What happens if your baby is measuring large for dates?

 

What happens if your baby is measuring large for dates? 

NHSPatient Information Leaflet

Large for Gestational Age (LGA)

What is a Large for Gestational Age (LGA) Baby?

🔹 Definition:

  • Babies weighing >4.5 kg (9 lbs 14.5 oz) at birth.
  • Defined as babies larger than 90th or 97th percentile on growth charts.

🔹 Individualized Growth Chart:

  • Created during your 12-week scan appointment, based on your height, weight, previous pregnancies, and ethnicity.

🔹 Prevalence:

  • About 5–8 out of 100 babies are identified as LGA.

Why Does it Matter if My Baby is LGA?

✅ Most large babies are healthy.
✅ 90% of women with LGA babies can have a vaginal birth.
⚠️ However, risks increase when:

  • Birthweight exceeds 4.5 kg.
  • Baby measures >97th percentile for gestational age on the growth chart.

What Causes a Baby to Be LGA?

  1. 🍭 Diabetes:

    • Pre-existing or gestational diabetes (GDM).

  2. 🤰 History of LGA Babies:

    • Previous baby weighing >4.5 kg at birth.

  3. ⚖️ Maternal Obesity/Overweight:

    • High BMI or excessive weight gain during pregnancy.

  4. 🧬 Genetics:

    • Parents who are taller or overweight tend to have larger babies.

  5. ⏳ Prolonged Pregnancy:

    • Gestation lasting 41 weeks or more.

What Are the Risks of Having an LGA Baby?

🌟 Most pregnancies with LGA babies are safe, but there are increased risks:

Maternal Risks:

  • 🏥 Cesarean Section (CS):
    • The likelihood of CS may double or more.
  • 🩸 Postpartum Hemorrhage (PPH):
    • Increased risk of significant blood loss after delivery.
  • 🧵 Perineal Tears:
    • Severe tears requiring stitches under anesthesia may be threefold higher, especially for first-time mothers.
  • ⏳ Delayed Labor Start:
    • Induction of labor (IOL) is more likely.

Neonatal Risks:

  • 💔 Shoulder Dystocia:
    • Baby’s shoulders may get stuck during delivery.
    • Occurs in 0.5% (1 in 200) of non-diabetic pregnancies.
  • 🦴 Birth Injuries:
    • Rarely, injuries like fractured clavicle (collarbone) or Erb’s Palsy (nerve damage).

How Do We Detect LGA Babies?

📊 Customized Growth Chart:

  • Tracks your baby’s expected growth pattern throughout pregnancy.

📏 Symphysis Fundal Height (SFH):

  • Measured at every antenatal visit after 26 weeks.
  • Plotted on the growth chart.

📷 Ultrasound Scan (USS):

  • Offered if SFH is larger than expected on two or more occasions.
  • Checks baby’s biometry (growth) and fluid volume.
  • Larger babies may have more fluid, but excessive fluid may indicate diabetes or infection.
    ⚠️ Accuracy decreases as pregnancy advances (10–15% error rate).

What Happens After the Assessment?

  1. Normal Growth:

    • Referred back to midwife for routine care.

  2. Suspected LGA Baby:

    • Glucose Tolerance Test (GTT):
      • Blood test to check for gestational diabetes.
      • Performed before 34 weeks (not reliable after this).
    • Consultant-led care beyond 34 weeks.

Induction of Labor (IOL)

  • 🔄 Routine: Offered at 39–40 weeks to reduce complications.
  • ⚖️ For Very Large Babies:
    • If EFW >5 kg or >97th percentile, cesarean section may be discussed.

What Happens During Labor?

  • 📈 Regular Monitoring:
    • Baby’s wellbeing and labor progress are continuously checked.
  • 🛑 Emergency Preparedness:
    • Midwives and doctors are trained to manage complications like shoulder dystocia or prolonged labor.

Is There Anything I Can Do to Reduce the Risk of an LGA Baby?

🌿 Healthy Lifestyle Choices:

  • Eat a balanced diet.
  • Engage in regular exercise.
    📞 Contact your midwife for personalized advice or a dietitian referral.

Summary

🔹 Large for Gestational Age (LGA): Refers to babies larger than most others at the same gestational age.
🔹 Key Points to Remember:

  • Most LGA babies are delivered safely.
  • Risks increase as weight or percentile rises.
  • Early identification and monitoring are crucial.
    🔹 Your Role: Maintain a healthy lifestyle and communicate with your healthcare team.






REFERENCES  National Institute for Health and Care Excellence, CG62 ‘ Antenatal Care for Uncomplicated Pregnancies’, March 2008. 

 National Institute for Health and Care Excellence, CG63 ‘ Diabetes in Pregnancy: Management from preconception to postnatal period’ February 2015. 

 NHS Choices: The UKs biggest health website, certified as a reliable source of health information- www.nhs.uk 

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