Archives of Gynecology and Obstetrics

, Volume 298, Issue 4, pp 725–730 | Cite as

Birthweight and large for gestational age trends in non-diabetic women with three consecutive term deliveries

  • Liran HierschEmail author
  • Shiri Shinar
  • Nir Melamed
  • Amir Aviram
  • Eran Hadar
  • Yariv Yogev
  • Eran Ashwal
Maternal-Fetal Medicine



Increased birthweight is a risk factor for early neonatal complications, as well as cardiovascular and metabolic disease later in adulthood. We aimed to assess birthweight trends and the rate of large for gestational age newborns in women in their third delivery according to birthweight in the first and second deliveries.

Study design

A retrospective cohort study of all women who delivered their first three consecutive deliveries in a single medical center (1994–2013). Only non-diabetic women with term (≥ 37 weeks) singleton deliveries in all three deliveries were included. BW centile (according to local gender- and gestational age-specific birth curves) trends between deliveries was assessed. In addition, the risk for large for gestational age (≥ 90th centile) infants in the third delivery was assessed according to the presence or absence of large for gestational age in previous deliveries. Pregnancies complicated by multiple gestations, preeclampsia, chronic or gestational hypertension or fetal anomalies were excluded.


Of the 121,728 deliveries during the study period, 3521 women (10,563 deliveries [8.6%]) met inclusion criteria. Mean birthweight centile in the first, second and third deliveries were 47.2 ± 26.3, 58.3 ± 25.8 and 61.5 ± 24.7, respectively (p < 0.001). While 45.9% women had their maximal birthweight centile in the third delivery, only 16.5% had it in the first delivery (p < 0.001). In multivariate analysis, adjusted for maternal age, gestational age at delivery and neonatal gender, the rate of large for gestational age infants in the third delivery was increased as the number of previous large for gestational age deliveries increased in a dose-dependent pattern (aOR = 4.37, CI  2.89–6.61 for women with large for gestational age infant only in the first delivery, aOR = 5.31, CI   4.15–6.79 for women with large for gestational age infants only in the second delivery, aOR = 10.62, CI  6.89–16.38 for women with large for gestational infants age in the first and second deliveries; women with no large for gestational age infants in both the first and second delivery served as reference group).


In women with repeated term deliveries, birthweight centile is frequently increased in the third delivery compared to the previous two deliveries. Moreover, the number and order of previous large for gestational age deliveries in the first two deliveries are major risk factors for large for gestational age in the third delivery.


Large for gestational age Birthweight Term deliveries Recurrence 


Author contributions

LH: involved in the study design, researched data, wrote the manuscript and reviewed/edited the manuscript. SS: reviewed and edited the manuscript. NM: involved in the study design and reviewed/edited the manuscript. AA: reviewed and edited the manuscript. EH: involved in the study design and reviewed/edited the manuscript. YY: involved in the study design and reviewed/edited the manuscript. EA: involved in the conception of the study, writing of the protocol, data extraction, data analysis and reviewed/edited the manuscript.



Compliance with ethical standards

Conflict of interest statement

ALL authors declare that they have no conflict of interest.


