Increasing prevalence of macrosomia in Flanders, Belgium: an indicator of population health and a burden for the future

Abstract

Macrosomia, defined as birth weight > 4 kg, increased in Flanders from 7.3% (4899/67143) in 1991 to 8.63% (6034/69924) in 2010 (p < 0.0001) in singleton pregnancies at term. There are at least 3 important factors contributing to this evolution. (1) Increase of maternal stature and length: during the last century, mean length ofBelgian women increased with approximately 10cm to the current value of 1.66m.(2)Increase ofmaternal age:theproportionofpregnantwomenaged35 years ormore increasedsignificantly from 6.1% in 1991 to 14.3% in 2010. (3)Increase of maternal overweight or obesity: between 1994 and 2000, there was an increase of 4% for both overweight and obesity in women and today, 44% ofBelgians are overweight(BMI > 25 kg/m²), and 12% are obese (BMI > 30 kg/m²). From these data, rate and increase of macrosomia can be considered indirect indicators of general public health. Nextto the risksfor obstetrical complications, neonates> 4 kg are atrisk for development of adult obesity and type 2 diabetes with related diseases,such as hypertension and metabolic syndrome. As adults,they also tend to deliver macrosomic baby’sthemselves. Assuch, macrosomia at birth is a burden for a community’sfuture health status, health care and related costs. Prenatal health care workers should be aware of the relevance to prevent macrosomia in the first generation by implementing guidelines on nutrition, physical activity and appropriate weight gain into routine preconceptional and prenatal care, screening for gestational diabetes with strict monitoring of blood sugar levels in affected individuals, and promotion of breastfeeding.