Large for Gestational Age Babies(LGA)
An infant weighing more than the weight of 90% of infants born at the same gestational age is said to be large for gestational age. It is irrespective of whether the infant is born premature, postmature or at term, as its birth weight is compared with the birth weight of babies born at the same gestational age.
- Heredity is a reason, as babies born to large-sized parents tend to be large in size at birth.
- Mothers who are diabetic usually have large for gestational age babies
- Large for gestational age babies are often delivered by caesarean section.
- When diabetes of the mother is the reason for the large size of the baby, the risk of being obese in adulthood is high
Large for gestational age infants are more often born to mothers who have diabetes. Obese women, and those who have previous history of giving birth to large sized babies, have an increased risk of having large for gestational age babies. Sometimes, certain genetic conditions such as Sotos’ syndrome or Beckwith-Wiedemann syndrome may be the reason for large for gestational age stature of infant.
When an abundant quantity of nutrition is available in the womb, the fetus tends to grow larger. In women with diabetes, the fetus receives a larger than usual amount of glucose via the placenta. Consequently, the pancreas of the fetus produces higher levels of the hormone insulin to utilize the glucose. This leads to increased growth of the fetus, resulting in large size. All the organs of the fetus, except the brain, also grow faster.
Symptoms and Complications
Some of the complications usually occurring in large for gestational age babies, and the associated symptoms are:
Polycythemia or abnormally large number of red blood cells: When babies are born large for gestational age, they may have a reddish tint to the skin due to the excess of red blood cells present; a condition known as polycythemia. When a large number of these red blood cells break down, it results in large amounts of bilirubin in the blood. The liver may not be competent enough to handle the overload of bilirubin. When feeding is insufficient, the removal of bilirubin via the digestive process also may be minimal. Accumulation of this substance in the blood causes jaundice, characterized by the yellowing of the skin and the whites of the eye.
Hypoglycemia or Low blood levels of glucose: When mothers have diabetes, the growing fetus in the womb is used to a higher level of glucose supplied by the placenta. Consequently, the pancreas of the fetus is conditioned to producing higher levels of insulin. When the infant is delivered, and its connection to the maternal supply is severed, the availability of glucose suddenly stops, but the insulin production remains high. This leads to severe hypoglycemia or abnormally low blood sugar levels. The infant usually does not display any symptoms of hypoglycemia, but in some cases, lack of muscle tone and listlessness may indicate this condition. The large babies born to diabetic mothers are poor feeders in the initial days after delivery, which is another factor contributing to hypoglycemia.
Respiratory problems: When the mother has diabetes, the lung development in the fetus may be delayed. Problems with the lungs and breathing are common in babies born by caesarian delivery. Premature babies are especially prone to developing a condition called respiratory distress syndrome due to extreme immaturity of their lungs even when their prematurity is only by a few weeks.
Higher risk of having birth injuries: Large sized infants are at higher risk of suffering birth injuries during delivery, including fractures of the collar bone or clavicle. The nerves running to the arms may get stretched, resulting in injuries to the brachial plexus. The risk of severe birth injuries is further increased if the fetus is in a breech position as the large head may have difficulty passing through the mother’s pelvis. Large for gestational size babies are usually delivered by a C-section, especially when the fetus is in breech position.
When the mother has diabetes, the risk of the baby having birth defects is much higher when compared to babies born to mothers without the disorder. When babies are born large for gestational age due to the sole reason of their mothers being diabetic, they have a higher risk of being obese as adults. Since they are already genetically predisposed to Diabetes mellitus, (type 2 diabetes), obesity further increases their risk of developing the condition.
Treatment
The treatment depends on the symptoms and the complications present. Frequent oral feedings are given to avoid hypoglycemia or low blood sugar. Sometimes the infant is fed through a feeding tube passed into the stomach. Occasionally, intravenous administration of glucose may be necessary to prevent hypoglycemia. If respiratory distress syndrome is present, oxygen is given nasally via a tube. The baby may have to be hooked to a ventilator to assist respiration, if severe respiratory distress is present. Phototherapy is given to infants who show symptoms of jaundice.
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Yasser Elnahas
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