Prevalence and determinants of macrosomia in low- and middle-income countries: a multilevel analysis of population survey data from 44 nations

Although excessive birth weight is associated with short-term and long-term effects for both neonates and mothers, there is a gap in our understanding of its prevalence and contributing factors in low- and middle-income countries. Moreover, previous studies primarily focused on low birth weight and were limited to a specific geographic area. Therefore, this study aimed to estimate the prevalence of macrosomia and identify its determinants using data from 44 countries. Data were obtained from demographic and health surveys conducted between 2015 and 2022 across 44 LMICs and a weighted total of 343,898 birth records was included in the analysis. Mixed-effect logistic regression models were fitted to identify determinants of excessive birth weight and the models were compared based on log-likelihood and deviance values. A p-value less than 0.05 and an adjusted odds ratio with the corresponding 95% confidence interval were used to identify determinants of macrosomia. The overall prevalence of excessive birth weight among neonates in LMCs was 7.1% [95% CI: 6.1%-8.1%], varying from 1.3% in India to 27% in Chad. The odds of excessive birth weight were higher in neonates born to mothers from households without health insurance [AOR (95% CI): 1.50 (1.36–1.65)], mothers with primary education [AOR (95% CI): 1.19 (1.09–1.31)], those born to multipara [AOR (95% CI): 1.13 (1.04–1.24), grand multipara [AOR (95% CI): 1.36 (1.20–1.54)], and overweight or obese mother [AOR (95% CI): 1.54 (1.44–1.66)]. Moreover, maternal age, number of antenatal care visits, sex of neonate, place of residence, and region were the other determinants of macrosomia. About 7% of neonates in low- and middle-income countries had excessive weight at birth, with a significant variation across the countries. Therefore, strengthening programs aimed at improving maternal literacy and promoting healthy weight management before and during pregnancy is crucial. Moreover, improving access to antenatal care and health insurance and developing programs that address the specific needs of at-risk populations, such as older, multiparous, and rural women could help reduce the incidence of macrosomia.