Can fetal macrosomia be predicted and prevented?

There is no consensus about the definition of macrosomia. Some authors prefer large for gestational age (LGA) (>90th%) and others birth weights (BW) of ≥4.0 kg, ≥4.1 kg, or ≥4.5 kg. ^{1 – 3} The American College of Obstetricians and Gynecologists (ACOG) defines macrosomia as an infant with a BW of ≥4.5 kg irrespective of gestational age or other demographic characteristics. ⁴ The use of centiles depends on the pregnancy being accurately dated by ultrasound, and this may not be possible in resource-poor settings. Macrosomia based on BW >4.0 kg in our hospital would include 12%–13% of neonates. ⁵ Adverse clinical consequences in this group are uncommon. This definition makes little sense because adverse consequences for a BW of 4.0–4.5 kg may occur, and any interventions have not been shown to improve clinical outcomes.