The authors thank Ms Judy Slome Cohain, CNM, for her interest in our paper.1,2 We acknowledge that one limitation of this study design was that the diagnosis of macrosomia was based on known fetal weight, which cannot be accurately determined until the fetus is delivered. We discussed this limitation in our paper (page 407), and emphasized in the Conclusion that further efforts to improve fetal weight estimations would be potentially beneficial (page 408).2 Furthermore, we did not make any recommendation regarding practice change or formulating clinical protocols based on our study findings.
We believe however that our study supports the hypothesis that induction of labour in this setting may provide improved perinatal outcomes, and future large, prospective, randomised clinical trials are necessary to further assess this association. In fact, a recent randomised controlled trial in France examined precisely the same clinical question (induction versus expectant management in women with suspected fetal macrosomia), and reported potential perinatal benefits with no increase in the rate of caesarean delivery.3
We also agree with Ms Cohain1 that nutrition counselling may certainly be prudent as part of routine prenatal care. Furthermore, nutrition counselling should not be limited to women at risk of having fetal macrosomia or women diagnosed with fetal macrosomia, but that all pregnant women may benefit from increased knowledge regarding healthy nutrition and lifestyle.