title: Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America.
abstract: BACKGROUND
  No consensus definition of macrosomia currently exists among researchers and obstetricians. 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.
  
  
  METHODS
  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 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 [reference group], 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 [reference group], 75(th)-89(th), 90(th)-94(th), 95(th)-96(th), and ≥97(th) percentile). Two-level logistic regression models were used to estimate odds ratios of MMMI and PMMI.
  
  
  RESULTS
  A total of 246,659 singleton term births from 363 facilities in 23 low- and middle-income countries were included. Adjusted odds ratios (aORs) for intrapartum caesarean sections exceeded 2.0 when birthweight was greater than 4000 g (2·00 [95% CI: 1·68, 2·39], 2·42 [95% CI: 2·02, 2·89], 2·01 [95% CI: 1·74, 2·33] in Africa, Asia and Latin America, respectively). aORs of MMMI reached 2.0 when birthweight was greater than 4000 g, 4500 g in Asia and Africa, respectively. aORs of PMMI approached to 2.0 (1·78 [95% CI: 1·16, 2·74]) when birthweight was greater than 4500 g in Latin America. When birthweight was at the 90(th) percentile or higher, aORs of MMMI and PMMI increased, but none exceeded 2.0.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. jiangfeng_ye@hotmail.com.|UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. jiangfeng_ye@hotmail.com.
authors.forename: Jiangfeng
authors.initials: J
authors.lastname: Ye
authors.affiliation: Department of Internal Medicine, Post Graduate program of Evidence Based Healthcare, São Paulo Federal University, São Paulo, SP, Brazil. ginecologia@terra.com.br.
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Torloni
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. otaerika@gmail.com.
authors.forename: Erika
authors.initials: E
authors.lastname: Ota
authors.affiliation: Family Health Bureau, Ministry of Health, 231, De Saram Place, Colombo 10, Sri Lanka. kapjay613@gmail.com.
authors.forename: Kapila
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authors.lastname: Jayaratne
authors.affiliation: Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. cynthiapileggi@gmail.com.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Pileggi-Castro
authors.affiliation: Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico. eduardo.ortiz@insp.mx.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ortiz-Panozo
authors.affiliation: Department of Obstetrics & Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. pisake@kku.ac.th.
authors.forename: Pisake
authors.initials: P
authors.lastname: Lumbiganon
authors.affiliation: Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan. morisaki-n@ncchd.go.jp.
authors.forename: Naho
authors.initials: N
authors.lastname: Morisaki
authors.affiliation: Department of Biostatistics & Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand. laopaiboonmalinee@yahoo.co.uk.
authors.forename: Malinee
authors.initials: M
authors.lastname: Laopaiboon
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. rintaromori@gmail.com.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
authors.affiliation: UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. tuncalpo@who.int.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Tunçalp
authors.affiliation: Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. fangfang19881106@163.com.
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.affiliation: School of Public Health, Guilin Medical College, Guangxi, China. yhp268@163.com.
authors.forename: Hongping
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. jpsouza@fmrp.usp.br.
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Souza
authors.affiliation: UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. vogeljo@who.int.
authors.forename: Joshua Peter
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. junjimzhang@gmail.com.
authors.forename: Jun
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authors.lastname: Zhang
mesh_terms: D000328:Adult; D000349:Africa; D001208:Asia; D016208:Databases, Factual; D005260:Female; D005320:Fetal Macrosomia / Q000175:diagnosis* / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007843:Latin America; D016015:Logistic Models; D008428:Maternal Mortality; D009017:Morbidity; D016017:Odds Ratio; D054238:Perinatal Mortality; D011204:Poverty Areas; D011247:Pregnancy; D011795:Surveys and Questionnaires; D047929:Term Birth; D014944:World Health Organization