal blood glucose levels has shown to be more effective than using insulin alone in reducing the likelihood of fetal macrosomia. There is a 20% lower chance of having an LGA baby when using metformin to manage diabetes compared to using insulin. Modifiable risk factors that increase the incidence of LGA births, such as gestational weight gain above recommended BMI guidelines, can be managed with lifestyle modifications, including maintaining a balanced diet and exercising.
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Difficult labor, also known as dystocia or obstructed labor, occurs when the child cannot easily pass through the birth canal. This can result in fetal distress or physical trauma to the child, especially broken clavicles and damage to the brachial plexus nerves. It can also deprive the child of oxygen as the umbilical cord is pinched, potentially causing brain damage or death. Difficult labor may occur because the baby is abnormally large (macrosomia), because the mother’s pelvis or birth canal is small or deformed, or because the baby is in an abnormal presentation for the birth (such as breech or transverse presentation).
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Large for gestational age (LGA) describes full-term or post-term infants that are born of high birth weight. The term LGA or large for gestational age is defined by birth weight above the 90th percentile for their gestational age and gender. In infants with birth weight above the 97th percentile in their gestational age and gender group, research has shown that greater risk of long-term health complications and fatal outcomes are present in LGA infants. Specifically, large for gestational age can be characterized by macrosomia, referring to a fetal growth beyond a certain threshold (threshold ranging from a body weight of 4,000 grams to above 5,000 grams).
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Macrocephaly-capillary malformation (M-CM) is a multiple malformation syndrome causing abnormal body and head overgrowth and cutaneous, vascular, neurologic, and limb abnormalities. Though not every patient has all features, commonly found signs include macrocephaly, congenital macrosomia, extensive cutaneous capillary malformation (naevus flammeus or port-wine stain type birthmark over much of the body; a capillary malformation of the upper lip or philtrum is seen in many patients with this condition), body asymmetry (also called hemihyperplasia or hemihypertrophy), polydactyly or syndactyly of the hands and feet, lax joints, doughy skin, variable developmental delay and other neurologic problems such as seizures and low muscle tone.
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In addition to sonography, fetal weight can also be assessed using clinical and maternal methods. Clinical methods for estimating fetal weight involves measuring the mother's symphysis-fundal height and performing Leopold's maneuvers, which can help with determining the fetus position in utero in addition to size. However, as this method relies heavily on practitioner experience and technique, it does not provide an accurate and definite diagnosis of an LGA infant and only would only serve as a potential indication of suspected macrosomia. Fetal weight can also be estimated through a mother's subjective assessment of the fetus size, but this method is dependent on a mother's experience with past pregnancies and may not be clinically useful.
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Post-maturity syndrome develops in about 20% of human pregnancies continuing past the expected dates. Ten years ago it was generally held that the postmature fetus ran some risk of dying in the uterus before the onset of labour because of degeneration and calcification of the placenta.Features of post-maturity syndrome include oligohydramnios, meconium aspiration, macrosomia and fetal problems such as dry peeling skin, overgrown nails, abundant scalp hair, visible creases on palms and soles, minimal fat deposition and skin colour become green or yellow due to meconeum staining. Post-maturity refers to any baby born after 42 weeks gestation or 294 days past the first day of the mother's last menstrual period.
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In shoulder dystocia, the shoulder is trapped after the head is delivered, preventing delivery of the rest of the baby. The major risk factor (other than prior history of shoulder dystocia) is the baby being too large (macrosomia), which can result from the mother being obese or gaining too much weight, diabetes, and the pregnancy lasting too long (post-term pregnancy). Shoulder dystocia can lead to further fetal complications such as nerve compression and injury at the shoulder (brachial plexus), fracture of the collarbone, and low oxygen for the fetus (whether due to compression of the umbilical cord or due to inability of the baby to breathe). Shoulder dystocia is often signaled by retreat of the head between contractions when it has already been delivered ("turtle sign").
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Risk factors for uterine atony include prolonged labor, precipitous labor (labor lasting less than 3 hours), uterine distension (multi-fetal gestation, polyhydramnios, fetal macrosomia), fibroid uterus, chorioamnionitis, indicated magnesium sulfate infusions, and prolonged use of oxytocin. Ineffective uterine contraction, either focally or diffusely, is additionally associated with a diverse range of etiologies including retained placental tissue, placental disorders (such as morbidly adherent placenta, placenta previa, and abruption placentae), coagulopathy (increased fibrin degradation products) and uterine inversion. Body mass index (BMI) above 40 (class III obesity) is also a recognized risk factor for postpartum uterine atony. Magnesium sulfate, used routinely in patients with preeclampsia and eclampsia, has the side effect of compromising post delivery uterine contractility; this may contribute to the observed association of hypertensive disease of pregnancy with severe postpartum hemorrhage caused by atony.
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