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Am J Perinatol
DOI: 10.1055/a-2722-8170
Original Article

Increasing Birth Weight above 4,000 Grams Is Associated with Adverse Outcomes among Births without Diabetes

Autoren

  • Alyssa R. Hersh

    1   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, United States

  • Katherine C. Fitch

    2   Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States

  • Bharti Garg

    1   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, United States

  • Aaron B. Caughey

    1   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, United States

  • Amy M. Valent

    1   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, United States
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Abstract

Objective

This study aimed to evaluate the association of increasing birth weight above 4,000 grams and adverse obstetric outcomes and explore the influence of key maternal risk factors, including prepregnancy body mass index (BMI) and gestational weight gain (GWG), among births not complicated by diabetes.

Study Design

This was a retrospective cohort study of singleton, non-anomalous, live births between 37 and 42 weeks' gestation in the United States between 2012 and 2021. Births complicated by diabetes or with birth weights less than 3,000 g were excluded. Births were stratified into four weight categories: 3,000 to 3,999 g (referent group), 4,000 to 4,499, 4,500 to 4,999, and ≥5,000 g. We performed stratified analyses by prepregnancy BMI and GWG per the National Academy of Medicine guideline recommendations. Analyses were performed via chi-square and adjusted incidence risk ratios for statistical comparisons.

Results

There were 23,487,820 births included in this analysis. Higher birth weights were significantly associated with a higher risk of adverse perinatal outcomes, including cesarean delivery, blood transfusion, unplanned hysterectomy, maternal ICU admission, and obstetric anal sphincter injury. Additionally, the adjusted risk of all adverse neonatal outcomes also increased with increasing birth weight. When stratified by maternal risk factors, including BMI and GWG groups, we similarly found higher risk of adverse outcomes among higher birth weight categories, particularly among births complicated by maternal obesity or GWG above the National Academies of Medicine (NAM) recommendations.

Conclusion

Among births without diabetes, birth weights above 4,000 g were associated with an increasingly higher risk of adverse perinatal outcomes, and adverse outcomes remained higher even after stratification by BMI and GWG.

Key Points

  • Increasing birth weight is associated with higher rates of adverse outcomes.

  • Perinatal outcomes by severity of macrosomia have not been thoroughly studied.

  • Obesity and excessive weight gain in pregnancy is associated with adverse neonatal outcomes.

Keywords

macrosomia - obstetrics - gestational weight gain - body mass index - obesity - cesarean delivery

Ethical Approval

Institutional Review Board approval was not needed as publicly available data were used.


Supplementary Material



Publikationsverlauf

Eingereicht: 25. Juni 2025

Angenommen: 13. Oktober 2025

Accepted Manuscript online:
14. Oktober 2025

Artikel online veröffentlicht:
07. November 2025

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