Talk:Large for gestational age

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 30 August 2021 and 21 September 2021. Further details are available on the course page. Student editor(s): Logbai707, Zayfay911, Shotokan75.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 23:55, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 29 June 2020 and 21 August 2020. Further details are available on the course page. Student editor(s): Carrie bi, H.K.Barton, Ucsfjchen, Mxphan.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 02:14, 17 January 2022 (UTC)

greater than 90% of the normal weight for that gestational age

"greater than 90% of the normal weight for that gestational age, adjusted for sex and ethnicity."

This doesn't make sense. 100% of the normal weight, ie the normal weight, is >90% and can not be abnormally large. Should it say >190%, or something else?

I agree with the above poster. Unless I'm missing something, I think the line should be changed to "greater than 90% over the normal weight for that gestational age" or "greater than 190% of the normal weight for that gestational age".

I've attempted to reword that to clarify it a bit more. The "90th percentile" birth weight refers to the top 10% weights of average newborns which works out (not taking into consideration sex or ethnicity) to around 4250g. I hope its clearer now. violet/riga (t) 21:47, 31 May 2005 (UTC)

"Occurs in up to 10% of pregnancies"

The lead notes that macrosomai "occurs in up to 10% of pregnancies". If macrosomia is based on a birth weight that is in the 90th percentile or above, wouldn't this mean macrosomia occurs in 10% of pregnancies, not "up to"? --Westendgirl 05:36, 1 Jun 2005 (UTC)

It's the 90th percentile adjusted for gestational age, sex and ethnicity. So a newborn may be classed as being above the 90th percentile of all births but it may not figure in the 90th percentile after the adjustment. I agree that it's quite a daft classification and that's why people tend to use the fixed weight nowadays. violet/riga (t) 09:27, 1 Jun 2005 (UTC)

Perhaps this should be noted in a footnote, and the 10% moved out of the lead definition. We probably don't want a one-line description that needs footnoting. --Westendgirl 22:36, 2 Jun 2005 (UTC)

kind of offensive

The chart is labeled "appropriate for gestational age". It should use some term other than "appropriate", and "adequate" is no good either. These work:

• normal
• average
• usual
• common

(BTW, when you fix the chart, please also put pounds and ounces on the right side)

The problem with "appropriate" is that such weights are not appropriate for all babies. The appropriate weight depends on the size of the parents. The same goes for the "40 weeks" too.

A few examples involving a 6'2" dad and a very healthy 5'10" mom:

• With my first kid, I knew when conception occurred. (a range of dates) Based on an ultrasound, the hospital chose a gestational age that was off by at least 2 weeks, possibly much more. Based on that, they insisted on inducing birth. At birth the kid showed signs of premature birth. As intelligence runs in the family and is associated with high birth weight, I'm especially upset about this birth.

• Kid number 3, the healthiest of the bunch, was about 10 pounds (4545 g) at birth. Again, we knew the ultrasound estimate was off by weeks. He was delivered naturally, at home of course, with no problems at all. The mom didn't tear, the baby was very responsive, and so on. Heh, your chart is too small. Almost two years later, this kid is now very tall, bright, and strong. He has conversations, uses the can, and beats up his older brothers.

• Even my twins went to 40 weeks and were not considered small. (they look tiny after the 10-pounder of course) We got 12.5 pounds of baby out of that birth.

This idea of diagnosing unusual-sized babies as "bad" and then trying to "fix" things makes people get hurt. What if we did that for feet? I'm a U.S. size 14. Maybe a doctor should remove part of my foot to make it "appropriate"? We could even enforce a standard height, skin color, nose shape...

AlbertCahalan 15:05, 4 Jun 2005 (UTC)

Sorry but that is the correct term in use today. The chart shows the median (50th percentile) of AGA along with the upper and lower bounds of what is considered "appropriate" (LGA and SGA). This is all calculated to include all variations in influences on the size (including the size of the parents). I see what you're saying, but that is the classification currently in use.

