Skip to main content

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

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusion

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Lu Y, Zhang J, Lu X, Xi W, Li Z (2011) Secular trends in macrosomia in southeast China, 1994–2005. BMC Public Health 11:1–9

    Article  Google Scholar 

  2. Lahmann PH, Wills R, Coory M (2009) Trends in birth size and macrosomia in Queensland, Australia from 1988 to 2005. Paediatr Perinat Epidemiol 23:533–541

    Article  Google Scholar 

  3. Shan X, Chen F, Wang W, Zhao J, Teng Y, Wu M et al (2014) Secular trends of low birthweight and macrosomia and related maternal factors in Beijing, China: a longitudinal trend analysis. BMC Pregnancy Childb 14:105

    Article  Google Scholar 

  4. do Nascimento MI, Pereira DF, Lopata C, Oliveira CLF, de Moura AA, da Silva Mattos MJ et al (2018) Trends in the prevalence of live macrosomic newborns according to gestational age strata, in Brazil, 2001–2010, and 2012–2014. Revista Brasileira de Ginecologia e Obstetrícia 39:8

    Google Scholar 

  5. Chauhan SP, Grobman WA, Gherman RA, Chauhan VB, Chang G, Magann EF et al (2005) Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol 193:332–346

    Article  Google Scholar 

  6. Lu GC, Rouse DJ, DuBard M, Cliver S, Kimberlin D, Hauth JC (2001) The effect of the increasing prevalence of maternal obesity on perinatal morbidity. Am J Obstet Gynecol 185:845–849

    CAS  Article  Google Scholar 

  7. Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ (2015) Births: final data for 2014. Natl Vital Stat Rep 64:1–64

    PubMed  Google Scholar 

  8. Bamberg C, Hinkson L, Henrich W (2005) Prenatal detection and consequences of fetal macrosomia. Fetal Diagn Ther 33:143–148

    Article  Google Scholar 

  9. Gu S, An X, Fang L, Zhang X, Zhang C, Wang J et al (2012) Risk factors and long-term health consequences of macrosomia: a prospective study in Jiangsu Province, China. J Biomed Res 26:235–240

    Article  Google Scholar 

  10. Dai RX, He XJ, Hu CL (2019) The association between advanced maternal age and macrosomia: a meta-analysis. Child Obes 15(3):149–155. https://doi.org/10.1089/chi.2018.0258

    Article  PubMed  Google Scholar 

  11. Szostak-Wegierek D, Szamotulska K (2011) Fetal development and risk of cardiovascular diseases and diabetes type 2 in adult life. Med Wieku Rozwoj 15:203–215

    PubMed  Google Scholar 

  12. CDC (2015) Updated estimates of neural tube defects prevented by mandatory folic acid fortification—United States, 1995–2011. Morb Mort Wkly Rep 64:1–5

    Google Scholar 

  13. Boulet SL, Salihu HM, Alexander GR (2006) Mode of delivery and the survival of macrosomic infants in the United States, 1995–1999. Birth 33:278–283

    Article  Google Scholar 

  14. Boulet SL, Salihu HM, Alexander GR (2004) Mode of delivery and birth outcomes of macrosomic infants. Obstet Gynecol 24:622–629

    CAS  Article  Google Scholar 

  15. Boulet SL, Alexander GR, Salihu HM (2005) Secular trends in cesarean delivery rates among macrosomic deliveries in the United States, 1989 to 2002. Perinatology 25:569–576

    Article  Google Scholar 

  16. Boulet S, Alexander GR, Salihu HM, Pass M (2003) Macrosomic births in the United States: determinants, outcomes, and proposed grades of risk. Obstet Gynecol 188:1372–1377

    Google Scholar 

  17. Catov JM, Lee M, Roberts JM, Xu J, Simhan HN (2015) Race disparities and decreasing birth weight: are all babies getting smaller? Am J Epidemiol 183:15–23

    Article  Google Scholar 

  18. American College of Obstetricians and Gynecologists (ACOG) (2016) Fetal macrosomia. Practice Bulletin No. 173. Obst Gynecol 128:e195–e209

    Article  Google Scholar 

  19. Rhodes JC, Schoendorf KC, Parker JD (2003) Contribution of excess weight gain during pregnancy and macrosomia to the cesarean delivery rate, 1990–2000. Pediatrics 111:1181–1185

    PubMed  Google Scholar 

  20. Salihu HM, Salinas A, August EM, Mogos MF, Weldeselasse H, Whiteman VE (2012) Small size for gestational age and the risk for infant mortality in the subsequent pregnancy. Ann Epidemiol 22:764–771

    Article  Google Scholar 

  21. Buchanan TA, Kjos SL, Montoro MN, Wu PY, Madrilejo NG, Gonzalez M et al (1994) Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care 17:275–283

    CAS  Article  Google Scholar 

  22. American College of Obstetrics and Gynecology (2001) ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Obst Gynecol 98(3):525–538

    Article  Google Scholar 

  23. American College of Obstetrics and Gynecology (2013) Practice Bulletin No. 137: gestational diabetes mellitus. Obstet Gynecol 122(2 Pt 1):406–416

    Google Scholar 

  24. American College of Obstetrics and Gynecology (2017) Practice Bulletin No. 180: gestational diabetes mellitus. Obst Gynecol 130(1):e17–e37

    Article  Google Scholar 

  25. American College of Obstetrics and Gynecology (2018) ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obst Gynecol 131(2):e49–e64

    Article  Google Scholar 

  26. Mack LR, Tomich PG (2017) Gestational Diabetes: diagnosis, classification, and clinical care. Obstet Gynecol Clin N Am 44(2):207–217

    Article  Google Scholar 

  27. American Diabetes Association (2019) 14. Management of diabetes in pregnancy: standards of medical care in diabetes—2019. Diabetes Care 42(Supplement 1):S165–S172

    Article  Google Scholar 

  28. Berger H, Melamed N (2014) Timing of delivery in women with diabetes in pregnancy. Obst Med 7:8–16

    Article  Google Scholar 

  29. Campbell S (2014) Fetal macrosomia: a problem in need of a policy (editorial). Ultrasounds Obst Gynecol 43:3–10

    Article  Google Scholar 

  30. Xie K, Fu Z, Li H, Gu X, Cai Z, Xu P et al (2018) High folate intake contributes to risk of large for gestational age birth and obesity in male offspring. J Cell Physiol 233:9383–9389

    CAS  Article  Google Scholar 

  31. Wang S, Ge X, Zhu B, Xuan Y, Huang K, Rutayisire E et al (2016) Maternal continuing folic acid supplementation after the first trimester of pregnancy increased the risk of large-for-gestational-age birth: a population-based birth cohort study. Nutrients 8:493

    Article  Google Scholar 

  32. Najafian M, Cheraghi M (2012) Occurrence of fetal macrosomia rate and its maternal and neonatal complications: a 5-year cohort study. Int Scholarly Res Netw Obst Gynecol 2012:1–5

    Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Hamisu M. Salihu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

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

Ethical approval

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1007/s00404-019-05400-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-019-05400-9

Keywords

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