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

Subnational Collaborative Group for Vulnerable Newborn Prevalence

doi:10.1111/1471-0528.70044

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

Subnational Collaborative Group for Vulnerable Newborn Prevalence

Department of Nutrition And Food Science

Johns Hopkins Bloomberg School of Public Health
Université Libre de Bruxelles
Ciudad Autónoma de Buenos Aires
Ghent University
Universite de Namur
International Food Policy Research Institute
Noora Health
Society for Applied Studies Kolkata
JiVitA Maternal and Child Health Research Project
Child Health Research Foundation
Projahnmo Research Foundation
Federal University of Pelotas
Children's Hospital of Philadelphia
Beth Israel Deaconess Medical Center
Xi'an Jiaotong University Health Science Center
Guangzhou Medical College
Addis Ababa University
Ambo University
St. Paul‘s Hospital Millennium Medical College
University of California at Davis
Kintampo Health Research Centre
Columbia University Medical Center
Qatar University
PHFI Center for Developmental and Lifecourse Research
University of Colombo Faculty of Medicine
IRCCS Ospedale Infantile Burlo Garofolo - Trieste
London School of Hygiene & Tropical Medicine
Maternal-Fetal Medicine Department
Tampere University and Tampere University Hospital
University of Malawi
The Aga Khan University
Department of Infectious Diseases
Charles Darwin University
University of California San Francisco
University of Rwanda
Mahidol University
Ubon Ratchathani University
Harvard T.H. Chan School of Public Health
George Mason University
University of Copenhagen
National Institute for Medical Research Tanzania
University of Copenhagen
Milken Institute School of Public Health
Ifakara Health Institute
Ministry of Health Zanzibar
Infectious Diseases Research Collaboration
Makerere University School of Public Health
Karolinska Institutet
South African Medical Research Council
Ariadne Labs
Brigham and Women’s Hospital
Boston University
Boston University Chobanian & Avedisian School of Medicine
University of Zambia
University of Alabama at Birmingham
National HIV/AIDS/STI/TB Council of Zambia
North West University
Queen Mary University of London
Zvitambo Institute for Maternal and Child Health Research
Brown University

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

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.

Original language	English
Pages (from-to)	S97-S108
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	132
Issue number	S8
DOIs	https://doi.org/10.1111/1471-0528.70044
Publication status	Published - Nov 2025

Keywords

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

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10.1111/1471-0528.70044

Cite this

@article{b3014a20e3fc4a2fa316349493f92ff1,

title = "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",

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",

author = "\{Subnational Collaborative Group for Vulnerable Newborn Prevalence\} and Fati Kirakoya-Samadoulougou and Joyeuse Ukwishaka and Calypse Ngwasiri and Seema Subedi and Hazel, \{Elizabeth A.\} and Erchick, \{Daniel J.\} and Wu, \{Lee Shu Fune\} and Carlos Grandi and Carl Lachat and Toe, \{La{\'e}ticia C{\'e}line\} and Dominique Roberfroid and Lieven Huybregts and Labrique, \{Alain B.\} and Mabhubur Rashid and Saijuddin Shaikh and Rezwanul Haque and Baqui, \{Abdullah H.\} and Saha, \{Samir K.\} and Rasheda Khanam and Sayedur Rahman and Silveira, \{Md Mari{\^a}ngela F.\} and Romina Buffarini and Shapiro, \{Roger L.\} and Rebecca Zash and Zhonghai Zhu and Lingxia Zeng and Xiu Qiu and Jianrong He and Gebreyesus, \{Seifu H.\} and Kokeb Tesfamariam and Grace Chan and Delayehu Bekele and Seth Adu-Afarwuah and Dewey, \{Kathryn G.\} and Stephaney Gyaase and Wylie, \{Blair J.\} and Sunita Taneja and Ranadip Chowdhury and Babu, \{Giridhara R.\} and R. Deepa and Mohamed Rishard and Marzia Lazzerini and Rodriguez-Sibaja, \{Maria J.\} and Sandra Acevedo-Gallegos and Per Ashorn and Kenneth Maleta and Mullany, \{Luke C.\} and Fyezah Jehan and Muhammad Ilyas and Rogerson, \{Stephen J.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley \& Sons Ltd.",

year = "2025",

month = nov,

doi = "10.1111/1471-0528.70044",

language = "English",

volume = "132",

pages = "S97--S108",

journal = "BJOG: An International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

publisher = "John Wiley and Sons Inc.",

number = "S8",

}

Subnational Collaborative Group for Vulnerable Newborn Prevalence 2025, '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', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 132, no. S8, pp. S97-S108. https://doi.org/10.1111/1471-0528.70044

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. / Subnational Collaborative Group for Vulnerable Newborn Prevalence.
In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 132, No. S8, 11.2025, p. S97-S108.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Prevalence of Large-for-Gestational Age and Macrosomia Among Livebirths in 23 Low- and Middle-Income Countries Between 2000 and 2021

T2 - An Individual Participant Data Analysis

AU - Subnational Collaborative Group for Vulnerable Newborn Prevalence

AU - Kirakoya-Samadoulougou, Fati

AU - Ukwishaka, Joyeuse

AU - Ngwasiri, Calypse

AU - Subedi, Seema

AU - Hazel, Elizabeth A.

AU - Erchick, Daniel J.

AU - Wu, Lee Shu Fune

AU - Grandi, Carlos

AU - Lachat, Carl

AU - Toe, Laéticia Céline

AU - Roberfroid, Dominique

AU - Huybregts, Lieven

AU - Labrique, Alain B.

AU - Rashid, Mabhubur

AU - Shaikh, Saijuddin

AU - Haque, Rezwanul

AU - Baqui, Abdullah H.

AU - Saha, Samir K.

AU - Khanam, Rasheda

AU - Rahman, Sayedur

AU - Silveira, Md Mariângela F.

AU - Buffarini, Romina

AU - Shapiro, Roger L.

AU - Zash, Rebecca

AU - Zhu, Zhonghai

AU - Zeng, Lingxia

AU - Qiu, Xiu

AU - He, Jianrong

AU - Gebreyesus, Seifu H.

AU - Tesfamariam, Kokeb

AU - Chan, Grace

AU - Bekele, Delayehu

AU - Adu-Afarwuah, Seth

AU - Dewey, Kathryn G.

AU - Gyaase, Stephaney

AU - Wylie, Blair J.

AU - Taneja, Sunita

AU - Chowdhury, Ranadip

AU - Babu, Giridhara R.

AU - Deepa, R.

AU - Rishard, Mohamed

AU - Lazzerini, Marzia

AU - Rodriguez-Sibaja, Maria J.

AU - Acevedo-Gallegos, Sandra

AU - Ashorn, Per

AU - Maleta, Kenneth

AU - Mullany, Luke C.

AU - Jehan, Fyezah

AU - Ilyas, Muhammad

AU - Rogerson, Stephen J.

PY - 2025/11

Y1 - 2025/11

N2 - 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.

AB - 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.

KW - birth weight

KW - large-for-gestational age

KW - low- and middle-income countries

KW - macrosomia

KW - vulnerable newborn types

UR - https://www.scopus.com/pages/publications/105021409363

U2 - 10.1111/1471-0528.70044

DO - 10.1111/1471-0528.70044

M3 - Article

C2 - 41213838

AN - SCOPUS:105021409363

SN - 1470-0328

VL - 132

SP - S97-S108

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

IS - S8

ER -

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

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