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The general objective of the WHO Global Survey on Maternal and Perinatal Health was to create a global database on health services and outcomes for maternal and perinatal health, which concentrated on the relationship between mode of delivery and perinatal outcomes.
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We aimed to identify a definition that was more predictive of maternal and perinatal mortality and morbidity in term pregnancies in LMICs, which also takes into account regional variation. Two types of definitions were compared: one based on empirical absolute birthweight and the other on the country-specific birthweight percentile at each gestational week. We assessed commonly used definitions of the term ‘macrosomia’ through an outcome-based approach. In this study we analyzed data from 23 LMICs in Africa, Asia, and Latin America that participated in the World Health Organization (WHO) Global Survey on Maternal and Perinatal Health (2004–2008). Furthermore, most studies on macrosomia have focused on Caucasian populations in high-income countries, and very few studies on the topic focus on LMICs.
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As it is increasingly recognized that racial variation in birthweight is substantial, more and more studies are using specific birthweight percentiles as cut-off points at a given gestational week (e.g., P 90 or P 97) based on the concept of large-for-gestational-age (LGA). The most commonly used definition is based on birthweight cut-off points (e.g., 4000 g or 4500 g). In this study, we aimed to explore a definition through an outcome-based approach and comparing commonly used definitions currently.Ĭurrently, no consensus definition exists among researchers and obstetricians. Thus, a precise definition of macrosomia that is more predictive of maternal and perinatal mortality and morbidity is needed. Complicated deliveries related to macrosomia could lead to more severe adverse outcomes in resource-poor settings due to limited availability of obstetric care. However, with the increasing prevalence of maternal obesity and diabetes a parallel increase in macrosomic infants might be expected in LMICs. But in many LMICs, macrosomia is still not perceived to have the same priority as other public health problems (e.g., HIV). In high-income countries, the prevalence of macrosomia has been increasing in the last two to three decades. In low-and middle- income countries (LMICs) or settings where antenatal care is sub–optimal, poorly controlled diabetes or undiagnosed gestational diabetes may be a more important cause for macrosomia than in high-income countries, where antenatal care is better. The condition may be caused by constitutional/genetic factors, maternal obesity and/or excessive gestational weight gain, or maternal hyperglycemia due to pre-existing diabetes or gestational diabetes that were not adequately controlled. “Macrosomia” is a term that describes a very large fetus or neonate. The population-specific definition of macrosomia using birthweight cut-off points irrespective of gestational age (4500 g in Africa and Latin America, 4000 g in Asia) is more predictive of maternal and perinatal adverse outcomes, and simpler to apply compared to the definition based on birthweight percentile for a given gestational age. When birthweight was at the 90 th percentile or higher, aORs of MMMI and PMMI increased, but none exceeded 2.0. 78 ) when birthweight was greater than 4500 g in Latin America.aORs of MMMI reached 2.0 when birthweight was greater than 4000 g, 4500 g in Asia and Africa, respectively. 01 in Africa, Asia and Latin America, respectively).Adjusted odds ratios (aORs) for intrapartum caesarean sections exceeded 2.0 when birthweight was greater than 4000 g (2 ResultsĪ total of 246,659 singleton term births from 363 facilities in 23 low- and middle-income countries were included. Two-level logistic regression models were used to estimate odds ratios of MMMI and PMMI. We compared adverse outcomes, which were assessed by the composite maternal mortality and morbidity index (MMMI) and perinatal mortality and morbidity index (PMMI) in subgroups with birthweight (3000–3499 g, 3500–3999 g, 4000–4099 g, 4100–4199 g, 4200–4299 g, 4300–4399 g, 4400–4499 g, 4500–4999 g) or country-specific birthweight percentile for gestational age (50 th–74 th percentile, 75 th–89 th, 90 th–94 th, 95 th–96 th, and ≥97 th percentile). We conducted a secondary data analysis using WHO Global Survey on Maternal and Perinatal Health data on Africa and Latin America from 2004 to 2005 and Asia from 2007 to 2008. We aimed to identify a definition of macrosomia that is more predictive of maternal and perinatal mortality and morbidity in low- and middle-income countries. No consensus definition of macrosomia currently exists among researchers and obstetricians.