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

BackgroundFetal macrosomia (birth weight [&ge;]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. MethodsWe 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. ResultThe 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. Conclusion and recommendatioThis 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.