Walsh Jennifer M, McAuliffe Fionnuala M
UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2012 Jun;162(2):125-30. doi: 10.1016/j.ejogrb.2012.03.005. Epub 2012 Mar 27.
Fetal macrosomia is associated with significant maternal and neonatal morbidity. In the long term, infants who are large for gestational age are more likely than other infants to be obese in childhood, adolescence and early adulthood, and are inherently at higher risk of cardiovascular and metabolic complications in adulthood. With over one billion adults in the world now overweight and more than 600 million clinically obese, preventing the vicious cycle effect of fetal macrosomia and childhood obesity is an increasingly pertinent issue. Fetal growth is determined by a complex interplay of various genetic and environmental influences. Consequently the prediction of pregnancies at risk of pathological overgrowth is difficult. Many risk factors for fetal macrosomia, such as maternal obesity and advanced maternal age, are also conversely associated with intrauterine growth restriction. Sonographic detection of fetal macrosomia is notoriously fraught with difficulties, with dozens of formulas for estimated fetal weight proposed but few with sufficient sensitivity to alter clinical practice. This calls into question policies of elective delivery based on projected estimated fetal weight cut-offs alone. More recently the identification of markers of fetal adiposity and maternal serum biomarkers are being investigated to improve the antenatal detection of the large for gestational age fetus. Prevention of fetal macrosomia is entirely dependent upon correct identification of those at risk. Maternal weight, gestational weight gain and glycaemic control are the risk factors for fetal macrosomia that are most amenable to intervention, and have potential maternal health benefits beyond pregnancy and childbirth. The ideal method of optimising maternal weight and glucose homeostasis is yet to be elucidated, though a number of promising advances are recently being reported. In this review we outline the contemporary evidence for the prediction and prevention of fetal macrosomia, which is indeed a contemporary dilemma.
巨大胎儿与显著的母体和新生儿发病率相关。从长远来看，大于胎龄儿在儿童期、青春期和成年早期比其他婴儿更易肥胖，并且成年后患心血管和代谢并发症的固有风险更高。鉴于目前全球有超过10亿成年人超重，超过6亿人临床肥胖，预防巨大胎儿和儿童肥胖的恶性循环效应已成为一个日益相关的问题。胎儿生长由多种遗传和环境影响的复杂相互作用决定。因此，预测有病理过度生长风险的妊娠很困难。许多巨大胎儿的风险因素，如母体肥胖和高龄产妇，也与宫内生长受限呈相反关联。超声检测巨大胎儿 notoriously fraught with difficulties，虽然提出了几十种估计胎儿体重的公式，但很少有公式具有足够的敏感性来改变临床实践。这对仅基于预计估计胎儿体重临界值的选择性分娩政策提出了质疑。最近，正在研究胎儿肥胖标志物和母体血清生物标志物的识别，以改善对大于胎龄胎儿的产前检测。预防巨大胎儿完全取决于正确识别有风险的人群。母体体重、孕期体重增加和血糖控制是巨大胎儿最易于干预的风险因素，并且对母体健康的益处可能超出妊娠和分娩期。尽管最近有一些有前景的进展被报道，但优化母体体重和葡萄糖稳态的理想方法仍有待阐明。在本综述中，我们概述了预测和预防巨大胎儿的当代证据，这确实是一个当代难题。 （注：原文中“notoriously fraught with difficulties”直译为“众所周知充满困难”，但放在语境中表述稍显生硬，可根据具体情况灵活调整译文，这里保留原文表述供你参考。）
