Large for Gestational Age

Large for gestational age (LGA) refers to newborns whose weight exceeds the typical range for
their gestational age. Specifically, infants are categorized as LGA if their weight surpasses that
of 90% of babies at the same gestational age. In the United States, newborns weighing over 8
pounds, 13 ounces (4,000 g) at 40 weeks gestation fall into the 90th percentile for weight.

Classification:

 LGA at Lighter weights – infants delivered before reaching 40 weeks gestation.

 LGA at slightly higher weights - those born after 40 weeks

Generally, newborns in the United States now tend to weigh slightly more compared to previous
years. Additionally, normal birth weight ranges may vary depending on ethnic backgrounds.

Etiology

Some infants inherit their size from their parents, who may themselves be larger individuals.
This hereditary trait can be passed down to their offspring. Additionally, a newborn's weight at
birth can be influenced by the weight of the birth parent prior to pregnancy or weight gained
during pregnancy. Pregnant individuals who have a higher pre-pregnancy weight or experience
significant weight gain during pregnancy often give birth to infants classified as large for
gestational age (LGA). Genetic factors may also contribute to the likelihood of a baby being
LGA.

However, the most common cause of LGA babies is diabetes in the pregnant individual. When a
pregnant person has elevated blood sugar levels, it can be transmitted to the baby. Consequently,
the baby's body produces insulin in response. All the excess sugar and insulin production can
result in rapid growth and accumulation of fat, leading to a larger-than-average baby. Moreover,
this scenario poses a risk of low blood sugar levels shortly after birth, as the maternal supply of
sugar is no longer available, yet the baby's insulin levels remain elevated.

Possible Complications

If an infant is too large to pass through the birth canal easily, labor and delivery can become
challenging, potentially resulting in various complications such as:

 Prolonged delivery duration

 Difficulties during childbirth
 Injuries to the newborn, such as fractures in the collarbone or damage to the nerves in the
arm (brachial plexus)
 Increased likelihood of requiring a cesarean section
Many large babies are born to mothers with diabetes, and inadequately managed blood sugar
levels can lead to additional issues, including:

 Hypoglycemia (low blood sugar) in the newborn during the initial hours after birth
 Elevated risk of birth defects
 Respiratory problems
 Potential aspiration of meconium into the lungs around the time of birth

LGA infants are also more susceptible to polycythemia, characterized by an excessive amount of
red blood cells. As these cells break down, the liver may struggle to process the increased
bilirubin levels, potentially leading to jaundice.

Diagnostic Tests

Babies experiencing this issue are frequently diagnosed before birth. Throughout pregnancy,
various methods can be employed to estimate the size of the baby. One method involves
measuring the height of the pregnant individual's uterus from the pubic bone. Typically, this
measurement in centimeters correlates with the number of weeks of pregnancy after the 20th
week. If the measurement exceeds expectations for the given number of weeks, it suggests that
the baby may be larger than anticipated. Before birth, healthcare professionals use the term "fetal
macrosomia" instead of LGA.

Additional methods for assessing fetal growth before birth include:

 Ultrasound: This diagnostic test utilizes sound waves to generate images of the baby and
the internal structures of the pregnant individual's body. While it is a more precise
method for estimating the baby's size, it is not entirely precise. Measurements can be
taken of the baby's head, abdomen, and upper leg bone to monitor their growth rate.
 Maternal weight gain during pregnancy: This factor can also influence the baby's size.
Excessive weight gain during pregnancy may lead to a larger-than-normal baby.

Following birth, babies are weighed within the first few hours, and their weight is compared to
their gestational age, with the information recorded in their medical records.

Treatment

 Planned cesarean section. If ultrasound examinations conducted during pregnancy

reveal that your baby is significantly oversized, your healthcare provider might suggest
early delivery. In such cases, a planned cesarean section may be necessary.
 Thorough examination. Following birth, a baby identified as large for gestational age
will undergo thorough examination to detect any injuries sustained during the birthing
process.
  Blood Glucose Testing. The baby may undergo blood glucose testing for a minimum of
12 hours post-birth to monitor for signs of low blood sugar.

Prevention

Consistent prenatal care holds significance in every pregnancy. Routine check-ups enable your
healthcare provider to monitor your baby's growth. If your baby appears larger than anticipated,
it could signal underlying issues such as undiagnosed diabetes. To mitigate certain risks for your
baby:
 Manage your diabetes effectively.
 Monitor your weight.
 Adhere to your healthcare provider's guidance.

Key points regarding infants classified as large for gestational age:

 Infants are categorized as large for gestational age if their birth weight exceeds the
expected weight for their gestational age (number of weeks of pregnancy).
 Diabetes stands as the primary cause of infants born large for gestational age.
 Difficulties during delivery can arise if the baby is too large to pass through the birth
canal easily.
 If ultrasound examinations during pregnancy indicate significant fetal size, early delivery
might be recommended by your healthcare provider.
 Regular prenatal check-ups play a crucial role in identifying whether the baby's size is
excessive.

Reference:

Freeborn, D., Terrell, M., & Wojcik, S. (n.d.). Large for gestational age. University of Rochester
Medical Center. https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=90&ContentID=P02383