title: Searching for the definition of macrosomia through an outcome-based approach.
abstract: BACKGROUND
  Macrosomia has been defined in various ways by obstetricians and researchers. The purpose of the present study was to search for a definition of macrosomia through an outcome-based approach.
  
  
  METHODS
  In a study of 30,831,694 singleton term live births and 38,053 stillbirths in the U.S. Linked Birth-Infant Death Cohort datasets (1995-2004), we compared the occurrence of stillbirth, neonatal death, and 5-min Apgar score less than four in subgroups of birthweight (4000-4099 g, 4100-4199 g, 4200-4299 g, 4300-4399 g, 4400-4499 g, 4500-4999 g vs. reference group 3500-4000 g) and birthweight percentile for gestational age (90th-94th percentile, 95th-96th, and ≥ 97th percentile, vs. reference group 75th-90th percentile).
  
  
  RESULTS
  There was no significant increase in adverse perinatal outcomes until birthweight exceeded the 97th percentile. Weight-specific odds ratios (ORs) elevated substantially to 2 when birthweight exceeded 4500 g in Whites. In Blacks and Hispanics, the aORs exceeded 2 for 5-min Apgar less than four when birthweight exceeded 4300 g. For vaginal deliveries, the aORs of perinatal morbidity and mortality were larger for most of the subgroups, but the patterns remained the same.
  
  
  CONCLUSIONS
  A birthweight greater than 4500 g in Whites, or 4300 g in Blacks and Hispanics regardless of gestational age is the optimal threshold to define macrosomia. A birthweight greater than the 97th percentile for a given gestational age, irrespective of race is also reasonable to define macrosomia. The former may be more clinically useful and simpler to apply.
authors.affiliation: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jiangfeng
authors.initials: J
authors.lastname: Ye
authors.affiliation: Department of Obstetrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.affiliation: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: ZhongCheng
authors.initials: Z
authors.lastname: Luo
authors.affiliation: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000502:physiology*; D044383:Black People; D005260:Female; D005320:Fetal Macrosomia / Q000175:diagnosis* / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D005865:Gestational Age; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000208:ethnology*; D007231:Infant, Newborn; D050498:Live Birth / Q000208:ethnology*; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D050497:Stillbirth / Q000208:ethnology*; D016019:Survival Analysis; D044465:White People