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

Fati Kirakoya-Samadoulougou; Joyeuse Ukwishaka; Calypse Ngwasiri; Seema Subedi; Elizabeth A Hazel; Daniel J Erchick; Lee Shu Fune Wu; Carlos Grandi; Carl Lachat; Laéticia Céline Toe; Dominique Roberfroid; Lieven Huybregts; Alain B Labrique; Mabhubur Rashid; Saijuddin Shaikh; Rezwanul Haque; Abdullah H Baqui; Samir K Saha; Rasheda Khanam; Sayedur Rahman; Md Mariângela F Silveira; Romina Buffarini; Roger L Shapiro; Rebecca Zash; Zhonghai Zhu; Lingxia Zeng; Xiu Qiu; Jianrong He; Seifu H Gebreyesus; Kokeb Tesfamariam; Grace Chan; Delayehu Bekele; Seth Adu-Afarwuah; Kathryn G Dewey; Stephaney Gyaase; Blair J Wylie; Sunita Taneja; Ranadip Chowdhury; Giridhara R Babu; R Deepa; Mohamed Rishard; Marzia Lazzerini; Maria J Rodriguez-Sibaja; Sandra Acevedo-Gallegos; Per Ashorn; Kenneth Maleta; Christentze Schmiegelow; Daniel Minja; Line Hjort; John P A Lusingu; 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

Fati Kirakoya-Samadoulougou^*, Joyeuse Ukwishaka, Calypse Ngwasiri, Seema Subedi, Elizabeth A Hazel, Daniel J Erchick, Lee Shu Fune Wu, Carlos Grandi, Carl Lachat, Laéticia Céline Toe, Dominique Roberfroid, Lieven Huybregts, Alain B Labrique, Mabhubur Rashid, Saijuddin Shaikh, Rezwanul Haque, Abdullah H Baqui, Samir K Saha, Rasheda Khanam, Sayedur RahmanMd Mariângela F Silveira, Romina Buffarini, Roger L Shapiro, Rebecca Zash, Zhonghai Zhu, Lingxia Zeng, Xiu Qiu, Jianrong He, Seifu H Gebreyesus, Kokeb Tesfamariam, Grace Chan, Delayehu Bekele, Seth Adu-Afarwuah, Kathryn G Dewey, Stephaney Gyaase, Blair J Wylie, Sunita Taneja, Ranadip Chowdhury, Giridhara R Babu, R Deepa, Mohamed Rishard, Marzia Lazzerini, Maria J Rodriguez-Sibaja, Sandra Acevedo-Gallegos, Per Ashorn, Kenneth Maleta, Christentze Schmiegelow, Daniel Minja, Line Hjort, John P A Lusingu, Subnational Collaborative Group for Vulnerable Newborn Prevalence

^*Corresponding author for this work

2 Citations (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
Journal	BJOG : an international journal of obstetrics and gynaecology
Volume	132 Suppl 8
Issue number	Suppl 8
Pages (from-to)	S97-S108
ISSN	1470-0328
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
Prevalence
Humans
Live Birth/epidemiology
Developing Countries/statistics & numerical data
Male
Gestational Age
Latin America/epidemiology
Pregnancy
Birth Weight
Female
Adult
Fetal Macrosomia/epidemiology
Infant, Newborn

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10.1111/1471-0528.70044

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Kirakoya-Samadoulougou, F., Ukwishaka, J., Ngwasiri, C., Subedi, S., Hazel, E. A., Erchick, D. J., Wu, L. S. F., Grandi, C., Lachat, C., Toe, L. C., Roberfroid, D., Huybregts, L., Labrique, A. B., Rashid, M., Shaikh, S., Haque, R., Baqui, A. H., Saha, S. K., Khanam, R., ... 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, 132 Suppl 8(Suppl 8), 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. / Kirakoya-Samadoulougou, Fati; Ukwishaka, Joyeuse; Ngwasiri, Calypse et al.
In: BJOG : an international journal of obstetrics and gynaecology, Vol. 132 Suppl 8, No. Suppl 8, 11.2025, p. S97-S108.

Research output: Contribution to journal › Journal article › Research › peer-review

Kirakoya-Samadoulougou, F, Ukwishaka, J, Ngwasiri, C, Subedi, S, Hazel, EA, Erchick, DJ, Wu, LSF, Grandi, C, Lachat, C, Toe, LC, Roberfroid, D, Huybregts, L, Labrique, AB, Rashid, M, Shaikh, S, Haque, R, Baqui, AH, Saha, SK, Khanam, R, Rahman, S, Silveira, MMF, Buffarini, R, Shapiro, RL, Zash, R, Zhu, Z, Zeng, L, Qiu, X, He, J, Gebreyesus, SH, Tesfamariam, K, Chan, G, Bekele, D, Adu-Afarwuah, S, Dewey, KG, Gyaase, S, Wylie, BJ, Taneja, S, Chowdhury, R, Babu, GR, Deepa, R, Rishard, M, Lazzerini, M, Rodriguez-Sibaja, MJ, Acevedo-Gallegos, S, Ashorn, P, Maleta, K, Schmiegelow, C, Minja, D, Hjort, L, Lusingu, JPA & 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 Suppl 8, no. Suppl 8, pp. S97-S108. https://doi.org/10.1111/1471-0528.70044

Kirakoya-Samadoulougou F, Ukwishaka J, Ngwasiri C, Subedi S, Hazel EA, Erchick DJ et al. 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. 2025 Nov;132 Suppl 8(Suppl 8):S97-S108. Epub 2025 Nov 10. doi: 10.1111/1471-0528.70044

Kirakoya-Samadoulougou, Fati ; Ukwishaka, Joyeuse ; Ngwasiri, Calypse et al. / 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. In: BJOG : an international journal of obstetrics and gynaecology. 2025 ; Vol. 132 Suppl 8, No. Suppl 8. pp. S97-S108.

@article{7bf9553f8e0c48b5a70968542a384927,

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, Prevalence, Humans, Live Birth/epidemiology, Developing Countries/statistics \& numerical data, Male, Gestational Age, Latin America/epidemiology, Pregnancy, Birth Weight, Female, Adult, Fetal Macrosomia/epidemiology, Infant, Newborn",

author = "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 Christentze Schmiegelow and Daniel Minja and Line Hjort and Lusingu, \{John P A\} and \{Subnational Collaborative Group for Vulnerable Newborn Prevalence\}",

note = "{\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 Suppl 8",

pages = "S97--S108",

journal = "BJOG : an international journal of obstetrics and gynaecology",

issn = "1470-0328",

publisher = "John Wiley and Sons Inc.",

number = "Suppl 8",

}

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 - 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 - Schmiegelow, Christentze

AU - Minja, Daniel

AU - Hjort, Line

AU - Lusingu, John P A

AU - Subnational Collaborative Group for Vulnerable Newborn Prevalence

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

KW - Prevalence

KW - Humans

KW - Live Birth/epidemiology

KW - Developing Countries/statistics & numerical data

KW - Male

KW - Gestational Age

KW - Latin America/epidemiology

KW - Pregnancy

KW - Birth Weight

KW - Female

KW - Adult

KW - Fetal Macrosomia/epidemiology

KW - Infant, Newborn

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

U2 - 10.1111/1471-0528.70044

DO - 10.1111/1471-0528.70044

M3 - Journal article

C2 - 41213838

SN - 1470-0328

VL - 132 Suppl 8

SP - S97-S108

JO - BJOG : an international journal of obstetrics and gynaecology

JF - BJOG : an international journal of obstetrics and gynaecology

IS - Suppl 8

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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