Choosing Wisely:

Don’t recommend delivery in a nondiabetic patient for suspected macrosomia before 39 0/7 weeks of gestation.

Rationale and Comments: Recommendations regarding the optimal timing of delivery seek to balance maternal and perinatal risks. Delivery before 39 0/7 weeks of gestation without medical indication has been associated with increased adverse perinatal outcomes compared to those at or beyond 39 weeks of gestation. For suspected macrosomia, the accuracy of estimated fetal weight using sonographic and clinical estimates is inherently imprecise. In addition, the data comparing delivery to expectant management for suspected macrosomia are inconsistent with regard to reducing the risk of shoulder dystocia, especially when weighed against the harms of early delivery. Given the imprecision in fetal weight assessment, the increase in adverse perinatal outcomes, and the limited data demonstrating benefit, delivery before 39 weeks of gestation is not recommended for suspected macrosomia in nondiabetic patients.
Sponsoring Organizations:
  • Society for Maternal-Fetal Medicine
  • Sources:
  • ACOG guidelines
  • Disciplines:
  • Obstetrical
  • References: • Parikh LI, Reddy UM, Männistö T, et al. Neonatal outcomes in early term birth. Am J Obstet Gynecol. 2014;211(3):265.e1-265.e11.
    • American College of Obstetrics and Gynecology. Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol. 2020;135(1):e18-e35.

    Email Alerts

    Don't miss a single issue. Sign up for the free AFP email table of contents.

    Sign Up Now