Predictors of excess birth weight in Brazil: a systematic review

Czarnobay, Sandra Ana; Kroll, Caroline; Schultz, Lidiane F.; Malinovski, Juliana; Mastroeni, Silmara Salete de Barros Silva; Mastroeni, Marco Fabio

doi:10.1016/j.jped.2018.04.006

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Review articles • J. Pediatr. (Rio J.) 95 (2) • Mar-Apr 2019 • https://doi.org/10.1016/j.jped.2018.04.006 copy

Predictors of excess birth weight in Brazil: a systematic review^☆ ☆ Please cite this article as: Czarnobay SA, Kroll C, Schultz LF, Malinovski J, Mastroeni SS, Mastroeni MF. Predictors of excess birth weight in Brazil: a systematic review. J Pediatr (Rio J). 2019;95:128-54.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To describe the main predictors for excess birth weight in Brazilian children.

Data sources:

Systematic review carried out in the bibliographic databases: PubMed/MEDLINE, Cochrane, Scopus, Web of Science, and LILACS. The research in the gray literature was performed using the Google Scholar database. The bias risk analysis was adapted from the Downs and Black scale, used to evaluate the methodology of the included studies.

Data synthesis:

Using the classifications of fetal macrosomia (>4.000 g or ≥4.000 g) and large for gestational age (above the 90th percentile), 64 risk factors for excess birth weight were found in 33 scientific articles in the five regions of the country. Of the 64 risk factors, 31 were significantly associated with excess birth weight, with excess gestational weight gain, pre-gestational body mass index ≥25 kg/m², and gestational diabetes mellitus being the most prevalent.

Conclusion:

The main predictors for excess birth weight in Brazil are modifiable risk factors. The implementation of adequate nutritional status in the gestational period and even after childbirth appears to be due to the quality and frequency of the follow-up of the mothers and their children by public health agencies.

KEYWORDS
Newborn; Excess weight; Obesity; Macrosomia; Gestational weight gain; Systematic review

