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Fetal macrosomia

Jacques S Abramowicz, MD, FACOG, FAIUM
Jennifer T Ahn, MD, FACOG
Section Editor
Deborah Levine, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


Fetal macrosomia is associated with an increased risk of several maternal and newborn complications. This topic will review the definition, prevalence, significance, risk factors, etiology, and diagnosis of macrosomia. Obstetric and pediatric management are discussed separately. (See "Shoulder dystocia: Risk factors and planning delivery of high-risk pregnancies" and "Large for gestational age newborn".)


Macrosomia refers to growth beyond a specific threshold, regardless of gestational age. In developed countries, the most commonly used threshold is weight above 4500 g (9 lb 15 oz), but weight above 4000 g (8 lb 13 oz) or 10 lb (4536 g) are also commonly used [1-4]. A grading system has also been suggested: grade 1 for infants 4000 to 4499 g, grade 2 for 4500 to 4999 g, and grade 3 for over 5000 g [5]. This system is useful at term for decision-making regarding operative delivery.

These thresholds are not based upon population statistics, where normal weight is typically defined as between the 10th and 90th percentile for gestational age (assuming a normal population distribution), and are not useful for identifying the preterm macrosomic fetus. Using a statistical approach, any fetus/infant weighing >90th percentile for gestational age is considered large for gestational age. The following table shows the 5th, 10th, 50th, 90th, and 95th percentile birth weights for gestational ages 24 to 42 weeks in the United States (table 1). Some researchers prefer to use the 95th percentile as the threshold for macrosomia as it corresponds to 1.90 standard deviations (SD) above the mean and defines 90 percent of the population as normal weight. Others use the 97.75th percentile, which corresponds to 1.96 SD above the mean and defines 95 percent of the population as normal weight.

The use of contemporary country-specific percentile tables is advisable when interpreting estimated fetal and newborn weight, particularly in the developing world. Newborn weights have increased over the past few decades, thus making older tables obsolete [6,7]. In addition, some older tables (eg, Lubchenco) excluded, by choice, African-American, Asian, and Native American infants [8]. Racial and ethnic differences influence birth weight and also should be considered when interpreting estimated fetal and newborn weight [9-11].


The worldwide prevalence of birth of infants ≥4000 g is approximately 9 percent and approximately 0.1 percent for weight ≥5000 g, with wide variations among countries [12].

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Literature review current through: Sep 2017. | This topic last updated: Feb 02, 2017.
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