FACTORS ASSOCIATED WITH FETAL MACROSOMIA AND MATERNAL-FETAL IMPLICATIONS: AN INTEGRATIVE REVIEW

Abstract

Objective: To analyze the factors associated with the development of fetal macrosomia and its maternal and neonatal implications in obstetric care. Methods: Integrative literature review conducted in PubMed, MEDLINE, LILACS, and SciELO databases, guided by the PICO framework. The search utilized DeCS/MeSH controlled descriptors. A total of 248 studies were identified, and after applying inclusion/exclusion criteria and critical appraisal, 12 articles were selected for the final synthesis. Results: The conceptual definition of fetal macrosomia requires strict differentiation: an absolute birth weight igual ou superior a 4,000 g defines macrosomia, whereas estimated fetal weight above the 90th percentile for gestational age characterizes large for gestational age (LGA) fetuses using standardized growth curves. Strongly associated factors include gestational or pre-gestational diabetes mellitus, maternal obesity, multiparity, excessive gestational weight gain, and advanced maternal age. Maternal complications demonstrated a magnitude equivalent to perinatal outcomes, notably uterine atony, postpartum hemorrhage, severe 3rd and 4th-degree perineal lacerations, and increased cesarean delivery rates. Neonatal complications included shoulder dystocia, clavicular fracture, brachial plexus injury, neonatal hypoglycemia, and perinatal asphyxia. Final Considerations: The management of fetal macrosomia demands rigorous prenatal care, metabolic screening, and gestational weight monitoring. Clinical decision-making regarding the mode of delivery must balancedly weigh maternal and neonatal risks to optimize outcomes.