#431: "Hold Your Beer" It's Fetal Macrosomia Guidelines

Episode 431

This week Blyss and Stu go on a deep dive into macrosomia, also known as a large baby. They review extensive data from multiple sources, including ACOG, NICE guidelines, and the Big Baby Study, and discuss the implications of predicted and actual macrosomia. They discuss risk factors, maternal and fetal morbidity, ultrasound accuracy, the pros and cons of induction of labor, and the impact of the standard of care. As always, Blyss balances the conversation with discussing the stark contrast between the way macrosomic babies are cared for in the hospital v at home under the care of midwives. She shares tips on how to reduce the risks of macrosomia, especially when a mom is diabetic or has gestational diabetes.

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Studies Referenced

NICE Study: National Institute for Health and Care Excellence. “Induction of Labour for Suspected Fetal Macrosomia: Evidence Review A.” NICE Guideline NG207, [2021]. PDF.

Big Baby Study: Gardosi, Jason, et al. “Induction of Labour versus Standard Care to Prevent Shoulder Dystocia in Fetuses Suspected to Be Large for Gestational Age in the UK (the Big Baby Trial): A Multicentre, Open-Label, Randomised Controlled Trial.” The Lancet, vol. 405, no. 10491, 17 May 2025, pp. 1743–1756. DOI: 10.1016/S0140-6736(25)00162-X.

ACOG Practice Guidelines: American College of Obstetricians and Gynecologists. “Macrosomia.” Practice Bulletin: Obstetrics, Committee on Practice Bulletins—Obstetrics, William H. Barth Jr, MD, and Rebecca Jackson, MD, [2016] PDF.

Preyer, Oliver, et al. “Fetal Weight Estimation at Term—Ultrasound versus Clinical Examination with Leopold’s Manoeuvres: A Prospective Blinded Observational Study.” BMC Pregnancy and Childbirth, vol. 19, 2019, article 122.

In This Episode