Large for gestational age
Classification and external resources
LGA: A healthy 11-pound newborn boy, delivered vaginally without complications (41 weeks; fourth child; no gestational diabetes)
ICD-10	P08.
ICD-9	766
DiseasesDB	21929
MedlinePlus	002251
eMedicine	med/3279
MeSH	D005320

Large for gestational age (LGA) babies are those whose birth weight lies above the 90th percentile for that gestational age. Macrosomia, also known as big baby syndrome, is sometimes used synonymously with LGA, or is otherwise defined as a fetus that weighs above 4000 grams (8 lb 13 oz) or 4500 grams (9 lb 15 oz) regardless of gestational age.

Contents 1 Diagnosis 2 Predetermining factors 3 Treatment 4 References

[edit] Diagnosis

LGA is generally not diagnosed until after the birth, as the size and weight of the child is rarely checked during the latter stages of pregnancy. Babies that are large for gestational age throughout the pregnancy can sometimes be seen during a routine ultrasound, although fetal weight estimations late in pregnancy are quite imprecise.^[1]

There are believed to be links with polyhydramnios (excessive amniotic sac fluid).

[edit] Predetermining factors

One of the primary risk factors is poorly-controlled diabetes, particularly gestational diabetes (GD), as well as preexisting diabetes mellitus (DM). This increases maternal plasma glucose levels as well as insulin, stimulating fetal growth. The LGA newborn exposed to maternal DM usually has an increase only in weight. LGA newborns that have complications other than exposure to maternal DM present with universal measurements >90th percentile.

Other determining factors include:

• Gestational age; pregnancies that go beyond 40 weeks increase incidence
• Fetal sex; male infants tend to weigh more than female infants
• Genetic factors; taller, heavier parents tend to have larger babies, with an obese mother greatly increasing the chances
• Excessive maternal weight gain
• Maternal Diabetes
• Multiparity (have 2-3x the number of LGA infants vs. primaparas)
• Congenital anomalies (transposition of great vessels) - Hydrops Fetalis
• Erythroblastosis fetalis - Hydrops Fetalis
• Use of some antibiotics (amoxicillin, pivampicillin) during pregnancy - Hydrops Fetalis

The condition is most common in mothers of African origin, partly due to the higher incidence of diabetes.

[edit] Treatment

Depending upon the relative size of the head of the baby and the pelvic diameter of the mother vaginal birth may become complicated. One of the most common complications is shoulder dystocia. Such pregnancies often end in caesarean sections in order to safely deliver the baby and to avoid birth canal lacerations. Upon birth, early feeding is essential to prevent fetal hypoglycemia. Early diagnosis of individual problems is required.

[edit] References

v • d • e Certain conditions originating in the perinatal period / fetal disease (P, 760-779) Maternal factors and complications placenta (Placenta praevia, Placental insufficiency) · Chorion/Amnion/Umbilical cord Chorioamnionitis  · Umbilical cord prolapse · Nuchal cord  · Twin-to-twin transfusion syndrome Length of gestation and fetal growth Small for gestational age · Large for gestational age · Preterm birth · Postmature birth Birth trauma Cephalhematoma · Brachial plexus lesion (Erb's palsy, Klumpke paralysis) By system Respiratory Intrauterine hypoxia · Infant respiratory distress syndrome · Transient tachypnea of the newborn · Meconium aspiration syndrome · pleural disease (Pneumothorax, Pneumomediastinum) · Wilson-Mikity syndrome · Bronchopulmonary dysplasia Cardiovascular Pneumopericardium · Persistent fetal circulation Haemorrhagic and haematological/ hematologic disease Vitamin K deficiency (Haemorrhagic disease of the newborn) · Hemolytic disease of the newborn (ABO HDN • Anti-Kell HDN • Rhesus c HDN • Rhesus D HDN • Rhesus E HDN) · Rh disease · Hydrops fetalis · Hyperbilirubinemia (Kernicterus, Neonatal jaundice) Velamentous cord insertion Digestive system Ileus · Necrotizing enterocolitis · Meconium peritonitis Integument and temperature regulation Erythema toxicum Nervous system Periventricular leukomalacia Musculoskeletal system Gray baby syndrome · muscle tone (Congenital hypertonia, Congenital hypotonia) Other disorders Perinatal infection (Congenital rubella syndrome, Neonatal herpes simplex) · Omphalitis Stillbirth/Perinatal mortality obstetric navs: pregnancy, conditions of mother/conditions of fetus, eponymous signs, proc