Macrosomia and large for gestational age in Asia: One size does not fit all

Abstract

Macrosomia, usually defined as infant birth weight of ≥4000 g, does not consider gestational age, sex, or country/region‐specific differences in mean birth weight and maternal body weight. This issue is particularly relevant for Asia, where 60% of the world's population lives, due to variations in maternal size and birth weights across populations. Large for gestational age (LGA), defined as birth weight > 90th centile, is a more sensitive measure as it considers gestational age and sex, though it is dependent on the choice of growth charts. We aimed to review reporting of macrosomia and LGA in Asia. We reviewed the literature on prevalence and risk of macrosomia and LGA in Asia over the last 29 years. Prevalence of macrosomia ranged from 0.5% (India) to 13.9% (China) while prevalence of LGA ranged from 4.3% (Korea) to 22.1% (China), indicating substantial variation in prevalence within and between Asian countries. High pre‐pregnancy body mass index, excessive gestational weight gain, and impaired glucose tolerance conferred risk of macrosomia/LGA. Incidence of macrosomia and LGA varies substantially within and between Asian countries, as do the growth charts and definitions. The latter makes it impossible to make comparisons but suggests differences in intrauterine growth between populations. Reporting LGA, using standardized country/regional growth charts, would better capture the incidence of high birth weight and allow for comparison and identification of contributing factors. Better understanding of local drivers of excessive intrauterine growth could enable development of improved strategies for prevention and management of LGA.

Association between gestational abnormal glucose tolerance and maternal‐fetal outcomes

“…"Large for gestational age" (LGA) is defined as a birthweight at or greater than the gestational age-specific 90th percentile. 22,23 "Gestational hypertension" is defined as a systolic blood pressure of greater than or equal to 140 mmHg and/or a diastolic blood pressure of greater than or equal to 90 mmHg at greater than or equal to 20 weeks of gestation in the absence of proteinuria or new signs of end-organ dysfunction. 24 "Preeclampsia" refers to the new onset of hypertension and proteinuria or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria after 20 weeks of gestation or postpartum.…”

Binge alcohol drinking before pregnancy is closely associated with the development of macrosomia: Korean pregnancy registry cohort

“…In the multiple previous literatures, various risk factors of macrosomia or high birth weight have been suggested [24][25][26][27][28][29][30][31]. Maternal age, higher parity, pre-pregnancy obesity, gestational diabetes, history of previous macrosomic infant delivery, post-term pregnancy and infant gender (male) are all positively associated with macrosomia.…”

“…Birth weight of infant, which is a significant fetal outcome, is well-known as a major determinant of an infant's immediate and child future health [24,25]. The prevalence of infant macrosomia, defined as a birth weight greater than 4000 g [26], has been a rising over the last two to three decades in different countries across the world [27][28][29][30]. Also, macrosomia predisposes newborns to altered growth development and increases the risk of obesity in childhood and associated co-morbidities, such as hypertension, cardiovascular disease, and cancer, later in life [31].…”

Long-Term Health Associated with Small and Large for Gestational Age Births among Young Thai Adults

“…Babies born at the extremes of the birth weight spectrum—small for gestational age (SGA) or large for gestational age (LGA) [ 1 ]—are at a greater risk of adverse health outcomes later in life (e.g., obesity, type-2 diabetes, and cardiovascular disease) [ 2 , 3 ]. Most of the evidence on the long-term outcomes associated with being born SGA or LGA comes from high-income countries (mainly from Caucasian populations in the USA and Europe [ 4 , 5 ]). However, the geographical, regional, and ethnic variations in maternal and perinatal characteristics may lead to SGA and LGA births [ 6 ].…”

“…Given that Asia is inhabited by 60% of the world’s population, it is necessary to better understand the associations between being born SGA or LGA and the long-term health outcomes in this region. The countries with the highest prevalence of LGA (>10%) in Asia (i.e., Bangladesh, China, India, Japan, Thailand, and Vietnam) are also those traditionally characterised by low average birth weights and a high prevalence of SGA births [ 5 ]. This is because many Asian countries experience the additional burden of malnutrition [ 8 ].…”