Birthweights at term have increased globally: insights from a systematic review of 183 million births - 29/03/24

Doi : 10.1016/j.ajog.2024.03.002

Giulia Bonanni, MD ^a,^b,^d,^⁎ , Chiara Airoldi, PhD ^c, Vincenzo Berghella, MD ^d
^a Maternal Fetal Care Center, Division of Fetal Medicine and Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA
^b Department of Women, Children, and Public Health Sciences, IRCCS Agostino Gemelli University Polyclinic Foundation, Catholic University of the Sacred Heart, Rome, Italy
^c Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
^d Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA

^∗Corresponding author: Giulia Bonanni, MD.

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Abstract

Objective

This study aimed to assess global trends in mean birthweights at term, as reported in peer-reviewed literature.

Data Sources

We electronically searched PubMed, Embase, and Web of Science up to September 2023, using combinations of the search terms: “birth weight”; “birth-weight”; “birthweight”; “trend”. There were no restrictions based on language or geographic area.

Study Eligibility Criteria

We included all ecological and observational studies reporting mean birthweight at term as a continuous numerical variable over time.

Methods

We assessed the quality of included studies using the Dufault and Klar checklist modified by Betran et al. Univariate and multivariate linear models were used to examine the effects of time (years) and geographical origins. Subgroup analyses focused on national data sources and on data collected from 1950 onward.

Results

Among 6447 reviewed articles, 29 met our criteria, reporting mean birthweight data from over 183 million infants worldwide. Most studies were hospital-based (48.3%), 44.8% used national data, and a minority used municipality, community, or regional data (6.9%). Geographically, North America (31.0%) had the highest representation, followed by Asia and Europe (27.6% each), and South America and Oceania (6.9% each). Our univariate linear regression model (Model 1) revealed a significant increase in mean birthweight at term over time (4.74 g/y; 95% confidence interval, 3.95–5.53; P<.001). Model 2, incorporating continental dummy variables into the first model, confirmed this trend (3.85 g/y; 95% confidence interval, 2.96–4.74; P<.001). Model 3, focusing on available national data, did not find a significant relationship. Model 4 narrowed its focus on records from 1950 onward, reporting a robust annual increase of 7.26 g/y (95% confidence interval, 6.19–8.33; P<.001). Model 5, adjusting for the number of participants included in each study, reported a conclusive mean term birthweight increase of 1.46 g/y (95% confidence interval, 0.74–2.18; P<.001).

Conclusion

This systematic review of 29 studies shows an increase in term birthweights over time, particularly when considering data since 1950. Limitations include study quality variations, data source diversity, and data sparsity, underscoring the need for future research to use precise gestational age distinctions and predetermined time frames to gain a deeper understanding of this trend and its implications for maternal and child health.

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