TITLE:
Fetal and Maternal Pregnancy Outcomes in the Presence of Macrosomia: Impact of Prenatal Detection
AUTHORS:
Thando Gwetu, Ahminah Fakier, Gregory Petro
KEYWORDS:
Postpartum Depression, Prevalence, EDPS, Buea Health District, Cameroon
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.16 No.8,
August
6,
2026
ABSTRACT: Introduction: A pregnancy with a macrosomic fetus is a high-risk condition. This research study sought to describe local methods for prenatal identification of macrosomia and to assess the impact of prenatal detection of macrosomia on neonatal and maternal pregnancy outcomes. Methods: Retrospective one-year file audit of pregnancies with delivery of a macrosomic baby born between 01/01/2022 and 31/12/2022 at New Somerset Hospital, Cape Town. This study assessed the health profile of pregnant women, including risk factors, clinical investigations, method of delivery, timing of delivery, and occurrence of neonatal and maternal complications. This research study was approved by the University of Cape Town Health Research Ethics Committee and the Western Cape Government, Department of Health. Results: Macrosomia occurred in 268/5855 (4.6%) of deliveries. Prenatal detection rate was 54.1%. SFH was more widely used (95.1%) compared to ultrasound (80.9%), although detection rates for macrosomia were higher with USS (45.6% vs 38%). Detection was influenced by maternal rather than fetal factors, e.g., IGT/GDM (p = 0.02), high BMI ≥ 30 (p = 0.01), previous CS (p = 0.027), previous macrosomia (p = 0.004), and EGA ≥ 40 weeks (p = 0.026). Most deliveries (84.3%) occurred in the 39 - 41 week range. Maternal complications occurred with 125 (46.6%) mothers, of which 68 (54.4%) were pregnancies with prenatal detection of macrosomia. The composite adverse maternal peripartum outcome occurred in 68/145 (46.9%) [Odds ratio 1.01, confidence interval (95% CI) 0.8 to 1.3] with prenatally detected macrosomia, versus 57/123 (46.3%) [OR 0.99, 95% CI 0.8 to 1.2] in the undetected group. The crude relative risk was 1.02 (95% CI 0.6 to 1.7). Shoulder dystocia occurred equally between the detection groups. Fetal complications occurred in 129 (48.1%) pregnancies, of which macrosomia was prenatally detected in 76 (58.9%). NICU admission rate was 13.1%. The composite adverse fetal perinatal outcome occurred in 52.4% infants [Odds ratio 1.2, 95% CI 0.9 to 1.6] for detected pregnancies versus 53/123 (43.1%) [OR 0.8, 95% CI 0.7 to 1.1] undetected. Conclusion: Prenatal detection occurred in about half of the study cases, with USS showing a higher detection rate than SFH monitoring. Composite maternal and fetal adverse outcomes were broadly similar between detected and undetected groups, although detected pregnancies appeared to undergo more intervention. Prenatal risk assessment questionnaires, diligent SFH monitoring, and selective third-trimester USS surveillance for high-risk pregnancies are expected to enhance diagnostic accuracy and resource optimization, particularly for low-resource settings. Individualization of delivery interventions by pregnancy risk factors, previous obstetric history, and personal preferences is supported.