Elsevier

The Lancet

Volume 381, Issue 9865, 9–15 February 2013, Pages 476-483
The Lancet

Articles
Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey

https://doi.org/10.1016/S0140-6736(12)61605-5Get rights and content

Summary

Background

Macrosomia is a risk factor for adverse delivery outcomes. We investigated the prevalence, risk factors, and delivery outcomes of babies with macrosomia in 23 developing countries in Africa, Asia, and Latin America.

Methods

We analysed data from WHO's Global Survey on Maternal and Perinatal Health, which was a facility-based cross-sectional study that obtained data for women giving birth in 373 health facilities in 24 countries in Africa and Latin America in 2004–05, and in Asia in 2007–08. Facilities were selected by stratified multistage cluster sampling and women were recruited at admission for delivery. We extracted data from the medical records with a standardised questionnaire. We used logistic regression with random effects to assess the risk factors for macrosomia and the risks for caesarean section and adverse maternal and perinatal outcomes (assessed by a composite score) in babies with the disorder.

Findings

Of 290 610 deliveries, we analysed data for 276 436 singleton livebirths or fresh stillbirths. Higher maternal age (20–34 years), height, parity, body-mass index, and presence of diabetes, post-term pregnancy, and male fetal sex were associated with a significantly increased risk of macrosomia. Macrosomia was associated with an increased risk of caesarean section because of obstructed labour and post-term pregnancy in all regions. Additionally, macrosomia was associated with an increased risk of adverse maternal birth outcomes in all regions, and of adverse perinatal outcomes only in Africa.

Interpretation

Increasing prevalence of diabetes and obesity in women of reproductive age in developing countries could be associated with a parallel increase in macrosomic births. The effect and feasibility of control of diabetes and preconception weight on macrosomia should be investigated in these settings. Furthermore, increased institutional delivery in countries where rates are low could be crucial to reduce macrosomia-associated morbidity and mortality.

Funding

None.

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

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