Large for gestational age newborn
- George T Mandy, MD
George T Mandy, MD
- Associate Professor of Pediatrics
- Baylor College of Medicine
Infants who are born large for gestational age (LGA), especially full-term or post-term infants, are at risk for perinatal morbidity and potentially long-term metabolic complications.
The pathogenesis, epidemiology, risk factors, complications, and management of infants born LGA will be reviewed here.
In general, LGA is defined as a birth weight (BW) greater than the 90th percentile for age. However, it has been suggested that the definition be restricted to infants with BW greater than the 97th percentile (2 standard deviations above the mean), as this more accurately describes infants who are at greatest risk for perinatal morbidity and mortality [1,2]. Using a national reference based on single live births in the United States, infants born at 40 weeks gestation at the 90th percentile had BW greater than 4000 g and those at the 97th percentile greater than 4400 g .
Macrosomia refers to excessive intrauterine growth beyond a specific threshold regardless of gestational age (GA). This condition usually is defined as a BW greater than 4000 or 4500 g. The American College of Obstetricians and Gynecologists (ACOG) supports use of the 4500 g threshold for diagnosis of macrosomia because morbidity increases sharply beyond this weight.
A grading system for macrosomia has been proposed based on BW (see "Fetal macrosomia", section on 'Definition'):To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Xu H, Simonet F, Luo ZC. Optimal birth weight percentile cut-offs in defining small- or large-for-gestational-age. Acta Paediatr 2010; 99:550.
- Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the united states: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol 2003; 188:1372.
- Alexander GR, Himes JH, Kaufman RB, et al. A United States national reference for fetal growth. Obstet Gynecol 1996; 87:163.
- Martin JA, Hamilton BE, Sutton PD, et al. Births: Final Data for 2006. Natl Vital Stat Rep 2010; 59:1. http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_01.pdf (Accessed on October 26, 2011).
- Surkan PJ, Hsieh CC, Johansson AL, et al. Reasons for increasing trends in large for gestational age births. Obstet Gynecol 2004; 104:720.
- Hadfield RM, Lain SJ, Simpson JM, et al. Are babies getting bigger? An analysis of birthweight trends in New South Wales, 1990-2005. Med J Aust 2009; 190:312.
- Kim SY, Sharma AJ, Sappenfield W, et al. Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births. Obstet Gynecol 2014; 123:737.
- Männik J, Vaas P, Rull K, et al. Differential expression profile of growth hormone/chorionic somatomammotropin genes in placenta of small- and large-for-gestational-age newborns. J Clin Endocrinol Metab 2010; 95:2433.
- Freemark M. Placental hormones and the control of fetal growth. J Clin Endocrinol Metab 2010; 95:2054.
- Filiberto AC, Maccani MA, Koestler D, et al. Birthweight is associated with DNA promoter methylation of the glucocorticoid receptor in human placenta. Epigenetics 2011; 6:566.
- Haworth KE, Farrell WE, Emes RD, et al. Methylation of the FGFR2 gene is associated with high birth weight centile in humans. Epigenomics 2014; 6:477.
- Homko CJ, Sivan E, Nyirjesy P, Reece EA. The interrelationship between ethnicity and gestational diabetes in fetal macrosomia. Diabetes Care 1995; 18:1442.
- DeVader SR, Neeley HL, Myles TD, Leet TL. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstet Gynecol 2007; 110:745.
- Linder N, Lahat Y, Kogan A, et al. Macrosomic newborns of non-diabetic mothers: anthropometric measurements and neonatal complications. Arch Dis Child Fetal Neonatal Ed 2014; 99:F353.
- Gillean JR, Coonrod DV, Russ R, Bay RC. Big infants in the neonatal intensive care unit. Am J Obstet Gynecol 2005; 192:1948.
- Spellacy WN, Miller S, Winegar A, Peterson PQ. Macrosomia--maternal characteristics and infant complications. Obstet Gynecol 1985; 66:158.
- Ju H, Chadha Y, Donovan T, O'Rourke P. Fetal macrosomia and pregnancy outcomes. Aust N Z J Obstet Gynaecol 2009; 49:504.
- Akinbi HT, Gerdes JS. Macrosomic infants of nondiabetic mothers and elevated C-peptide levels in cord blood. J Pediatr 1995; 127:481.
- Ahlsson FS, Diderholm B, Ewald U, Gustafsson J. Lipolysis and insulin sensitivity at birth in infants who are large for gestational age. Pediatrics 2007; 120:958.
- Groenendaal F, Elferink-Stinkens PM, Netherlands Perinatal Registry . Hypoglycaemia and seizures in large-for-gestational-age (LGA) full-term neonates. Acta Paediatr 2006; 95:874.
- Schaefer-Graf UM, Rossi R, Bührer C, et al. Rate and risk factors of hypoglycemia in large-for-gestational-age newborn infants of nondiabetic mothers. Am J Obstet Gynecol 2002; 187:913.
- Dollberg S, Marom R, Mimouni FB, Yeruchimovich M. Normoblasts in large for gestational age infants. Arch Dis Child Fetal Neonatal Ed 2000; 83:F148.
- Lackman F, Capewell V, Richardson B, et al. The risks of spontaneous preterm delivery and perinatal mortality in relation to size at birth according to fetal versus neonatal growth standards. Am J Obstet Gynecol 2001; 184:946.
- Lapunzina P, Camelo JS, Rittler M, Castilla EE. Risks of congenital anomalies in large for gestational age infants. J Pediatr 2002; 140:200.
- Sørensen HT, Sabroe S, Rothman KJ, et al. Relation between weight and length at birth and body mass index in young adulthood: cohort study. BMJ 1997; 315:1137.
- Seidman DS, Laor A, Gale R, et al. A longitudinal study of birth weight and being overweight in late adolescence. Am J Dis Child 1991; 145:782.
- Chiavaroli V, Giannini C, D'Adamo E, et al. Insulin resistance and oxidative stress in children born small and large for gestational age. Pediatrics 2009; 124:695.
- Darendeliler F, Poyrazoglu S, Sancakli O, et al. Adiponectin is an indicator of insulin resistance in non-obese prepubertal children born large for gestational age (LGA) and is affected by birth weight. Clin Endocrinol (Oxf) 2009; 70:710.
- Giapros V, Evagelidou E, Challa A, et al. Serum adiponectin and leptin levels and insulin resistance in children born large for gestational age are affected by the degree of overweight. Clin Endocrinol (Oxf) 2007; 66:353.
- Evagelidou EN, Kiortsis DN, Bairaktari ET, et al. Lipid profile, glucose homeostasis, blood pressure, and obesity-anthropometric markers in macrosomic offspring of nondiabetic mothers. Diabetes Care 2006; 29:1197.
- Paulson JF, Mehta SH, Sokol RJ, Chauhan SP. Large for gestational age and long-term cognitive function. Am J Obstet Gynecol 2014; 210:343.e1.
- RISK FACTORS AND ETIOLOGY
- Genetic factors
- - Genetic syndromes
- - Race and ethnicity
- Maternal factors
- - Maternal diabetes
- - Maternal prepregnancy weight
- - Excessive maternal weight gain
- Other factors
- NEONATAL COMPLICATIONS
- Birth injury
- Respiratory distress
- Other abnormalities
- - Hypoglycemia
- - Polycythemia
- - Perinatal asphyxia
- Congenital anomalies
- Neonatal mortality
- NEONATAL MANAGEMENT
- POTENTIAL LONG-TERM EFFECTS
- SUMMARY AND RECOMMENDATIONS