ArticlesMacrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey
Introduction
Macrosomia is a term used to describe an abnormally large fetus. Although there is no absolute consensus about the definition of the disorder, previous studies1 have used birthweights of greater than 4000–4500 g, the 90th percentile, or two standard deviations for gestational age as definitions. Macrosomia is an important risk factor for perinatal asphyxia, death, and shoulder dystocia, and mothers of babies with macrosomia are at an increased risk of caesarean section, prolonged labour, abnormal haemorrhage, and perineal trauma.1, 2 The known risk factors for macrosomia are male fetal sex, high parity, maternal age and height, post-term pregnancy, obesity, large gestational weight gain, and pregestational and gestational diabetes.3
The prevalence of macrosomia in developed countries is between 5% and 20%;1 however, an increase of 15–25% has been reported in the past two to three decades, mainly driven by an increase in maternal obesity and diabetes.1 Although data for the changing prevalence of macrosomia in developing countries are scarce, investigators of one study in China4 noted an increase from 6·0% in 1994, to 7·8% in 2005. As the prevalence of diabetes and obesity in women of reproductive age increases in developing countries,5, 6 a parallel increase in macrosomic births might be expected.
Complicated delivery due to macrosomia can incur additional hazards to the mother and newborn baby more in resource-limited settings than in resource-rich settings because of the restricted availability of emergency obstetric and other essential care,7 but studies of this topic are scarce. We analysed data from 23 developing countries in Africa, Asia, and Latin America that participated in WHO's Global Survey on Maternal and Perinatal Health to investigate the prevalence and risk factors for macrosomia, and the risk for caesarean section and maternal and perinatal morbidity and mortality in babies with macrosomia in settings where only few data exist.
Section snippets
Study design and data extraction
We undertook a secondary data analysis with WHO's Global Survey on Maternal and Perinatal Health. The purpose of this survey was to develop a global data system for maternal and perinatal health services and outcomes, with the primary aim of describing the association between mode of delivery and pregnancy outcomes. Methodological details of the survey have been published elsewhere.8 Briefly, the survey was a facility-based cross-sectional study that used a stratified multistage cluster
Results
The figure shows the study profile. We analysed data for 276 436 deliveries in 23 countries (figure). We noted a large variation in the prevalence of babies with birthweights of 4000 g and greater, ranging from 0·5% in India, to 14·9% in Algeria (table 1). Maternal older age (20–34 years), greater height, higher parity, infant male sex, post-term pregnancy, BMI, and diabetes were all significantly associated with increased odds for macrosomia in all regions (table 2). In all regions, mothers
Discussion
Our findings show that maternal BMI and diabetes were strong risk factors for macrosomia, and mothers of babies with the disorder were in turn at an increased risk of caesarean section in all regions, and for adverse maternal and perinatal outcomes in some regions. The strength of our study is the large sample size and data obtained by use of a standardised questionnaire across countries and continents. To the best of our knowledge, this is the first multicountry study that focuses on fetal
References (29)
Diabetes in women: the global perspective
Int J Gynaecol Obstet
(2009)- et al.
Evidence-based, cost-effective interventions: how many newborn babies can we save?
Lancet
(2005) - et al.
A global reference for fetal-weight and birthweight percentiles
Lancet
(2011) - et al.
Obstetric fistula: the international response
Lancet
(2004) Definition, size of the problem, screening and diagnostic criteria: who should be screened, cost-effectiveness, and feasibility of screening
Int J Gynaecol Obstet
(2009)Pregnancy and diabetes scenario around the world: Africa
Int J Gynaecol Obstet
(2009)- et al.
Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America
Lancet
(2006) - et al.
Macrosomic births in the United States: determinants, outcomes, and proposed grades of risk
Am J Obstet Gynecol
(2003) - et al.
Nutrition and obstructed labor
Am J Clin Nutr
(2000) - et al.
The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome
Best Pract Res Clin Endocrinol Metab
(2010)
The macrosomic fetus: a challenge in current obstetrics
Acta Obstet Gynecol Scand
Suspected big baby: a difficult clinical problem in obstetrics
Acta Obstet Gynecol Scand
ACOG issues guidelines on fetal macrosomia. American College of Obstetricians and Gynecologists
Am Fam Physician
Secular trends of macrosomia in southeast China, 1994–2005
BMC Public Health
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