title: [Prevention of shoulder dystocia risk factors before delivery].
abstract: OBJECTIVE
  To determine whether it is possible to prevent the occurrence of risk factors for shoulder dystocia before or during pregnancy.
  
  
  METHODS
  The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. Studied measures were exercise before or during pregnancy, dietary management, and gestational diabetes management in obese and non-obese patients.
  
  
  RESULTS
  No study has proven that the correction of these risk factors (except gestational diabetes) would reduce the risk of shoulder dystocia. In the general population, physical exercise is recommended either before or during pregnancy to reduce the risk of gestational diabetes (physical activity before pregnancy) (grade B), fetal macrosomia (grade C) or maternal weight gain during pregnancy (grade C). No dietary regimen is recommended to reduce these issues (grade B). In overweight or obese (body mass index [BMI]>25), physical activity coupled with dietary management is recommended (grade A) because it reduces fetal macrosomia (EL1). In addition, it allows a modest reduction in maternal weight gain during pregnancy (EL2), but did have an effect on the occurrence of gestational diabetes (EL1). In case of gestational diabetes, diabetes care is recommended (diabetic diet, glucose monitoring, insulin if needed) (grade A) as it reduces the risk of macrosomia and shoulder dystocia (EL1). The recommended weight gain during pregnancy is 11.5 kg to 16 kg for normal BMI patients (grade B). Obese patients should be aware of the importance of controlling their weight gain during pregnancy (professional consensus). It is recommended that patients regain their pre-conception weight, and ideally a BMI between 18 and 25 kg/m(2), 6 months postpartum (grade B) to reduce the risk of gestational diabetes and macrosomia in a subsequent pregnancy (EL2).
  
  
  CONCLUSIONS
  Physical activity is recommended before and during pregnancy to reduce the occurrence of risk factors for shoulder dystocia. In obese patients, physical activity should be coupled with dietary measures to reduce fetal macrosomia and weight gain during pregnancy.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et santé des populations (CESP), U1018, reproduction et développement de l'enfant, 94807 Villejuif, France. Electronic address: florent.fuchs@bct.aphp.fr.
authors.forename: F
authors.initials: F
authors.lastname: Fuchs
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000517:prevention & control; D004420:Dystocia / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D050177:Overweight / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D012782:Shoulder
keywords: Diabetes; Diabète; Dietary measures; Dystocie des épaules; Exercice physique; Exercise; Macrosomia; Macrosomie fœtale; Mesures diététiques; Obesity; Obésité; Prise de poids maternelle pendant la grossesse; Shoulder dystocia; Weight gain during pregnancy