title: Widening inequality in extreme macrosomia between Indigenous and non-Indigenous populations of Québec, Canada.
abstract: OBJECTIVE
  To evaluate trends in macrosomia by severity in Indigenous vs. non-Indigenous populations of Québec, Canada.
  
  
  METHODS
  We used a retrospective cohort of 2,298,332 singleton live births in the province of Québec, 1981-2008. Indigenous births were identified by community of residence (First Nations, Inuit, non-Indigenous) and language spoken (First Nations, Inuit, French/English). High birth weight (HBW) and large-for-gestational-age (LGA) births were categorised by severity (moderate, very, extreme). Time trends in HBW and LGA, by severity, were estimated using odds ratios (OR) and rate differences for Indigenous vs. non-Indigenous births, adjusting for maternal characteristics.
  
  
  RESULTS
  Relative to non-Indigenous, First Nations (but not Inuit) had higher rates of extreme HBW (1.3% vs. 0.1%) and extreme LGA birth (12.6% vs. 2.2%), and rates increased over time. First Nations had progressively elevated ORs with greater severity of macrosomia, and associations were strongest for extreme HBW >5,000 g (OR=12.4) and LGA >97th percentile (OR=7.2).
  
  
  CONCLUSIONS
  Inequalities in extreme macrosomia between First Nations and non-Indigenous Quebecers are pronounced and widened between 1981 and 2008.
  
  
  CONCLUSIONS
  Studies are needed to determine why macrosomia rates are increasing in Québec's First Nations, and how they compare with Indigenous sub-groups of demographically similar countries, including Australia and New Zealand.
authors: Institut national de santé publique du Québec, Montréal, Québec, Canada. nathalie.auger@inspq.qc.ca
authors: Nathalie
authors: N
authors: Auger
authors: Alison L
authors: AL
authors: Park
authors: Hamado
authors: H
authors: Zoungrana
authors: Mélanie
authors: M
authors: Fon Sing
authors: Ernest
authors: E
authors: Lo
authors: Zhong-Cheng
authors: ZC
authors: Luo
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005320:Fetal Macrosomia / Q000208:ethnology*; D005865:Gestational Age; D006801:Humans; D004930:Inuit / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011247:Pregnancy; D015995:Prevalence; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors