Big for gestational age

Large for Gestational Age and Obesity-Related Comorbidities

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Large for Gestational Age: Meaning and Complications

Written by Sarah Vallie

Reviewed by Dan Brennan, MD on July 24, 2022

What Does Large for Gestational Age Mean?

If your provider tells you that your baby is large for gestational age (LGA), that means that your baby measures larger than the doctor would expect for how far along you are in your pregnancy or how far along you were when the baby was born.

Gestational age is calculated by determining the first day of your last period. This means that at the time of ovulation, you may already be two weeks into your pregnancy. By the time someone misses their first period, they are already four weeks along. Therefore, even if you think you know the date of conception, your calculated due date may be different than your doctor’s.

If your periods are irregular, your doctor can also estimate gestational age with an ultrasound. The most accurate guesses for gestational age via ultrasound are from ultrasounds done sometime between the 8th and 18th weeks.

A fetus may be described as large for gestational age if they measure larger than their gestational age would usually indicate. A newborn baby is classified as large for gestational age if they are in the 90th percentile for their weight.

Large for Gestational Age Causes

A few factors can cause a fetus or baby to be large for gestational age, and some are more a cause for concern than others.

Incorrect estimated gestational age. The simplest, least concerning cause of a fetus or baby being LGA is that your doctor miscalculated gestational age. This can happen if your menstrual cycle is irregular, if you don’t remember when your last cycle was, if you take hormones or hormonal birth control, or if the doctor miscalculated from the ultrasound or the ultrasound was difficult to see.

Diabetes. Diabetes is the number-one cause of LGA babies. This includes gestational diabetes and those who had diabetes before pregnancy.

Gestational diabetes is diabetes that occurs in pregnancy and often goes away after pregnancy. Researchers don’t know exactly why some pregnancies include gestational diabetes, and some don’t. The best guess is that, as hormones change within your body, sometimes those changes cause the body to have a difficult time managing blood sugar.

Someone with diabetes before pregnancy also has a higher chance of having an LGA baby, especially if their diabetes is not well managed. A person with diabetes may pass their high blood sugar on to their fetus, whose body then, in turn, makes extra insulin to compensate. This excess insulin can lead to fast growth and fat deposits.

Size of the Parents. Genetics may contribute to the fetus or baby’s size. Parents with a larger stature are more likely to have babies that are large as well.

Gaining too much weight during pregnancy can also contribute to an LGA baby. Some weight gain during pregnancy is expected, but how much weight you should safely gain will depend on many factors like your pre-pregnancy size and activity levels. Much of this weight gain comes from simply growing another human, but too much excess weight gain can result in a large baby.

Complications of LGA Babies

In some cases, complications may arise if your baby is large for gestational age. The severity of these complications depends on what caused the LGA and the baby’s size.

Delivery Complications. Sometimes, the LGA baby is too large to fit easily into the birth canal, which can cause delivery complications. These include:

Prolonged labor and delivery.Prolonged labor creates its own complications. A baby stuck in a prolonged labor might not get enough oxygen. They may also get an infection, get sepsis, or aspirate meconium, the infant’s first bowel movement.
Difficult birth. A difficult birth isn’t just a long labor. A difficult birth can also include high-stress labor and delivery. It may also include the need for extra intervention, which could be the use of forceps, a vacuum extractor, or an episiotomy to get the baby out.
Birth injuries. If the baby has difficulty getting through the birth canal, injuries like a broken collarbone or damaged arm nerves may occur. Other complications, like brain trauma or cerebral palsy, may occur if the baby doesn’t get adequate oxygen.
Increased risk of cesarean delivery. While many pregnant patients have successful cesarean deliveries, an emergency cesarean can be incredibly scary. C-sections also have their own risks, such as an increased risk of heavy bleeding and blood clots. They may lead to a longer recovery time than a vaginal delivery.

Blood sugar complications. Why are LGA babies at risk for hypoglycemia? Hypoglycemia, or low blood sugar, occurs if the LGA is caused by gestational or poorly-controlled diabetes. While the baby is in utero, its body produces excess insulin to accommodate the high blood sugar it’s getting. After birth, the baby no longer has that supply of high sugar but still has high insulin. This can cause blood sugar levels to plummet, resulting in hypoglycemia.

Other complications for babies born to diabetic patients may include breathing difficulties, increased risk of obesity and type II diabetes later in life, and can even be stillborn if the diabetes is left untreated.

What to Do If You’re Concerned

If you have an LGA pregnancy or are concerned that your baby will be large, the best thing you can do is talk to your doctor. Together, the two of you can work out a plan for how you want your birth to go and what contingencies you may need to put in place.

Use of various methods to detect large (for gestational age) fetus sizes to improve health outcomes

What is the problem (question)?