Author	Type of institution	Type of study	Sample	Risk factors considered	Criteria for excess birth weight	Excess birth weight	Main results
South region
Souza et al.⁶¹61 Souza ML, Tanaka ACA, Siqueira AA, Santana RM. Live births at maternity hospitals. 1. Birth weight, sex, delivery type and the mother's health insurance. Rev Saude Publica. 1988;22:489-93.	Not informed	Cross-sectional	n = 18,491	Maternal social security affiliation: private, INPS/IPESC, and indigent/social service	≥4000 g, without reference	10.2%, 11.2% and 5.7%, respectively	NB ≥ 4000 g was associated with maternal social security affiliation for private institution and INPS/IPESC (p < 0.01)^a a p-value calculated by the authors.
Madi et al.⁵⁵55 Madi JM, Rombaldi RL, Araújo BF, Zatti H, Oliveira-Filho PF, Madi SR. Fatores maternos e perinatais relacionados à macrossomia fetal. Rev Bras Ginecol Obstet. 2006;28:232-7.	Public	Cross-sectional	n = 7760	DM	Macrosomia ≥4000 g, without reference	5.3%	Presence of DM was > in the macrosomic group (OR = 4.2, 95% CI 2.7-6.4)
Araujo and Sant'Ana⁵⁹59 Araujo SG, Sant'Ana DM. Relação entre a idade materna e o peso ao nascer: um estudo da gravidez na adolescência no município de Umuarama, PR, Brasil em 2001. Ciênc Cuid Saúde. 2003;2:155-60.	Public	Cross-sectional	n = 1406	Maternal age	≥4000 g, without reference	<20 years: 2.8% 20-29 years: 3.4% ≥30 years: 6.2% Total prevalence: 3.9%	Association between NB ≥ 4000 g with women >30 years (p = 0.048)^a a p-value calculated by the authors.
Gonçalves et al.⁴⁵45 Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome. Rev Bras Ginecol Obstet. 2012;34:304-9.	Public	Cross-sectional	n = 1117	Pre-gestational BMI and GWG	≥4000 g, without reference	Not described	The higher the BMI at the beginning of pregnancy and the GWG, the greater the risk of macrosomia (p = 0.001 and p = 0.03, respectively)
Baggenstoss et al.²⁷27 Baggenstoss R, Petzhold SV, Willemann IKM, Pabis FS, Gimenes P, De Souza BV, et al. Study of polymorphism G54D of MBL2 gene in gestational diabetes mellitus. Arq Bras Endocrinol Metabol. 2014;58:900-5.	Public	Cohort	n = 105	G54D polymorphism of the MBL2 gene	LGA: >higher than the 90th percentile, without reference. Macrosomia >4000 g, Marcondes⁷⁸78 Marcondes E. Crescimento normal: tabelas e gráficos. In: Marcondes E, editor. Crescimento normal e deficiente. São Paulo: Savier; 1989. p. 42-69.	LGA/wild allele: LGA/13.2% Mutated allele: 24.3%	There were no association between G54D polymorphism and LGA NB
Leal et al.⁵⁷57 Leal RC, Santos CN, Lima MJ, Moura SK, Pedrosa AO, Costa AC. Maternal-perinatal complications in high risk pregnancy. J Nurs UFPE on line. 2017;11:1641-9.	Public	Cross-sectional	n = 43	Maternal overweight/obesity, urinary infection, sexually transmitted diseases, hypertensive syndrome and GDM	Macrosomia: Weight >90th percentile or birth weight >4000 g, without reference	18.6%	There was no association between macrosomia and maternal overweight/obesity, urinary infection, sexually transmitted diseases, hypertensive syndrome, and GDM
Madi et al.²⁵25 Madi SR, Garcia RM, Souza VC, Rombaldi RL, Araujo BF, Madi JM. Effect of obesity on gestational and perinatal outcomes. Rev Bras Ginecol Obstet. 2017;39:330-6.	Not informed	Cohort	n = 3892	Pre-gestational BMI	Macrosomia ≥4000 g, RNHBPEPWG⁷⁹79 RNHBPEPWG. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183:S1-S22.	11.8%	Pre-gestational maternal obesity led to an increase in the odds of macrosomic NB (OR = 1.82, 95% CI 1.44-2.32).
Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.	Public	Cross-sectional	n = 210	Maternal age, education, family income, marital status, pregnancies, interpregnancy interval, pre-gestational BMI, GWG, pre-gestational smoking, DM, NB gender and ADIPOQ rs2241766, LEP rs7799039 and FTO rs9939609 polymorphisms	LGA >90th percentile, Lubchenco et al.³⁶36 Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics. 1963;32:793-800.	Prevalence of the project: 24.4% Prevalence of the study: 50.0%	Excess GWG (p = 0.013) and LEP gene polymorphism (p = 0.043) in NB were associated with LGA. NB carriers of the GG genotype of the LEP-rs7799039 polymorphism had 1.98-fold greater chance of being born LGA compared to patients with the GA + AA genotypes (OR = 1.98, 95% CI 1.05-3.74).
Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.	Público	Cross-sectional	n = 435	Maternal age, marital status, schooling, family income, prenatal consultations, parity, DM, age of the first child, interpregnancy interval, pre-gestational BMI, GPG, smoking status before and during pregnancy, NB gender	Weight >90th percentile, Lubchenco et al.³⁶36 Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics. 1963;32:793-800.	LGA: 24.4% Macrosomia: 9.7%	Maternal age <20 years in the first pregnancy (OR = 1.9, 95% CI: 1.14-3.17), excess GWG (OR = 2.11, 95% CI: 1.27-3.15), normal pre-gestational BMI + excess GWG (OR = 2.08, 95% CI 1.10-3.95), and pre-gestational excess weight + excess GWG (OR = 2.54, 95% CI 1.27-5.10) were associated with LGA.
Southeast region
Siqueira et al.³⁹39 Siqueira AA, Areno FB, Almeida PA, Tanaka AC. The relationship among infant birth weight and sex, and type of delivery. Rev Saude Publica. 1981;15:283-90.	Public/private	Cross-sectional	Assistance care n = 12,919, Private n = 3176	NB gender	>4000 g, without reference	Public: Male 3.07%; Female 1.74%. Private: Male 6.28%; Female 3.77%	Male gender was associated with NB >4000 g in both hospitals (Assistance care hospital, p < 0.001; private hospital, p = 0.002)^a a p-value calculated by the authors.
Lizo et al.³²32 Lizo CL, Azevedo-Lizo Z, Aronson E, Segre CA. Relação entre ganho de peso materno e peso do recém-nascido. J Pediatr (Rio J). 1998;74:114-8.	Private	Cohort	n = 2275	GWG	≥4000 g, without reference	GWG <12 kg: 2.6%; 12-20 kg: 7.0%; >20 kg: 8.5% Total prevalence: 5.3%	GWG >12 kg was associated to NB ≥4000 g^a a p-value calculated by the authors.
Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.	Public	Case-control	n = 803, macrosomia: 242; no macrosomia: 561	Maternal age, parity, GWG, BMI; family, personal and obstetric history of DM and macrosomia, hypertension, smoking, DM, GDM, Rudge groups (IB, IIA + IIB), total blood glucose mean, fasting and postprandial blood glucose, insulin.	Macrosomia: weight >90th percentile, without reference	30.1%	GWG >16 kg (OR = 1.79, 95% CI 1.23-2.60), minimum BMI of ≥25 kg/m² (OR = 1.83, 95% CI 1.27-2.64), blood glucose mean = 120 mg/dL in the 3rd trimester (OR = 1.78, 95% CI 1.13-2.80), personal history of DM (OR = 1.56, 95% CI 1.05-2.31) and previous macrosomia (OR = 2.37, 95% CI 1.60-3.50) showed a risk for macrosomia
Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.	Public	Cohort	n = 195 pairs	Maternal age, marital status, skin color, schooling, family income, age of menarche, parity, miscarriages, gestational age, blood glucose, physical activity, height, pre-gestational nutritional status, GWG, and NB gender	Macrosomia ≥4000 g, Brazil⁸⁰80 Ministério da Saúde. Departamento de Informática do SUS. SINASC-Sistema de Informações de Nascidos Vivos (SINASC). Brasília: Ministério da Saúde; 2008. and Sysyn⁸¹81 Sysyn GD. Abnormal fetal growth: intrauterine growth retardation, small for gestational age, large for gestational age. Pediatr Clin North Am. 2004;51:639-54.	Incidence 6.7%	Parity ≥2 children (RR = 3.8, 95% CI 1.1-1.9) and male gender (RR = 7.5, 95% CI 1.0-37.6) were determinants for macrosomia occurrence
