Giving birth to a macrosomic infant can have terrifying consequences!

Author｜Chuan Zhi Xiao Hong Lou: Liu Jiaojiao

Source｜Medical World Obstetrics and Gynecology Channel

The drama "The Story of Minglan" was a hit recently. It turns out that it wasn't just the empresses in the palace who had difficulty protecting their pregnancies; the ladies in these deep mansions also lived in constant fear, as if walking on thin ice.

For example, when the female protagonist's own mother was pregnant, the fetus was quite large. She should have been eating a light diet and exercising more, but others kept giving her "nutritious meals" and telling her to "lie down and not move." As a result, she died from postpartum hemorrhage during childbirth.

You might think this is just a TV drama, and it can't be that serious; a pregnant woman eating nutritious food is definitely good for the baby! Actually, that's not the case. The storyline is based on scientific principles…

Blindly supplementing nutrition may lead to overnutrition for mothers, and the newborn's weight may also "rise accordingly." In fact, research shows [1] that the normal weight range for a baby at birth (40 weeks) is 2820~3900g, and it is not the case that the bigger the better.

According to the scientific definition of obstetrics in China, a newborn with a birth weight equal to or greater than 4 kg is called a macrosomic infant. Macrosomia is a relatively common fetal complication in obstetrics and has become a high-risk factor for dystocia. The incidence of macrosomia in my country is about 7%[2]. However, with the improvement of living conditions, it has gradually increased in recent years, so pregnant mothers need to be more vigilant!

What are the factors that contribute to macrosomia (large baby)?

1. Genetic factors:

When it comes to diseases, people will think of genetic issues first. Of course, genetic factors do affect fetal weight, including fetal sex, race and ethnicity, and genetic factors of the father and mother. Related data show that normal male infants usually weigh about 200g more than female infants; and in the process of obesity, about 80% is caused by genetic factors[3], so genes are likely to determine the baby's weight.

2. Nutritional status:

In recent years, it has been found that a baby's birth weight is mainly related to the mother's nutritional status before pregnancy and nutritional intake during pregnancy. If the mother is overweight during pregnancy, it is easy for the baby to be overweight[4]. Not only that, the mother may also be more susceptible to gestational diabetes and hypertension, and may also be frequently tired and feel that her physical condition is not as good as before.

3. Advanced gestational age:

Studies have shown that the incidence of macrosomia is 20% at 40-42 weeks of gestation, and as high as 43% at 42-44 weeks of gestation[4]. The risk of giving birth to a macrosomic baby increases significantly when the gestational age is extended. Most importantly, the late stage of pregnancy is when the baby grows and develops the fastest. The longer the mother's gestational age, the longer the baby's rapid growth period. However, mothers should not panic. They should take active measures and cooperate with doctors to terminate the pregnancy in a timely manner to minimize the risk of prolonged pregnancy.

4. Multiple production runs:

Mothers who have given birth multiple times have looser abdominal and uterine walls, which increases the space for fetal growth; at the same time, insufficient attention to pregnancy and imbalanced nutrition supply lead to a surge in weight. Related data also show that as the number of pregnancies increases, the weight of the fetus increases significantly[5].

5. Gestational diabetes mellitus (GDM):

Pregnant women are prone to GDM during pregnancy, which is extremely dangerous: excess blood sugar from the pregnant woman can pass through the placenta into the fetus, but insulin cannot cross the placental blood barrier. When the fetus's blood sugar is consistently high, the fetus will activate its own small pancreas to secrete insulin, which will accelerate the fetus's metabolism, enhance growth and development, and thus increase its weight.

We understand that macrosomia (large baby) is influenced by a variety of factors, and pregnant mothers need to be constantly vigilant. So, is it easy for mothers to experience dystocia (difficult labor) when their baby is large? What challenges do mothers face when delivering a macrosomic infant? What are the potential dangers of childbirth with a macrosomic baby?

Giving birth to a macrosomic baby is a pain you can't imagine.

