Association between fetal macrosomia and risk of obesity in children under 3 years in Western China: a cohort study

  • Xiong-Fei Pan
  • Li Tang
  • Andy H. Lee
  • Colin Binns
  • Chun-Xia Yang
  • Zhu-Ping Xu
  • Jian-Li Zhang
  • Yong Yang
  • Hong Wang
  • Xin SunEmail author
Original Article



Fetal macrosomia, defined as birth weight equal or over 4000 g, is a major concern for both neonatal and maternal health. A rapid increasing trend in fetal macrosomia is observed in different regions of China. We aimed to examine the association between fetal macrosomia and risk of childhood obesity in Western China.


All macrosomic live singletons (≥ 4000 g), and a random sample of singletons with normal birth weight (2500–3999 g) born in four districts of Chengdu, Western China, in 2011 were included in the cohort study. Maternal demographics, obstetric factors, labor and delivery summary at baseline were extracted from the Chengdu Maternal and Child Health Management System. Anthropometric measurements before 3 years and infant feeding information at around 6 months were also collected. Childhood obesity under 3 years was primarily defined as a weight-for-length/height z score ≥ 1.645 using the WHO growth reference. Secondary definitions were based on weight-for-age and body mass index (BMI)-for-age over the same cut-offs.


A total of 1767 infants were included in the analyses, of whom 714 were macrosomic. After controlling for maternal age, parity, gestational age and anemia at the first antenatal visit, pre-pregnancy BMI, gestational weight gain, gestational age at birth, baby age and sex, and breastfeeding practices at 6 months, the risk of childhood obesity defined according to weight-for-length/height among macrosomic babies was 1.90 (95% confidence interval 1.04–3.49) times that of babies with normal birth weight. The risk of childhood obesity for macrosomic babies was 3.74 (1.96–7.14) and 1.64 (0.89–3.00) times higher based on weight-for-age and BMI-for-age, respectively.


Fetal macrosomia is associated with increased risk of obesity in children under 3 years in Western China.


Birth weight Child growth China Fetal macrosomia Obesity 



We thank relevant staff at four maternal and child health hospitals, who managed the district data for the Chengdu Maternal and Child Health Management System. Part of the work was presented at the 48th Asia–Pacific Academic Consortium for Public Health Conference (10-2-O) in Tokyo on September 18, 2016.

Author contributions

XFP and LT contributed equally to the article. XFP, LT, AHL, CB, CXY, and XS conceived the study. ZX, JZ, YY, and HW originally supervised data collection. XFP, LT, and XS conducted data analysis, interpretation, and presentation, and prepared the manuscript draft. All authors have contributed to, seen, and approved the manuscript.


The study was supported by the China Medical Board Open Competition fund (no. 14-199).

Compliance with ethical standards

Ethical approval

The study was approved by the Ethics Committee of Sichuan University Fourth Hospital/West China School of Public Health.

Conflict of interest

No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.


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Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2019

Authors and Affiliations

  • Xiong-Fei Pan
    • 1
    • 2
  • Li Tang
    • 3
  • Andy H. Lee
    • 4
  • Colin Binns
    • 4
  • Chun-Xia Yang
    • 5
  • Zhu-Ping Xu
    • 6
  • Jian-Li Zhang
    • 7
  • Yong Yang
    • 8
  • Hong Wang
    • 9
  • Xin Sun
    • 1
    Email author
  1. 1.Chinese Evidence-based Medicine Center, Center for Clinical Epidemiology and Evidence-based MedicineWest China Hospital, Sichuan UniversityChengduChina
  2. 2.Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  3. 3.Department of Research and EducationSichuan Jinxin Women’s and Children’s HospitalChengduChina
  4. 4.Department of Epidemiology and Biostatistics, School of Public HealthCurtin UniversityPerthAustralia
  5. 5.Department of Epidemiology and Biostatistics, West China School of Public HealthSichuan UniversityChengduChina
  6. 6.Shuangliu Maternal and Child Health HospitalChengduChina
  7. 7.Wenjiang Maternal and Child Health HospitalChengduChina
  8. 8.Longquan Maternal and Child Health HospitalChengduChina
  9. 9.Pidu Maternal and Child Health HospitalChengduChina

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