Fetal macrosomia and gestational diabetes: what's the problem?

OBJECTIVE

To review the definition of, morbidity attendant upon, and interventions designed to prevent fetal macrosomia in gestational diabetes.

DATA SOURCES

Both MEDLINE and manual searches of the Index Medicus from 1980-1992 for articles pertaining to fetal macrosomia were employed. Macrosomia was also cross-referenced with pregnancy in diabetes.

METHODS OF STUDY SELECTION

Seventy-nine articles that provided definitions, data, and opinions relevant to this topic were selected.

DATA EXTRACTION AND SYNTHESIS

There is no universally accepted definition of fetal macrosomia. Potential associated morbidities include birth trauma, neonatal hypoglycemia, and childhood and adolescent obesity. Maternal glucose intolerance, age, parity, race and ethnicity, weight, weight gain, smoking status, and fetal gender may influence birth weight. Not all of these factors have been considered in analyses of the impact of interventions designed to prevent macrosomia.

CONCLUSIONS

A consensus definition of fetal macrosomia is a necessary and attainable goal. Randomized trials are necessary in which all factors that influence fetal growth and development are uniformly analyzed to develop appropriate clinical interventions.