The baby (during fetal development) can sometimes grow to a size larger than expected and gain a high body weight by the time of birth. If overgrowth is suspected, the mother-to-be may require additional unscheduled antenatal visits [antenatal visits] and examinations to assess her health and the health of her developing baby.

Why is this important?

Examination can show if there are signs of any deterioration in the condition of the infant or the development of complications in the mother. The recommended frequency and combinations of types of examination (tests) vary in local protocols and guidelines. The examination may include counting fetal movements, assessing fetal heartbeats (cardiotocography), checking the mother's blood sugar or using ultrasound to determine fetal growth, Doppler ultrasound of the fetal blood vessels, and assessing fluid volume around the infant.

Large fetal (infant) size is associated with increased risk for both mother and infant, including increased risk of fetal death and stillbirth. At birth, such a baby has a higher risk of low oxygen levels, shoulder dystocia [difficulty in labor], nerve damage, bone fractures, low blood sugar, and admission to the neonatal intensive care unit. Maternal complications include prolonged labor, operative labor including caesarean section, perineal trauma, postpartum hemorrhage, and uterine ruptures.

Interventions that can slow accelerated fetal growth and improve maternal and child health outcomes include dietary advice, lifestyle changes, and blood glucose control and insulin therapy in women with diabetes or gestational diabetes.

What evidence did we find?

We searched for studies up to 10 August 2015, but did not find any randomized controlled trials investigating the effect of additional testing (examination) on health outcomes in pregnant women with post-infant overgrowth. 20 weeks pregnant.

What does this mean?

Randomized controlled clinical trials are needed in this area to inform clinical practice when a large fetus/infant is detected during pregnancy, to assess whether additional testing (examination) or observation can improve the health of these women and their children. It is also important to identify any harm that may be associated with additional testing and follow-up. identifying women with suspected large fetuses may lead to unnecessary maternal anxiety through additional investigations and interventions, including induction of labor or caesarean section.

Translation notes:

Translation: Yudina Ekaterina Viktorovna. Editing: Ziganshina Lilia Evgenievna. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions regarding this transfer, please contact us at: [email protected]

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Surely you have heard how after giving birth a large baby is called a “hero”? In fact, very often (although not always) the birth of a child over 4500 g indicates problems during pregnancy and / or carries risks directly during and after childbirth.
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Gynecologist Anna Kolyadina about a fetus that is too large for her gestational age and, accordingly, a large newborn.
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So, the diagnosis of fetal macrosomia is made if, during a full-term pregnancy, the child was born more than 4000-4500 g (in different countries, different upper limits), or more than 90-95 percentile for a given period.
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Why is fetal macrosomia dangerous?
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For the mother:
🔸Long labor
🔸Increased likelihood of operative vaginal delivery (vacuum extractor) or caesarean section
🔸Ruptures of the vagina, perineum of varying degrees
🔸Risk of postpartum hemorrhage
🔸In rare cases, rupture of the uterus
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During childbirth for the fetus: manipulations). This situation increases the likelihood of trauma to the baby and mother during childbirth
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For newborns:
🔺 Hypoglycemia (low glucose levels)
🔺 Polycythemia (elevated hematocrit and hemoglobin, which can lead to increased blood viscosity)
🔺 Respiratory problems, risk of perinatal asphyxia
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delayed consequences for children:
▪ ▪ The carbohydrate metabolism
▪ Metabolic syndrome
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Risk factors that increase the likelihood of a large child:
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✔ Claus. a child over 4000 g in a previous pregnancy
✔ Mother's own birth weight over 4000 g
✔ Rarely - some hereditary syndromes
✔ Postterm pregnancy
✔ Maternal obesity
✔ Excessive weight gain during pregnancy (with a normal BMI and weight gain of more than 16 kg, the risk of having a fetus with macrosomia increases by 2.5 times) : many women who have given birth to large children do not have three main factors (obesity, diabetes and overweight)! Probably, the role of genetic and epigenetic factors is also great.
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❓Why the fetus weighs more than it should
It is believed that the main mechanism for the development of fetal macrosomia is an increased level of glucose in a pregnant woman, which, in turn, leads to its increased level in the fetus. As a result, the level of insulin, IGF and growth hormone begins to “storage” fat by the fetus.
Other parameters associated with the risk of macrosomia include elevated triglycerides (⬆️risk) and HDL (⬇️risk) in the mother.

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DIAGNOSTICS
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During pregnancy, the large size of the fetus and large weight can be determined using ultrasound (the closer the ultrasound date to childbirth, the more accurate the weight forecast for the newborn)
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During routine visits to the gynecologist, suspicion of a large the fetus can occur when it is palpated and measuring the height of the fundus of the uterus. But this method is quite subjective and imprecise.
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PREVENTION
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All of the above was not intended to scare the expectant mother, but to convey an important message: most macrosomia risk factors can be corrected!
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In diabetes or gestational diabetes, prevention of fetal macrosomia is GLUCOSE CONTROL and maintenance of its target values.