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. 2025 Nov 10.
doi: 10.1111/1471-0528.70044. Online ahead of print.

Prevalence of Large-for-Gestational Age and Macrosomia Among Livebirths in 23 Low- and Middle-Income Countries Between 2000 and 2021: An Individual Participant Data Analysis

Fati Kirakoya-Samadoulougou  1   2 , Joyeuse Ukwishaka  2 , Calypse Ngwasiri  2 , Seema Subedi  1 , Elizabeth A Hazel  1 , Daniel J Erchick  1 , Lee Shu Fune Wu  1 , Carlos Grandi  3 , Carl Lachat  4 , Laéticia Céline Toe  4 , Dominique Roberfroid  5 , Lieven Huybregts  4   6 , Alain B Labrique  1 , Mabhubur Rashid  7 , Saijuddin Shaikh  8 , Rezwanul Haque  9 , Abdullah H Baqui  1 , Samir K Saha  10 , Rasheda Khanam  1 , Sayedur Rahman  11 , Md Mariângela F Silveira  12 , Romina Buffarini  12 , Roger L Shapiro  13 , Rebecca Zash  14 , Zhonghai Zhu  15 , Lingxia Zeng  15 , Xiu Qiu  16 , Jianrong He  16 , Seifu H Gebreyesus  17 , Kokeb Tesfamariam  18 , Grace Chan  13 , Delayehu Bekele  19 , Seth Adu-Afarwuah  20 , Kathryn G Dewey  21 , Stephaney Gyaase  22 , Blair J Wylie  23 , Sunita Taneja  24 , Ranadip Chowdhury  24 , Giridhara R Babu  25 , R Deepa  26 , Mohamed Rishard  27 , Marzia Lazzerini  28   29 , Maria J Rodriguez-Sibaja  30 , Sandra Acevedo-Gallegos  30 , Per Ashorn  31 , Kenneth Maleta  32 , Luke C Mullany  1 , Fyezah Jehan  33 , Muhammad Ilyas  34 , Stephen J Rogerson  35 , Holger W Unger  36 , Rakesh Ghosh  37 , Sabine Musange  38 , Aroonsri Mongkolchati  39 , Paniya Keentupthai  40 , Wafaie Fawzi  41 , Dongqing Wang  42 , Christentze Schmiegelow  43   44   45 , Daniel Minja  46 , Line Hjort  47   48 , John P A Lusingu  46 , Emily R Smith  49 , Honorati Masanja  50 , Fathma Mohamed Kabole  51 , Salim Nassir Slim  51 , Abel Kakuru  52 , Richard Kajubi  52 , Dilys Walker  53 , Peter Waiswa  54   55 , Vundli Ramokolo  56 , Wanga Zembe-Mkabile  57 , Katherine Semrau  58   59 , Davidson H Hamer  60   61 , R Matthew Chico  62 , Enesia Banda Chaponda  63 , Albert Manasyan  64 , Jake M Pry  65 , Kebby Musokotwane  66 , Bowen Banda  67 , Andrew Prendergast  68 , Bernard Chasekwa  69 , Joanne Katz  1 , Anne C C Lee  70 , Robert E Black  1 ; Subnational Collaborative Group for Vulnerable Newborn Prevalence
Collaborators, Affiliations

Prevalence of Large-for-Gestational Age and Macrosomia Among Livebirths in 23 Low- and Middle-Income Countries Between 2000 and 2021: An Individual Participant Data Analysis

Fati Kirakoya-Samadoulougou et al. BJOG. .

Abstract

Objective: To examine the prevalence of large-for-gestational age (LGA) and macrosomia in 23 countries between 2000 and 2021.

Design: Descriptive multi-country secondary data analysis.

Setting: Subnational, population-based cohort studies (k = 45 for LGA, k = 25 for macrosomia) in 23 low- and middle-income countries (LMICs).

Population: Liveborn infants.

Methods: We conducted a secondary analysis of individual-level data from the Vulnerable Newborn Measurement Collaboration, using INTERGROWTH-21st standards to define LGA (> 90th centile for gestational age and sex) and macrosomia (≥ 4000 g, regardless of gestational age). We included LMIC population-based datasets with reliable gestational age and birthweight data, excluding studies with small sample sizes, high missing data, or implausible measurements. Prevalence estimates were stratified by region, study period and gestational age, and results were summarised as medians and interquartile ranges (IQR).

Main outcome measures: Prevalence of LGA and macrosomia.

Results: Among 476 939 live births, the median prevalence of LGA was 5.1% (IQR: 2.9%-9.6%) and was highest in Latin America and the Caribbean at 9.6% (4 studies, IQR: 2.7%-16.1%) and lowest in South Asia at 2.7% (13 studies, IQR: 2.3%-3.7%). Over time, the median LGA prevalence increased from 4.9% (12 studies; IQR: 4.1%-7.9%) during the period from 2000 to 2010 to 5.9% (33 studies, IQR: 2.7%-11.2%) from 2011 to 2021. Term LGA was more common at 3.2% (0.9-5.1) than preterm or post-term LGA. Among 313 064 live births, the median prevalence of macrosomia was 1.3% (n = 313 064, IQR: 0.2%-2.4%), which was highest in Latin America and the Caribbean (4 studies, 3.1%, IQR: 0.7%-6.8%) and lowest in South Asia (8 studies, 0.1%, IQR: 0.0%-0.7%). The median prevalence remained stable over time: 1.1% (8 studies, IQR: 0.2%-3.1%) in older studies (2000-2010) and 1.3% (17 studies, IQR: 0.5%-2.4%) in more recent studies (2011-2021). Term macrosomia was more common at 1.2% (0.2-2.0) than preterm and post-term macrosomia.

Conclusions: The overall prevalence of LGA and macrosomia was lower in these LMIC studies than is reported in high-income countries. The prevalence of large babies was highest in Latin America and the Caribbean.

Keywords: birth weight; large‐for‐gestational age; low‐ and middle‐income countries; macrosomia; vulnerable newborn types.

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References

    1. L. Suárez‐Idueta, J. Yargawa, H. Blencowe, et al., “Vulnerable Newborn Types: Analysis of Population‐Based Registries for 165 Million Births in 23 Countries, 2000–2021,” BJOG: An International Journal of Obstetrics & Gynaecology (2023): 1–15.
    1. L. Suárez‐Idueta, H. Blencowe, Y. B. Okwaraji, et al., “Neonatal Mortality Risk for Vulnerable Newborn Types in 15 Countries Using 125.5 Million Nationwide Birth Outcome Records, 2000–2020,” BJOG: An International Journal of Obstetrics and Gynaecology (2023): 1–11.
    1. E. A. Hazel, D. J. Erchick, J. Katz, et al., “Neonatal Mortality Risk of Vulnerable Newborns: A Descriptive Analysis of Subnational, Population‐Based Birth Cohorts for 238 203 Live Births in Low‐ and Middle‐Income Settings From 2000 to 2017,” BJOG: An International Journal of Obstetrics and Gynaecology (2023): 1–12.
    1. S. K. Ng, A. Olog, A. B. Spinks, C. M. Cameron, J. Searle, and R. J. McClure, “Risk Factors and Obstetric Complications of Large for Gestational Age Births With Adjustments for Community Effects: Results From a New Cohort Study,” BMC Public Health 10 (2010): 460.
    1. C. Mayer and K. S. Joseph, “Fetal Growth: A Review of Terms, Concepts and Issues Relevant to Obstetrics,” Ultrasound in Obstetrics & Gynecology 41, no. 2 (2013): 136–145.

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