Rodrigues et al.⁴⁴44 Rodrigues PL, Oliveira CL, Brito AD, Kac G. Determinant factors of insufficient and excess gestational weight gain and maternal-child adverse outcomes. Nutrition. 2010;26:617-23.	Public	Cohort	n = 173	GWG	Macrosomia ≥4000 g, without reference	7.7%	The prevalence of macrosomia in pregnant women with excess GWG was higher (23.5%) than those who had insufficient or adequate GWG (4.5% and 1.8%, respectively, p < 0.001).
Paula et al.²³23 Paula HA, Salvador BC, Barbosa L, Cotta RM. Peso ao nascer e variáveis maternas no âmbito da promoção da saúde. Rev APS. 2011;14:67-74.	Public	Cross-sectional	n = 6456	NB gender, pregnancy duration, type of delivery, prenatal consultations, maternal age, schooling, marital status	Macrosomia ≥4000 g, WHO⁸²82 WHO. World Health Organization. Physical status: the use and interpretation of anthropometry. Technical Report Series. Geneva: World Health Organization Technical Report Series, 854; 1995. p. 375-409.	4.1%	There was a higher prevalence of male NBs ≥4000 g, with ≥42 weeks of gestation, cesarean birth, ≥seven prenatal consultations, between 20 and 35 years, with no schooling and widows.
Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.	Public	Cross-sectional	n = 409	Fasting blood glucose, age, history of GDM, history of macrosomia, chronic hypertension, BMI	LGA: >90th percentile; Macrosomia >4000 g, without reference	Macrosomia 8.6% and LGA 19.3%	Risk of macrosomia increased for history of macrosomia (RR = 3.2, 95% CI 1.5-6.6). Risk of LGA increased for history of macrosomia (RR = 2.0, 95% CI 1.2-3.4) and maternal BMI ≥25 kg/m² (RR = 1.9, 95% CI 1.2-3.0)
Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.	Public	Cross-sectional	n = 374	White color, nulliparous, smoking, clinical/obstetric complications (systemic arterial hypertension, DM, maternal heart disease, premature rupture of membranes, collagenosis), cesarean section, classification by pre-gestational BMI and at the end of pregnancy (low weight, adequate weight, overweight, and obesity).	GIG >90th percentile, Alexander et al.⁸³83 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996;87:163-8.	3.5%	DM (OR = 20.2, 95% CI, 5.3-76.8) and obesity at the end of pregnancy (OR = 3.6, 95% CI, 1.1-11.7) were independently associated with LGA NB
Fonseca et al.⁴⁷47 da Fonseca MR, Laurenti R, Marin CR, Traldi MC. Ganho de peso gestacional e peso ao nascer do concepto: estudo transversal na região de Jundiaí, São Paulo, Brasil. Cienc Saude Colet. 2014;19:1401-7.	Public	Cross-sectional	n = 712	Initial BMI of the pregnant woman and GWG	Excess weight: ≥4000 g, WHO⁸²82 WHO. World Health Organization. Physical status: the use and interpretation of anthropometry. Technical Report Series. Geneva: World Health Organization Technical Report Series, 854; 1995. p. 375-409.	4.2%	There was a higher prevalence of NB with excess weight in the group of pregnant women with overweight/obesity at the beginning of pregnancy (p < 0.01) and with excess GWG (p < 0.01)
Padilha et al.⁵⁰50 Padilha C, Barros DC, Campos AB, Ayeta AC, Queiroz JA, Saunders C. Performance of an anthropometric assessment method as a predictor of low birthweight and being small for gestational age. J Hum Nutr Diet. 2014;28:292-9.	Public	Cross-sectional	n = 827	GWG	LGA >90th percentile Pedreira et al.⁸⁴84 Pedreira CE, Pinto FA, Pereira SP, Costa ES. Birth weight patterns by gestational age in Brazil. An Acad Bras Cienc. 2011;83:619-25.	5.7%	There was no association between GWG and LGA NB
