Macrosomia has its roots in early placental development

Abstract

Introduction We sought to determine if early placental size, as measured by 3-dimensional ultrasonography, is associated with an increased risk of delivering a macrosomic or large-for-gestational age (LGA) infant. Methods We prospectively collected 3-dimensional ultrasound volume sets of singleton pregnancies at 11–14 weeks and 18–24 weeks. Birth weights were collected from the medical records. After delivery, the ultrasound volume set were used to measure the placental volume (PV) and placental quotient (PQ=PV/gestational age), as well as the mean placental and chorionic diameters (MPD and MCD, respectively). Placental measures were analyzed as predictors of macrosomia (birth weight ≥4000 grams) and LGA (birth weight ≥90th percentile). Results The 578 pregnancies with first trimester volumes included 44 (7.6%) macrosomic and 43 (7.4%) LGA infants. 373 subjects also had second trimester volumes available. A higher PV and PQ were both significantly associated with macrosomia and LGA in both the first and second trimesters. Second trimester MPD was significantly associated with both outcomes as well, while second trimester MCD was only associated with LGA. The above associations remained significant after adjusting for maternal demographic variables such as race, ethnicity, age and diabetes. Adjusted models yielded moderate prediction of macrosomia and LGA (AUC: 0.71–0.77). Conclusions Sonographic measurement of the early placenta can identify pregnancies at greater risk of macrosomia and LGA. Macrosomia and LGA are already determined in part by early placental growth and development.

Macrosomia. A Systematic Review of Recent Literature

“…The insulin growth factor II secreted by the obese pregnant women stimulates the placental growth [1]. A large size placenta in the first trimester of pregnancy allows a bigger nutrient transfer, and this rate of exchange remains throughout the whole pregnancy [3].…”

Rates and Risk Factors in Macrosomic Newborns among Non-Diabetic Parturients at Tiznit City, Morocco: A Case-Control Study

“…Several epidemiologic studies have focused on this condition, and have identified a number of risk factors for macrosomic births. These encompass preexisting maternal diabetes, maternal age over 40 years, multi-parity, high pre-gravid body mass index (BMI ≥ 25 kg/m²), maternal height (≥165 cm), excessive gestational weight gain (GWG), male sex, prolonged gestation (>41 weeks), placental factors, parental non-smoking status, preexisting gestational diabetes, maternal obesity/overweight, and lifestyle behaviors [5]. Although macrosomia's risk factors have been well studied, the reasons behind it are still complex and unclear.…”

Accelerated fetal growth in early pregnancy and risk of severe large‐for‐gestational‐age and macrosomic infant: a cohort study in a low‐risk population

“…However, in the analysis restricted to healthy mothers with normal BMI and without gestational diabetes, a discrepancy of at least 7 days was still associated with a 70 and 110% increased risk of severely LGA birth and macrosomia, respectively. Our findings suggest that accelerated fetal growth may start early in pregnancy and be present among normal‐weight mothers and when clinical signs of gestational diabetes are absent .…”