Because macrosomic infants are excessively large and have broad shoulders, mothers may face dystocia, increased postpartum bleeding, perineal tears, or even uterine rupture. Special attention should be paid to obese pregnant women, as excess fat accumulation and weak muscle strength can lead to uterine atony, prolonging labor and increasing the risk of postpartum hemorrhage.

At the same time, fetal distress and neonatal asphyxia may occur during childbirth, which increases the difficulty of delivery and the cesarean section rate for mothers.

In addition, macrosomic infants are prone to obesity in adulthood, gradually becoming a high-risk group for chronic diseases such as diabetes and hypertension, and even getting closer to prostate cancer or breast cancer[6].

Having said all that, how exactly should you supplement your diet during pregnancy?

Many mothers are still unclear about what supplements to take during pregnancy, when to take them, and how much to take. So let's learn how to maintain good health during pregnancy and prevent macrosomia (large baby) by referring to the "Dietary Guidelines for Chinese Residents" and clinical knowledge!

1. Achieve real-time monitoring:

A medical record is established from the start of pregnancy. Mothers need to have a routine prenatal check-up every 4 weeks in the early and mid-pregnancy (before 28 weeks) and every 2 weeks in the late pregnancy (28-40 weeks). The check-up usually includes weight, blood and urine routine tests, blood pressure and blood sugar, fetal heart rate monitoring, etc.

2. Understand the nutritional needs during pregnancy:

Folic acid: Folic acid is arguably the top nutrient for pregnancy health, an essential element for fetal growth and development. Women planning to conceive are advised to start taking 100μg to 300μg of folic acid daily before pregnancy. Throughout pregnancy, a daily oral folic acid supplement of 400μg is recommended, along with consuming 200g of folic acid-rich leafy green vegetables.

Energy: The basal metabolic rate gradually increases in the mid-to-late stages of pregnancy, so the Chinese Nutrition Society's Dietary Reference Intakes (DRIs) recommend that energy intake in the mid-to-late stages of pregnancy should be increased by 200 kcal per day compared to pre-pregnancy levels.

Protein: Pregnant women urgently need protein to promote the baby's growth and development, nourish the uterus and breasts, and prepare for childbirth. Therefore, DRIs recommend increasing protein intake by 5g, 15g, and 30g in the first, second, and third trimesters respectively, based on pre-pregnancy levels. This includes increasing intake of fish, poultry, eggs, lean meat, and 200g of milk. It is particularly noted that deep-sea fish are beneficial for the development of the fetal brain and retina, so it is best to consume them 2-3 times per week.

Calcium, iron, zinc, iodine, etc.: These are especially important for the health of pregnant women and fetuses. Calcium deficiency can cause calcium loss from the mother's bones, which can harm bone health. Therefore, it is recommended that the total calcium intake should reach 1000mg/day. Eat animal organs and meat to supplement iron in moderation. Eat iodized salt to supplement iodine in moderation.

Vitamins: During pregnancy, due to the dilution of blood plasma, the levels of most vitamins in the plasma decrease slowly. Therefore, it is recommended that pregnant women consume 300-500g of vegetables, mainly leafy green vegetables and red and yellow colored vegetables, and 200-400g of fruits to meet their vitamin requirements.

Carbohydrates: You must consume at least 130g of carbohydrates every day, which can be 200-250g of easily digestible grains, 50g of tubers, etc.

3. Appropriate exercise:

After 16 weeks of pregnancy, pregnant women can start moderate-intensity aerobic exercise and activities, such as prenatal yoga, gymnastics, brisk walking, swimming, and various household chores. This can improve insulin sensitivity, improve blood sugar and blood lipid levels, and reduce weight. Of course, you can choose the type of exercise according to your own condition and pre-pregnancy exercise habits, do what you can, and proceed gradually[7].

With the joint efforts of expectant mothers' families and doctors, it is hoped that pregnant mothers can maintain a reasonable diet, control their food intake, monitor their blood sugar and weight gain, and thus give birth to healthy babies, avoid macrosomia, and say goodbye to difficult labor and complications!