Redefining Macrosomia Risk Factors in Low-Resource Settings: A Cross-Sectional Study from an Ethiopian Tertiary Hospital

Background Fetal macrosomia (birth weight ≥4000g), as defined by WHO, poses significant risks for maternal and neonatal health, particularly in low-resource settings. In Ethiopia, where obstetric services face substantial challenges, the predictors of macrosomia extend beyond traditional risk factors like diabetes and obesity. This cross-sectional study at a tertiary hospital in South Ethiopia aimed to investigate underrecognized determinants of macrosomia, to inform targeted antenatal risk stratification. The findings address a critical evidence gap in the region and provide actionable insights for clinical practice.

We conducted a facility-based cross-sectional study at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH) from October 1 to December 30, 2020, involving 467 randomly selected postpartum women. Data were collected through structured questionnaires and medical record review, capturing maternal characteristics and birth outcomes. After data entry using EpiData version 3.1, we performed statistical analysis in SPSS 25, including: descriptive statistics for baseline characteristics, bivariate logistic regression to identify potential predictors, and multivariate logistic regression to determine independent associations with macrosomia. Statistical significance was set at p<0.05 with 95% confidence intervals.

The study revealed a macrosomia prevalence of 15.8% among 467 deliveries. Three key predictors emerged: male fetal sex (AOR=2.71, 95%CI:1.22-5.98), prior macrosomic delivery (AOR=8.53, 95%CI:2.64-27.62), and hormonal contraceptive use (AOR=3.57, 95%CI:1.30-9.79). Notably, injectable contraceptives accounted for 54% of family planning methods among mothers of macrosomic infants.

and recommendatio This study identifies hormonal contraception as a novel, modifiable risk factor for macrosomia in low-resource settings, alongside established predictors (male sex, prior macrosomia). The findings advocate for: (1) enhanced antenatal screening for contraceptive history, (2) targeted fetal monitoring for high-risk pregnancies, and (3) provider education on non-traditional macrosomia risks. These evidence-based interventions could significantly reduce adverse outcomes in resource-limited hospitals. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical review committee of Wolaita Sodo University I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors ABBREVIATIONS AND ACRONYMS - ACOG - [American College of Obstetricians and Gynecologists] - [BMI] - Body Mass Index - [GDM] - Gestational Diabetes Mellitus - [GWG] - Gestational Weight Gain - [LGA] - Large for Gestational Age - [WHO] - World Health Organization - [WSUTRH] - Wolaita Sodo University teaching and referral hospital