As for the look of the chart, I'm not entirely happy with it at the moment and have some ideas on how to make it look a bit better, including pounds/ounces on the other Y scale. violet/riga (t) 15:23, 4 Jun 2005 (UTC)

I've reworked the graph now. violet/riga (t) 16:26, 4 Jun 2005 (UTC)

Thanks. I was thinking that you might best just label the graph by percentile, but I like what you did. How do you make graphs like that? AlbertCahalan 17:07, 4 Jun 2005 (UTC)

The original one was made in Excel. This time I used Excel to make the background and plot some of the points, then used Macromedia Fireworks to create the rest of it. I considered adding the percentiles to it but didn't want to further increase its size. violet/riga (t) 17:45, 4 Jun 2005 (UTC)

Think about what "calculated to include all variations in influences on the size (including the size of the parents)" really means. It means you have the average. To have a chart that properly accounts for my family, you'd really need to move the SGA line. My 2812g kid (a "full term" twin) was terribly scrawny. Very long limbs throw off the weight. AlbertCahalan 17:07, 4 Jun 2005 (UTC)

That's true, but it's not really possible to represent every every individual family in a chart. It's also based on released statistics and what is classed as SGA and LGA. It may be silly to categorise the newborns so simply, but it's not saying that an AGA baby isn't scrawny and thin. violet/riga (t) 17:45, 4 Jun 2005 (UTC)

Here's a nice example (happy ending even) of how people can be hurt: a lady, with previous successful experience delivering a 12-pound baby, goes to a hospital to give birth. They insist that her 12-pounder absolutely must be delivered by cesarean. She is stubborn enough to get up and walk out while in labor. She easily gives birth in a different hospital. Meanwhile, the first hospital has gone to a judge to get an emergency custody order that would allow them to force the mother to have a cesarean. (They expect her to come back! WTF???) The mother finds out about the court order when news reporters visit her in the second hospital. (In case you didn't know, cesareans interfere with breastfeeding, create risk of infection and future uterine rupture, and cause a very long and painful recovery.) AlbertCahalan 17:07, 4 Jun 2005 (UTC)

If you could find a source for that it might be good to add it to the article, noting that LGA isn't necessarily a direct lead onto a caesarian. violet/riga (t) 17:45, 4 Jun 2005 (UTC)

think I found it

Big babies do not always need to be delivered by Caesarean section.

• http://allnurses.com/forums/archive/index.php/t-54674
• http://www.jehovahs-witness.com/16/72675/1.ashx

Note that the hospital lied on court papers, over both the mother's reason and over her success with previous children.

AlbertCahalan 01:02, 5 Jun 2005 (UTC)

Birth weight/merge

Birth weight/merge has been created which merges the following articles:

• Birth weight
• Small for gestational age
• Large for gestational age

Comments would be appreciated on this possible way forward. violet/riga (t) 14:12, 5 Jun 2005 (UTC)

Mothers of African origin

The article includes the unsourced statement "The condition is most common in mothers of African origin, partly due to the higher incidence of diabetes." Since Africa as far as I am aware experiences a high incidence of low birth weights, I can't help but wonder if this is another of Wikipedia's many frankly shameful examples of statements being made about the United States or some other rich country as if the rest of the world did not exist. I say shameful because, if I'm right, in this case the author of that sentence wrote "African origin" without it even occurring to them that Africa is where most people of African origin live, and they are disproportionately affected by factors that lead to low birth weight. So, do we mean African-origin mothers worldwide, or African-origin mothers in a particular country? Either way it needs a source. Credulity (talk) 19:23, 14 September 2012 (UTC)

Inconsistent use of units

I can't help but notice that the article is trying to strike a balance between using metric units (grams) and US ones (pounds & ounces). The lead of the article & the chart is in grams, while the rest is mostly US units, making it difficult to relate the chart to the text.

A decision needs to be made about which units to use. --NetRolller 3D 01:09, 29 April 2014 (UTC)

Slovenly writing

"In the end", "In the end", "In the end"... Appalling, and unclear. But that's not so much a problem as the quasi-technical phraseology of the article. Editors should keep sight of the need of readers with little technical knowledge. Articles like this should not be written as if the target reader was a member of the medical or nursing professions. It should be written so that an anxious mother can understand it. This also applies to many of the related articles. This article struck me as linguistically far too complicated for a general reader. Macdonald-ross (talk) 09:48, 3 August 2017 (UTC)

Foundations II 2020 Group 29 proposed edits

- Overall, we would like to properly clarify the medical jargon and make the spelling more consistent.

- "Large for gestational age (LGA) is an indication of high prenatal growth rate." We would like to update the leading sentence to explain what exactly LGA is and provide a citation. This phrase should be used as a supporting sentence somewhere else in the article rather than as the introductory sentence.

