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Trends in the incidence of fetal macrosomia and its phenotypes in the United States, 1971–2017



Studies have reported a surge in the prevalence of obesity among various demographic groups including pregnant women in the U.S. Given the association between maternal obesity and risk of fetal macrosomia, we hypothesized that the incidence of fetal macrosomia will be on the rise in the U.S. We examined trends in fetal macrosomia and macrosomia phenotypes in the U.S. among singleton live births within the gestational age of 28–42 weeks inclusive.


This was a retrospective cohort study covering the period 1971–2017 using U.S. Natality Data files. We applied Joinpoint regression models to derive the average annual percentage change in the outcome. We measured incidence and trends of fetal macrosomia which was defined as birth weight ≥ 4000 g. We further subdivided macrosomia into its phenotypes as previously recommended: Grade 1 (4000–4499 g), Grade 2 (4500–4999 g) and Grade 3 (≥ 5000 g).


A total of 147,331,305 singleton births over the entire study period of 47 years were analyzed. From a baseline incidence of 8.84%, the rate of fetal macrosomia declined to 8.07% by the end of the study representing a drop of 8.70% in relative terms. The greatest drop was among infants with Grade 3 macrosomia, the most severe and lethal phenotype. The most impactful factors were maternal age and gestational weight gain.


This study is the largest population-based study conducted regarding fetal macrosomia. The rate of fetal macrosomia declined over the previous 5 decades with the most substantial drop observed in the phenotype with the worst prognosis.

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Authors and Affiliations



HMS: project development, manuscript writing. DD: data analysis, manuscript writing/editing, reviewing. LMK: manuscript writing/editing. KKY: manuscript writing/editing. SI: manuscript editing. AAS-M: manuscript writing/editing.

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Correspondence to Hamisu M. Salihu.

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Study was considered by the Baylor College of Medicine IRB as exempt.

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The study was performed on de-identified secondary data. IRB approval from Baylor College of Medicine was obtained.

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Salihu, H.M., Dongarwar, D., King, L.M. et al. Trends in the incidence of fetal macrosomia and its phenotypes in the United States, 1971–2017. Arch Gynecol Obstet 301, 415–426 (2020).

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  • Macrosomia in US
  • Macrosomia
  • Pregnancy weight gain
  • Types of macrosomia