Carniello et al.⁵⁴54 Carniello LV, Guarnieri GU, Venâncio JA, Cruz FL, Rodrigues EC, Augusto CC, et al. Resultado perinatal dos recém-nascidos em relação ao índice de massa corpórea (IMC) materno no momento do parto em um hospital terciário da Baixada Santista. Rev UNILUS Ensino Pesqui. 2015;12:79-85.	Public	Cross-sectional	n = 232	Maternal nutritional status	Weight >90th percentile, Lubchenco et al.³⁶36 Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics. 1963;32:793-800.	19.3%	Higher prevalence of LGA NB for overweight/obese mothers (p = 0.030)
Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.	Public	Cross-sectional	n = 297	NB gender, skin color, marital status, smoking, alcohol consumption, parity, pre-gestational BMI, GWG, cholesterol, and saturated, monosaturated, and polyunsaturated fat	LGA >90th percentile, Villar et al.⁸⁵85 Villar J, Papageorghiou AT, Pang R, Ohuma EO, Ismail LC, Barros FC, et al. The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st Project: the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study. Lancet Diabetes Endocrinol. 2014;2:781-92.	13.1%	There was a positive association between dietary cholesterol intake (PR = 2.48, 95% CI 1.31-4.66), excess GWG (PR = 2.26, 95% CI 1.21-4.24) and family income (PR = 1.01, 95% CI 1.00-1.01) with LGA NB.
Vernini et al.⁵²52 Vernini JM, Moreli JB, Magalhães CG, Costa RA, Rudge MV, Calderon IM. Maternal and fetal outcomes in pregnancies complicated by overweight and obesity. Reprod Health. 2016;13:100.	Public	Cross-sectional	n = 258	Pre-gestational BMI	≥4000 g, LGA, without reference	≥4000 g: 7.4% LGA: 8.9%	Obese women showed the highest rate of LGA NB (p = 0.021).
Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.	Public	Cohort	n = 199	Maternal age, schooling, smoking, alcohol consumption, parity, physical activity in the pre-gestational leisure time, pre-gestational BMI, pre-gestational energy consumption, GWG, blood glucose, HDL-c, LDL-c, total cholesterol, triglycerides, leptin, and adiponectin per trimester.	LGA: weight >90th percentile, Villar et al.⁸⁵85 Villar J, Papageorghiou AT, Pang R, Ohuma EO, Ismail LC, Barros FC, et al. The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st Project: the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study. Lancet Diabetes Endocrinol. 2014;2:781-92.	18.1%	Higher frequency of LGA in women with overweight or early obesity (p = 0.042). The rate of gestational HDL-c was negatively associated with LGA (OR = 0.02, 95% CI 0.0003-0.88). Higher basal level of gestational leptin was positively associated with LGA (OR = 3.92, 95% CI, 1.18-12.95)
North region
Santos et al.⁵⁸58 Santos JB, Silva JB, Silva MG, Lopes MN, Dantas PN, Lopes CM. Newborn birth weight, maternal age group and delivery method. Rev Bras Enferm. 2001;54:517-27.	Public	Cross-sectional	n = 23,961	Maternal age	≥4000 g, without reference	<20 years: 3.8% 20-29 years: 7.7% ≥30 years: 11.8% Total prevalence: 6.8%	Higher prevalence of NB ≥4000 g with increasing age (p < 0.001)^a a p-value calculated by the authors.
Northeast region
Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.	Public	Cross-sectional	n = 277	Maternal age, marital status, schooling, per capita income, parity, interpregnancy interval, prenatal care frequency, and maternal height.	≥4000 g, Puffer and Serrano,⁸⁶86 Puffer RR, Serrano CV. Patterns of birth weight, chapter 4 combination of birth weight and length of gestation. Scientific Publication No. 504, Washington DC, USA: Pan American Health Org, WHO; 1987. p. 52-65. PAHO	5.4%	Association between birth weight ≥4000 g and maternal height >1.50 m (p = 0.001)
Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.	Public	Cross-sectional	n = 551	Maternal age, parity, pre-gestational overweight/obesity, excess weight gain, overweight/obese at the last consultation, hypertension, DM (any type), preeclampsia, GDM	Macrosomia ≥4000 g, WHO⁸²82 WHO. World Health Organization. Physical status: the use and interpretation of anthropometry. Technical Report Series. Geneva: World Health Organization Technical Report Series, 854; 1995. p. 375-409.	5.4%	Macrosomia was associated with any type of DM (adjusted risk = 17.7; 95% CI = 4.8-64.9) and excess GWG (adjusted risk = 6.1, 95% CI = 2.7-13.7)
Santos et al.³⁴34 Santos EM, Amorim LP, Costa OL, Oliveira N, Guimarães AC. Profile of gestational and metabolic risk in the prenatal care service of a public maternity in the Brazilian Northeast. Rev Bras Ginecol Obstet. 2012;34:102-6.	Public	Cohort	n = 204	GWG and anemia	LGA: >90th percentile, without reference	9.8%	Excess GWG (RR = 4.7, 95% CI 1.6-14.0) and anemia (RR = 3.4, 95% CI 1.4-8.1) were associated with LGA NB
Silva and Macedo⁴⁰40 Silva DG, Macedo NB. Association between gestational weight gain and pregnancy outcome. Sci Med. 2014;24:229-36.	Public/Private	Cross-sectional	n = 158	GWG	Macrosomia ≥4000 g, without reference	17.8%	Higher frequency of macrosomia in women with excess GWG (p = 0.044)
Midwest region
Costa et al.⁴⁶46 Costa BM, Paulinelli RR, Barbosa MA. Association between maternal and fetal weight gain: cohort study. Sao Paulo Med J. 2012;130:242-7.	Public	Cohort	n = 200	GWG	Macrosomia ≥4000 g, without reference	Incidence: 6.5%	Macrosomia was associated with excess GWG (p < 0.01).
South, Southeast, North, and Northeast regions
Nucci et al.⁵¹51 Nucci LB, Schmidt MI, Duncan BB, Fuchs SC, Fleck ET, Britto MM. Nutritional status of pregnant women: prevalence and associated pregnancy outcomes. Rev Saude Publica. 2001;35:502-7.	Public	Cohort	n = 5564	Pre-gestational BMI	Macrosomia: weight >90th percentile, without reference	Not described	Pre-obese and obese women showed higher risk of having children with macrosomia (OR = 1.6, 95% CI 1.3-2.0 and OR = 1.5, 95% CI 1.1-2.2)
Schmidt et al.²⁶26 Schmidt MI, Duncan BB, Reichelt AJ, Branchtein L, Matos MC, Costa e Forti A, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24:1151-5.	Public	Cohort	n = 4977	GDM	Macrosomia: birth weight ≥90th percentile of gestational age, without reference	ADA⁸⁷87 ADA. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2000;23:S77-9.: 17.7%; WHO⁸²82 WHO. World Health Organization. Physical status: the use and interpretation of anthropometry. Technical Report Series. Geneva: World Health Organization Technical Report Series, 854; 1995. p. 375-409.: 14.6%	GDM predicts an increased risk of 30-45% of children born with macrosomia
Drehmer et al.⁴⁸48 Drehmer M, Duncan BB, Kac G, Schmidt MI. Association of second and third trimester weight gain in pregnancy with maternal and fetal outcomes. PLOS ONE. 2013;8:e54704.	Public	Cohort	n = 2244	GWG	LGA>90th percentile in relation to gestational age, without reference	10.5%	Increased risk for LGA in women with excess GWG in the second trimester (RR = 1.64, 95% CI 1.16-2.31) and excess total GWG (RR = 2.12, 95% CI 1.55-2.89).
Trujillo et al.⁵⁶56 Trujillo J, Vigo A, Duncan BB, Falavigna M, Wendland EM, Campos MA, et al. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res Clin Pract. 2015;108:288-95.	Public	Cohort	n = 4926	DM	LGA >90th percentile, without reference	11.8%	Pregnant women with GDM had an increased risk (RR = 1.27-1.86) for the birth of LGA NB in the IADPSG and WHO classifications