"Large for gestational age (LGA) describes full-term or post-term infants that are born of high birth weight." We will go on to incorporate 'high birthweight' in the next segment of information. Carrie bi (talk) 18:15, 30 July 2020 (UTC)

- "LGA is often defined as a weight, length, or head circumference that lies above the 90th percentile for that gestational age. However, it has been suggested that the definition be restricted to infants with birth weights greater than the 97th percentile (2 standard deviations above the mean) as this more accurately describes infants who are at greatest risk for perinatal morbidity and mortality." (rewritten followed below)

"The term LGA or large for gestational age is defined by birth weight above the 90th percentile for their gestational age and gender. In infants with birth weight above the 97th percentile in their gestational age and gender group, research has shown that greater risk of long-term health complications and fatal outcomes are present in LGA infants. Carrie bi (talk) 18:50, 30 July 2020 (UTC)

- "Some experts consider a baby to be big when it weighs more than 8 pounds 13 ounces (4,000 g) at birth, and others say a baby is big if it weighs more than 9 pounds 15 ounces (4,500 g)." This phrase was taken directly from Evidence Based Birth website, and we propose to reword the phrase and provide the appropriate citation. We would also like to clarify source #5.

Specifically, large for gestational age can be characterized by macrosomia, referring to a fetal growth beyond a certain threshold (threshold ranging from a body weight of 4000 grams to above 5000 grams). Experts in Obstetrics and Gynecology currently use a grading system to evaluate LGA infants, where their birth weight may help identify risks associated with their birth, including labor complications of both mother and child, potential long-term health complications of the neonate and infant mortality. Carrie bi (talk) 21:03, 31 July 2020 (UTC)

Signs and Symptoms - For the signs and symptoms section, we believe that this heading is not an appropriate description for this section, which describes risks that are involved with LGA.

We would like to change the heading to "Characteristics" and move the leading paragraph's sentence on macrosomia to this section, as it describes what LGA is. :- In addition, we'd like to include a subsection for "Complications" to describe the risks associated with LGA. In addition, following the leading sentence: "Common risks in LGA babies include shoulder dystocia,[3] hypoglycemia,[3] metatarsus adductus, hip subluxation[6] and talipes calcaneovalgus due to intrauterine deformation," we would like to add paragraphs clarifying each complication involved with LGA babies and if possible, provide a percentage that describes the frequency of how often these complications occur.

medical articles on Wikipedia follow a "manual of style" Please check here and follow this guideline before changing any headings. Medical Manual of Style (you can find your article type and it lists the suggested headings/subheadings WP:MEDMOS. JenOttawa (talk) 02:29, 29 July 2020 (UTC)

Propose to add subheadings for "maternal" and "neonatal" complications.Ucsfjchen (talk) 02:26, 1 August 2020 (UTC)

Subheadings were added. Ucsfjchen (talk) 18:09, 1 August 2020 (UTC)

- In addition, for the phrase, "researches have found that it is impossible to predict who will have shoulder dystocia and who will not," we would like to rephrase this sentence to make it less frightening for readers.

Please include the exact edit that you wish to make so that it is easier for people on the talk page to see your proposed improvement. JenOttawa (talk) 02:29, 29 July 2020 (UTC)

- For the section on shoulder dystocia, we would like to find appropriate citations, as the entire section is not cited.

See above regarding sharing your exact edit and citation, rather than just a summary. You have some great ideas here! JenOttawa (talk) 02:29, 29 July 2020 (UTC)

Several references have been added to this section.Ucsfjchen (talk) 02:08, 1 August 2020 (UTC)

- The section that begins with "induction of labour for women with a baby..." we believe that this would be more appropriate to place under "Treatment" section and would like to move this paragraph.

makes sense to me JenOttawa (talk) 02:29, 29 July 2020 (UTC)

This section has been moved. H.K.Barton (talk) 05:43, 3 August 2020 (UTC)

- "Big babies are at higher risk of hypoglycemia in the neonatal period, independent of whether the mother has diabetes." This particular sentence lacks a source, and we hope to find an appropriate reference. However, if one is not available, we would like to remove this sentence from this section and place it under "Risk factors" as a risk factor associated with babies born to diabetic mothers.

See WP:MEDRS when choosing a source to ensure that it is a secondary source and recent within the last 5 years if possible as per WP:MEDDATE.

Reference found and added.Ucsfjchen (talk) 19:43, 1 August 2020 (UTC)

- We would like to have two separate paragraphs designating complications for the infant and the mother.

Risk factors - In the section for risk factors, we would like to clarify that diabetes is present in the mothers and not the infant, and change "poorly-controlled diabetes" to "poorly-controlled maternal diabetes." Seeing as the source for this sentence directs readers to a German article that costs $40, we hope to find a more accessible and recent article.

As mentioned refer to WP:MEDRS and please share your exact wording and source here before adding to the article. This makes it easier for volunteers to help moderate these improvements before the article goes live. JenOttawa (talk) 02:29, 29 July 2020 (UTC)

- "LGA newborns that have complications other than exposure to maternal DM present with universal measurements above the 90th percentile." We do not believe this sentence reaches an understandable conclusion and would like to remove it.

