At what estimated fetal weight may a planned cesarean birth be offered for a mother with diabetes, according to ACOG?

The recommendation from the American College of Obstetricians and Gynecologists (ACOG) suggests that for mothers with diabetes, a planned cesarean birth may be offered when the estimated fetal weight exceeds 4500 grams (9 lb 9 oz). This is based on the increased risk of shoulder dystocia and other complications associated with larger fetal sizes, especially in the context of maternal diabetes, which can lead to macrosomia (excessive fetal growth).

The threshold of 4500 grams is considered a safer cut-off for the recommendation of cesarean delivery, as it helps mitigate potential harms to both the mother and the baby that may arise from attempting a vaginal delivery at such weights. This guidance reflects concerns about the likelihood of complications, which are known to increase as fetal weight rises, especially in diabetic pregnancies. Therefore, when assessing the safest delivery methods, this specific weight provides a clinical benchmark to ensure better outcomes for both mother and child.