Macrosomia
Roya Sohaey, MD
DIFFERENTIAL DIAGNOSIS
Common
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Idiopathic Macrosomia
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Diabetes
Less Common
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Hydrops
Rare but Important
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Beckwith-Wiedemann Syndrome
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
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Large for gestational age fetus
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↑ Estimated fetal weight (EFW)
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> 90th or 95th percentile
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Birth weight > 4,000-4,500 g
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AC alone can predict macrosomia
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37% risk of macrosomia if AC > 37 cm
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< 1% risk of macrosomia if AC < 35 cm
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AC often 1st measurement to ↑
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↑ Glycogen stores in liver
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Truncal obesity
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Prevalence
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16-18% in diabetics
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6-8% in non-diabetics
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Helpful Clues for Common Diagnoses
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Idiopathic Macrosomia
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No fetal anomalies
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Hereditary factors (↑ risk if mom is large)
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1/3 with polyhydramnios
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Diabetes
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Polyhydramnios common
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Associated anomalies
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Caudal dysplasia/regression
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Open neural tube defect
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Cardiac anomalies (5x ↑ risk)
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Polydactyly
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GU/GI anomalies
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Single umbilical artery
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Helpful Clues for Less Common Diagnoses
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Hydrops
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Immune and nonimmune causes
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Excessive body fluid
large fetus-
Anasarca ± cystic hygroma
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Pleural effusion
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Ascites
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Helpful Clues for Rare Diagnoses
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Beckwith-Wiedemann Syndrome
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Signs/symptoms
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Macroglossia
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Enlarged internal organs (especially kidneys)
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Hemihypertrophy
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Omphalocele
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Prognosis
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20% infant mortality
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7-10% tumor risk (Wilms tumor most common)
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Other Essential Information
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Fetal complications of macrosomia
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Shoulder dystocia (10%)
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Asphyxia
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Hypoglycemia, hypocalcemia
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Macrosomia associated with polyhydramnios
Image Gallery
Axial ultrasound of the fetal abdomen shows increased truncal subcutaneous fat
 . The abdominal circumference measurement was 5 wks greater than the other fetal biometric measurements. Stay updated, free articles. Join our Telegram channel
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