Risk factors: Genetics - This section can be expanded and should elaborate on the role of genetics on LGA.

Note WP:MEDRS and be sure to paraphrase.JenOttawa (talk) 02:29, 29 July 2020 (UTC)

Risk factors: Other - Each bullet point should have a citation.

Please review WP:MEDRS carefully when selecting sources. JenOttawa (talk) 02:29, 29 July 2020 (UTC)

"There are believed to be links with polyhydramnios (excessive amniotic sac fluid). Preterm labor is also highly likely for polyhydramnios." Propose to delete this phrase, as there is no direct citation and no indication of who has claimed this link between polyhydramnios and LGA. While polyhydramnios is associated with some genetic syndromes, such as Costello syndrome, which has exhibited fetal overgrowth, there is no direct link between polyhydramnios causing LGA. Mxphan (talk) 18:30, 30 July 2020 (UTC)

I am not familiar with the evidence base. There was no citation in the article and you can not find a WP:MEDRS source on PubMed etc, it is important to remove non evidence-based information shared in this article. Good catch! JenOttawa (talk) 20:37, 31 July 2020 (UTC)

Propose deletion of the following bullet points: Congenital anomalies (transposition of great vessels) – Hydrops fetalis; Erythroblastosis fetalis – Hydrops fetalis; Use of some antibiotics (amoxicillin, pivampicillin) during pregnancy – Hydrops fetalis" as there are no resources that state that hydrops fetalis is a risk factor of LGA nor do they draw any conclusion that hydrops fetalis leads to LGA. Mxphan (talk) 20:28, 31 July 2020 (UTC)

Diagnosis - The graph lacks a reliable source for the information provided. - The last paragraph that describes complications associated with LGA should be moved to our proposed Complications sections, as it does not involve diagnosing of LGA. - The point that describes how the complication that arises from care providers perceiving a LGA baby is big is more harmful than the LGA baby, is a point that should be described under complications for the mothers.

These proposed article improvements make sense based on the info you proposed. Just make sure that each sentence is followed by the citation. Re-using citations in a paragraph and in different sections of the article is fine too! Thank you againJenOttawa (talk) 20:37, 31 July 2020 (UTC)

After further review of this Diagnosis section, it became apparent that a large portion was plagiarized and taken directly from Evidence-based Birth, which was cited. I will be paraphrasing this section, and moving it to the Complications section. Mxphan (talk) 20:42, 31 July 2020 (UTC)

There is an article by J.Gardosi et al that addresses outcomes of a personalized fetal growth estimation for each mother to limit adverse outcomes of generalizing birth weight categories. Will add once I locate full text. H.K.Barton (talk) 07:10, 3 August 2020 (UTC)

Epidemiology - We hope to add information about the incidence and prevalence of LGA. Mxphan (talk) 21:25, 28 July 2020 (UTC)

I have added a few comments inline. Thank you for all your efforts to improve this article. Please do include your exact edits (we do not need an explanation usually) and leave it up on the talk page for a few days at least before editing major portions of the article so that the community can help review these article improvements before they go live in the article. Thank you again for this great contribution. JenOttawa (talk) 02:29, 29 July 2020 (UTC)

added epidemiology sections in compliance with WP:MEDMOS format and citations. Carrie bi (talk) 04:52, 3 August 2020 (UTC)

References

Group #30 Foundation II Peer Review

Part 1: Do the group's edits substantially improve the article as described in the Wikipedia peer review "Guiding framework"? Has the group achieved its overall goals for improvement?

Overall, group 29 had substantially improved the article "Large for gestational age". Epidemiology and Treatment sections were added. A majority of the citations and reliable references were appropriately added (specifically for Diagnosis and Risk Factors section). Group 29 also corrected the plagiarized paragraphs (Diagnosis section). Wording was changed in order to create a more neutral tone. Group expanded the introduction in order to give more insight into a broader overview of the topic, for example they defined the term macrosomia and its relation to large for gestational age. A.Nono, Future UCSF PharmD. (talk) 21:09, 3 August 2020 (UTC) J.W.Hon (talk) 21:10, 3 August 2020 (UTC)Cynthia Fu, Future UCSF Pharm.D. (talk) 21:11, 3 August 2020 (UTC)

