Birth weight is an essential indicator for assessing child health in terms of early exposure to childhood morbidity and mortality 12. Described as a newborn with an excessive birth weight, fetal macrosomia has become one of the major public health concern because of its increased risks for both mothers and infants 34.The neonate is considered to be macrosomic when its birth weight is greater than 4000-4500 g or greater than 90% for gestational age 56. Thus, measuring the birth weight soon after delivery can be a fundamental tool for the diagnosis of the fetal macrosomia 7.
On one hand, cesarean delivery, labor augmentation with oxytocin, postpartum hemorrhage, protracted labor, infection, 3rd- and 4th-degree perineal tears, and thromboembolic events are well-known risks that macrosomic newborn poses to the mother 8910. On the other hand, birth trauma (shoulder dystocia, brachial plexus injury, skeletal injuries), prenatal asphyxia, hypoglycemia, fetal death are the risks of macrosomia in infants 5101112. Moreover, high birth weight has also been associated with subsequent childhood and adult overweight or obesity 13. Consequently, overweight/obese children are more likely to develop non-communicable diseases such as type II diabetes and cardiovascular diseases at both younger and older ages 1415. Prior literature has identified potential risk factors related to the causation of macrosomia. These include high pre-pregnancy Body Mass Index (BMI) 16, excessive weight gain during pregnancy 17, gestational diabetes and fasting blood glucose 18, multiparty, male sex, and parental height 51920.
A broad understanding of the underlying risk factors is essential to inform well-designed preventive and management efforts. In Malawi, most efforts have been concentrated on under-nutrition as well as low birthweight in children under the age five. However, fetal macrosomia has received no attention despite its detrimental effects on childhood health outcomes. According to the 2015-16 Malawi Demographic and Health Survey (MDHS), Four percent of births are reported as very small, 12% as smaller than average, and 83% as average or larger than average 21. Thus, we aimed to explore the risk factors associated with fetal macrosomia.