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, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Joyeuse Ukwishaka, Centre de Recheche en Epidemiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
Calypse Ngwasiri, Centre de Recheche en Epidemiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
Seema Subedi, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Elizabeth A. Hazel, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Daniel J. Erchick, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Lee Shu Wu, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Carlos Grandi, Argentine Society of Paediatrics, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
Carl Lachat, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
Laéticia Céline Toe, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
Dominique Roberfroid, Department of Medicine, Namur University, Namur, Belgium.
Lieven Huybregts, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
Alain B. Labrique, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Mabhubur Rashid, Noora Health, Dhaka, Bangladesh.
Saijuddin Shaikh, Centre for Health Research and Development, Society for Applied Studies, Dehli, India.
Rezwanul Haque, JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh.
Abdullah H. Baqui, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Samir K. Saha, Child Health Research Foundation, Dhaka, Bangladesh.
Rasheda Khanam, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Sayedur Rahman, Projahnmo Research Foundation, Dhaka, Bangladesh.
Md Mariângela Silveira, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Romina Buffarini, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Roger L. Shapiro, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Rebecca Zash, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Zhonghai Zhu, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Lingxia Zeng, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Xiu Qiu, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Jianrong He, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Seifu H. Gebreyesus, Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Kokeb Tesfamariam, Department of Public Health, School of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia.
Grace Chan, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Delayehu Bekele, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Document Type

Journal Article

Publication Date

11-10-2025

Journal

BJOG : an international journal of obstetrics and gynaecology

DOI

10.1111/1471-0528.70044

Keywords

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

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.

Department

Global Health

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