Gestational Diabetes Mellitus and Macrosomia: A Literature Review

Abstract

Background: Fetal macrosomia, defined as a birth weight ≥4,000 g, may affect 12% of newborns of normal women and 15-45% of newborns of women with gestational diabetes mellitus (GDM). The increased risk of macrosomia in GDM is mainly due to the increased insulin resistance of the mother. In GDM, a higher amount of blood glucose passes through the placenta into the fetal circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia, which is also called ‘large for gestational age'. This paper reviews studies that explored the impact of GDM and fetal macrosomia as well as macrosomia-related complications on birth outcomes and offers an evaluation of maternal and fetal health. Summary: Fetal macrosomia is a common adverse infant outcome of GDM if unrecognized and untreated in time. For the infant, macrosomia increases the risk of shoulder dystocia, clavicle fractures and brachial plexus injury and increases the rate of admissions to the neonatal intensive care unit. For the mother, the risks associated with macrosomia are cesarean delivery, postpartum hemorrhage and vaginal lacerations. Infants of women with GDM are at an increased risk of becoming overweight or obese at a young age (during adolescence) and are more likely to develop type II diabetes later in life. Besides, the findings of several studies that epigenetic alterations of different genes of the fetus of a GDM mother in utero could result in the transgenerational transmission of GDM and type II diabetes are of concern.

Serum Fructosamine and Glycosylated Hemoglobin in Monitoring the Glycemic Control in Gestational Diabetes Mellitus

“…In addition; Kc et al, reported that the fetal macrosomia is a common adverse outcome of GDM if unrecognized and untreated properly [29]. Kc et al, concluded that the fetal macrosomia increases the risk of shoulder dystocia, clavicle fractures, brachial plexus injury, NICU admissions, cesarean delivery, postpartum hemorrhage, and vaginal lacerations [29].…”

“…Kc et al, concluded that the fetal macrosomia increases the risk of shoulder dystocia, clavicle fractures, brachial plexus injury, NICU admissions, cesarean delivery, postpartum hemorrhage, and vaginal lacerations [29].…”

Postnatal Prevention of Childhood Obesity in Offspring Prenatally Exposed to Gestational Diabetes mellitus: Where Are We Now

“…Finally, birth weight is also considered as a significant predictor of childhood obesity risk [26]. In GDM pregnancy, maternal hyperglycemia leads to fetal hyperinsulinemia, which increases fetal growth and then the risk of being born with a high birth weight [27]. Some authors suggested that the association between exposure to GDM and obesity risk in childhood would be partially explained by elevated birth weight, highlighting the importance to consider this cofactor in analyses [28].…”

Relationship Between Clinical, Placentary, Obstetric and Neonatal Aspects and Intrauterine Growth in High Risk Pregnancies

“…3 The incidence of mortality in preterm newborns is higher if IUGR is also present, increasing the perinatal mortality percentages by two to ten times. 9 Just as IUGR may result in adults with diseases, macrosomia in adulthood can also trigger obesity, dyslipidemia, hypertension and type 2 diabetes. 8 Fetal macrosomia is the term used to define fetuses or newborns considered abnormally large, weighing 4000 grams or more; large for gestational age (LGA) newborns are those who are above the 90 th percentile for gestational age.…”

“…Macrosomia is observed among cases with poorly controlled diabetes, those with long evolution and those with vascular alterations. 8 Understanding the relevance of IUGDs as a predisposing factor to the increased risk of fetal/ neonatal morbidity and mortality, and recognizing deviations as well as their etiopathogenesis is extremely important, 9 being a fundamental task in quality prenatal care.…”