  1. 1.
    Weissmann-Brenner A, Simchen MJ, Zilberberg E, Kalter A, Weisz B, Achiron R et al (2012) Maternal and neonatal outcomes of large for gestational age pregnancies. Acta Obstet Gynecol Scand 91:844–849CrossRefPubMedGoogle Scholar
  2. 2.
    Bukowski R, Hansen NI, Willinger M, Reddy UM, Parker CB, Pinar H et al (2014) Fetal growth and risk of stillbirth: a population-based case-control study. PLoS Med 11:e1001633CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Henriksen T (2008) The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand 87:134–145CrossRefPubMedGoogle Scholar
  4. 4.
    Moussa HN, Alrais MA, Leon MG, Abbas EL, Sinbai BM (2016) Obesity epidemic: impact from preconception to postpartum. Future Sci OA 2:FSO137CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chiavaroli V, Castorani V, Guidone P, Derraik JG, Liberati M, Chiarelli F et al (2016) Incidence of infants born small- and large-for-gestational-age in an Italian cohort over a 20-year period and associated risk factors. Ital J Pediatr 42:42CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Jain AP, Gavard JA, Mostello DJ, Rice JJ, Catanzaro RB, Hopkins SA (2016) Characteristics of recurrent large-for-gestational-age infants in obese women. Am J Perinatol 33:918–924CrossRefPubMedGoogle Scholar
  7. 7.
    Boghossian NS, Yeung E, Albert PS, Mendola P, Laughon SK, Hinkle SN et al (2014) Changes in diabetes status between pregnancies and impact on subsequent newborn outcomes. Am J Obstet Gynecol 210:431.e1-14CrossRefPubMedGoogle Scholar
  8. 8.
    Dolberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES (2005) Birth weight standards in the live-born population in Israel. Isr Med Assoc J 7:311–314Google Scholar
  9. 9.
    Lahmann PH, Wills RA, Coory M (2009) Trends in birth size and macrosomia in Queensland, Australia, from 1988 to 2005. Paediatr Perinat Epidemiol 23:533–541CrossRefPubMedGoogle Scholar
  10. 10.
    Surkan PJ, Hsieh CC, Johansson AL, Dickman PW, Cnattingius S (2004) Reasons for increasing trends in large for gestational age births. Obstet Gyneco 104:720–726CrossRefGoogle Scholar
  11. 11.
    Hiersch L, Shinar S, Melamed N, Aviram A, Hadar E, Yogev Y et al (2017) Recurrent placenta-mediated complications in women with three consecutive deliveries. Obstet Gynecol 129:416–421CrossRefPubMedGoogle Scholar
  12. 12.
    Zhang X, Decker A, Platt RW, Kramer MS (2008) How big is too big? The perinatal consequences of fetal macrosomia. Am J Obstet Gynecol 198(517):e1–e6Google Scholar
  13. 13.
    Boulet SL, Salihu HM, Alexander GR (2004) Mode of delivery and birth outcomes of macrosomic infants. J Obstet Gynaecol 24:622–629CrossRefPubMedGoogle Scholar
  14. 14.
    Rendtorff R, Hinkson L, Kiver V, Dröge LA, Henrich W (2017) Pregnancies in women aged 45 years and Older—a 10-year retrospective analysis in Berlin. Geburtshilfe Frauenheilkd 77:268–275CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Fisher SC, Kim SY, Sharma AJ, Rochat R, Morrow B (2013) Is obesity still increasing among pregnant women? Prepregnancy obesity trends in 20 states, 2003–2009. Prev Med 56:372–378CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Adesina OA, Olayemi O (2003) Fetal macrosomia at the University College Hospital, Ibadan: a 3-year review. J Obstet Gynaecol 23:30–33CrossRefPubMedGoogle Scholar
  17. 17.
    Onyiriuka AN (2006) High birth weight babies: incidence and foetal outcome in a mission hospital in Benin City, Nigeria. Niger J Clin Pract 9:114–119PubMedGoogle Scholar
  18. 18.
    Modanlou HD, Dorchester WL, Thorosian A, Freeman RK (1980) Macrosomia-maternal, fetal, and neonatal implications. Obstet Gynecol 55:420–424PubMedGoogle Scholar
  19. 19.
    Okun N, Verma A, Mitchell BF, Flowerdew G (1997) Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia. J Matern Fetal Med 6:285–290PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyHelen Schneider Hospital for Women, Rabin Medical CenterPetah TiqwaIsrael
  2. 2.Lis Maternity Hospital, Tel Aviv Sourasky Medical CenterTel Aviv UniversityTel AvivIsrael
  3. 3.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada

Personalised recommendations