Associations between Foetal Macrosomia and Adverse Maternal and Child Health Outcomes in South and Southeast Asia: A pooled Analyses of National Surveys from 11 Low-and-middle-income Countries
1
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
2
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
Popul. Med. 2026;8(Supplement Supplement 1):A2145
ABSTRACT
INTRODUCTION:
Foetal macrosomia, often overlooked in LMIC agendas, is rising alongside maternal obesity and diabetes. We assessed the prevalence of macrosomia and its associations with key maternal (caesarean-delivery and maternal overweight or obesity), and child (under-five overweight and under-five mortality) outcomes in South and Southeast Asia.
METHODS:
We conducted a pooled cross-sectional analysis of Demographic and Health Surveys, 2015 to 2022, from Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines, and Timor-Leste. The sample comprised singleton births to women aged 15 to 49 years in the five years preceding each survey. Macrosomia was defined primarily as birth weight 4000 g or higher, with country-specific 90th percentile thresholds examined secondarily. We estimated weighted prevalence and fitted survey-weighted logistic regression models with country fixed effects, adjusting for maternal, obstetric, and socioeconomic covariates.
RESULTS:
The analytic sample included 255,756 singleton births. Macrosomia prevalence varied widely across countries (18% in Afghanistan to 3% in Cambodia), using the 4000g definition. Macrosomia was associated with higher odds of caesarean delivery in both regions [South Asia: aOR 1.5, 95% CI 1.4-1.6; and Southeast Asia: aOR 1.4, 95% CI 1.2 to 1.5]. It was also associated with maternal overweight or obesity [South Asia: aOR 1.7, 95% CI 1.6-1.8; and Southeast Asia: aOR 1.4, 95% CI 1.2 to 1.7]. For child outcomes, odds of under-five overweight were elevated (aOR 1.4, 95% CI 1.3-1.6), and under-five mortality showed a positive association (aOR 1.6, 95% CI 1.4-1.8) in South Asia only. Associations using country-specific 90th percentile thresholds were directionally similar with modest attenuation.
CONCLUSIONS:
Macrosomia is linked with adverse maternal and child health outcomes in South and Southeast Asia. Prevention strategies should focus on reducing maternal BMI and system readiness for safe delivery and early-life nutrition, tailored by region.
Foetal macrosomia, often overlooked in LMIC agendas, is rising alongside maternal obesity and diabetes. We assessed the prevalence of macrosomia and its associations with key maternal (caesarean-delivery and maternal overweight or obesity), and child (under-five overweight and under-five mortality) outcomes in South and Southeast Asia.
METHODS:
We conducted a pooled cross-sectional analysis of Demographic and Health Surveys, 2015 to 2022, from Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines, and Timor-Leste. The sample comprised singleton births to women aged 15 to 49 years in the five years preceding each survey. Macrosomia was defined primarily as birth weight 4000 g or higher, with country-specific 90th percentile thresholds examined secondarily. We estimated weighted prevalence and fitted survey-weighted logistic regression models with country fixed effects, adjusting for maternal, obstetric, and socioeconomic covariates.
RESULTS:
The analytic sample included 255,756 singleton births. Macrosomia prevalence varied widely across countries (18% in Afghanistan to 3% in Cambodia), using the 4000g definition. Macrosomia was associated with higher odds of caesarean delivery in both regions [South Asia: aOR 1.5, 95% CI 1.4-1.6; and Southeast Asia: aOR 1.4, 95% CI 1.2 to 1.5]. It was also associated with maternal overweight or obesity [South Asia: aOR 1.7, 95% CI 1.6-1.8; and Southeast Asia: aOR 1.4, 95% CI 1.2 to 1.7]. For child outcomes, odds of under-five overweight were elevated (aOR 1.4, 95% CI 1.3-1.6), and under-five mortality showed a positive association (aOR 1.6, 95% CI 1.4-1.8) in South Asia only. Associations using country-specific 90th percentile thresholds were directionally similar with modest attenuation.
CONCLUSIONS:
Macrosomia is linked with adverse maternal and child health outcomes in South and Southeast Asia. Prevention strategies should focus on reducing maternal BMI and system readiness for safe delivery and early-life nutrition, tailored by region.
| eISSN: | 2654-1459 |
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