Part 2: 1. Does the draft submission reflect a neutral point of view?' Yes, their draft overall reflects a neutral point of view. For example in the risk factor section, they addressed the percent incidence of shoulder dystocia in both diabetic and non-diabetic women, so they were not just mentioning one side. However, in the "treatment section," it may be better to reword or re-organize what are the pros and cons for induction versus not to induce labor so that readers can distinguish between the two. It seemed to us that there is no definite treatment, but it was a bit confusing about whether or not induction of labor provides the benefit that outweigh the risk when reading the paragraph.Cynthia Fu, Future UCSF Pharm.D. (talk) 21:53, 3 August 2020 (UTC)

2. Are the points included verifiable with cited secondary sources that are freely available? Under "Neonatal" in the "complication" section, this sentence: "The bone should heal spontaneously, and most babies will make a full recovery from this birth injury" needs to be revised on adding an appropriate citation or source. In the "Others" subtopic under "Risk Factors" section and "Diagnosis section", reference 21 and 28 were cited from Uptodate, which we believed that belongs to a tertiary source, so that could be revised. Reference 27 could also be revised to determine whether it is a reliable secondary source. Otherwise, most of the sources in the article are verifiable.A.Nono, Future UCSF PharmD. (talk) 22:00, 3 August 2020 (UTC)

3. Are the edits formatted consistent with Wikipedia's manual of style? Yes. They have all the relevant sections for the condition. Complications, risk factors, diagnosis, treatment, and epidemiology are relevant to the topic and are all presented in the correct order. J.W.Hon (talk) 21:56, 3 August 2020 (UTC)

FA and LB proposed workplan

This article seems to have a solid foundation with good overall organization. To help improve overall content and structure we plan to do the following:

- Fill in some missing sections such as signs and symptoms, causes (triggers, genetics, virology), mechanism, Prevention/Screening.
- Remove some of the extra information that is presented (such as details of specific complications) that while important are actually housed under separate wiki pages.
- Remove repetitive information and condense existing information.
- Clarify the definitions of Large for Gestational age and Macrosomia.
- Add additional citations to the information presented earlier on in the page that does not have them.

Logbai707 (talk) 20:22, 3 September 2021 (UTC)

2021 CIC Peer reviews

Amrik:

• Check subject-verb agreement for "describe" in second sentence of intro
• I wonder if it would be helpful to briefly list some of the most common risks and health complications of LGA directly in the intro paragraph; it feels like that info should be available on the initial glance.
• Is there a simpler, more public-friendly term that you can use when defining LGA than "for their given gestational age"? Maybe something like "compared to other babies at the same number of weeks of development"?
• When talking about signs and symptoms, it feels like symptoms of the gestational parent and of the fetus should be separated. When using terms like "patient", it's not really clear who is experiencing the symptoms
• Is it possible to use simpler language when describing shoulder dystocia? The public likely will not be able to fully understand the paragraph.
• It feels like there is a disproportionate focus on shoulder dystocia in the complications section; as the main page is linked, some of the information can likely be cut out.
• I think the epidemiology on shoulder dystocia is great and thorough
• feels like the maternal complications section can be fleshed out a little more, and it currently lacks links to some of the symptoms listed
• not clear whether frozen embryo transfer is more or less likely to cause LGA
• The diagnosis section feels quite good, as it is concise, informative, and has good references
• need a reference for screening for LGA during prenatal check-ups
• Also feels like prevention and screening might be able to be combined into a single section
• Epidemiology section looks nice. I wonder if there is a world chart or some similar graphic that could be inserted here from one of the referenced papers.

Akwiki16 (talk) 08:21, 17 September 2021 (UTC)

Sei:

Love the article! I learned a lot because it's clearly written and easy to follow (with lots of appropriate section breaks). My main feedback is related to using slightly less jargon, or when medical jargon is used, having a colloquial term in parentheses that links to the associated Wiki page (if appropriate).

• Prevention section: "poor glycemic control" --> high blood sugar levels, uncontrolled blood sugar levels, etc.
• Screening section: "fundal height" --> size of uterus
• Also, the introduction could clarify the difference between LGA and macrosomia because although I understand macrosomia is an "absolute" measurement, I'm not sure the general public would understand that distinction with only 1 sentence of explanation
• Great citations!

I understand not all of these alternative phrases are as accurate as the original medical term, which is why I don't necessarily think replacing them is necessary, perhaps just occasionally peppering synonyms throughout the article so people reading don't get too lost. Great job! Patricklow9 (talk) 17:19, 20 September 2021 (UTC)

I think this should be renamed

The other name for this(macrosomia) is less wordy, so I think it should be renamed to this. I'm not sure if there's policies for this though. (and large for gestational age gets more hits on google) DiaamondMiner999 (talk) 03:05, 23 September 2021 (UTC)