No.	Author	Obtained score/maximum score	Relative frequency (%)
01	Siqueira et al.³⁹39 Siqueira AA, Areno FB, Almeida PA, Tanaka AC. The relationship among infant birth weight and sex, and type of delivery. Rev Saude Publica. 1981;15:283-90.	17/22^b b Cross-sectional and cohort study.	77.3
02	Souza et al.⁶¹61 Souza ML, Tanaka ACA, Siqueira AA, Santana RM. Live births at maternity hospitals. 1. Birth weight, sex, delivery type and the mother's health insurance. Rev Saude Publica. 1988;22:489-93.	17/22^b b Cross-sectional and cohort study.	77.3
03	Lizo et al.³²32 Lizo CL, Azevedo-Lizo Z, Aronson E, Segre CA. Relação entre ganho de peso materno e peso do recém-nascido. J Pediatr (Rio J). 1998;74:114-8.	13/22^b b Cross-sectional and cohort study.	59.1
04	Schmidt et al.²⁶26 Schmidt MI, Duncan BB, Reichelt AJ, Branchtein L, Matos MC, Costa e Forti A, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24:1151-5.	17/22^b b Cross-sectional and cohort study.	77.3
05	Santos et al.⁵⁸58 Santos JB, Silva JB, Silva MG, Lopes MN, Dantas PN, Lopes CM. Newborn birth weight, maternal age group and delivery method. Rev Bras Enferm. 2001;54:517-27.	12/12^a a Cross-sectional prevalence study.	100.0
06	Nucci et al.⁵¹51 Nucci LB, Schmidt MI, Duncan BB, Fuchs SC, Fleck ET, Britto MM. Nutritional status of pregnant women: prevalence and associated pregnancy outcomes. Rev Saude Publica. 2001;35:502-7.	14/22^b b Cross-sectional and cohort study.	63.6
07	Araujo and Sant'Ana⁵⁹59 Araujo SG, Sant'Ana DM. Relação entre a idade materna e o peso ao nascer: um estudo da gravidez na adolescência no município de Umuarama, PR, Brasil em 2001. Ciênc Cuid Saúde. 2003;2:155-60.	12/12^a a Cross-sectional prevalence study.	100.0
08	Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.	17/22^b b Cross-sectional and cohort study.	77.3
09	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.	17/22^b b Cross-sectional and cohort study.	77.3
10	Madi et al.⁵⁵55 Madi JM, Rombaldi RL, Araújo BF, Zatti H, Oliveira-Filho PF, Madi SR. Fatores maternos e perinatais relacionados à macrossomia fetal. Rev Bras Ginecol Obstet. 2006;28:232-7.	17/22^b b Cross-sectional and cohort study.	77.3
11	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.	19/22^b b Cross-sectional and cohort study.	86.4
12	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.	19/22^b b Cross-sectional and cohort study.	86.4
13	Rodrigues et al.⁴⁴44 Rodrigues PL, Oliveira CL, Brito AD, Kac G. Determinant factors of insufficient and excess gestational weight gain and maternal-child adverse outcomes. Nutrition. 2010;26:617-23.	19/22^b b Cross-sectional and cohort study.	86.4
14	Paula et al.²³23 Paula HA, Salvador BC, Barbosa L, Cotta RM. Peso ao nascer e variáveis maternas no âmbito da promoção da saúde. Rev APS. 2011;14:67-74.	19/22^b b Cross-sectional and cohort study.	86.4
15	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.	16/22^b b Cross-sectional and cohort study.	72.7
16	Gonçalves et al.⁴⁵45 Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome. Rev Bras Ginecol Obstet. 2012;34:304-9.	19/22^b b Cross-sectional and cohort study.	86.4
17	Santos et al.³⁴34 Santos EM, Amorim LP, Costa OL, Oliveira N, Guimarães AC. Profile of gestational and metabolic risk in the prenatal care service of a public maternity in the Brazilian Northeast. Rev Bras Ginecol Obstet. 2012;34:102-6.	18/22^b b Cross-sectional and cohort study.	81.8
18	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.	15/22^b b Cross-sectional and cohort study.	68.2
19	Costa et al.⁴⁶46 Costa BM, Paulinelli RR, Barbosa MA. Association between maternal and fetal weight gain: cohort study. Sao Paulo Med J. 2012;130:242-7.	16/22^b b Cross-sectional and cohort study.	72.7
20	Drehmer et al.⁴⁸48 Drehmer M, Duncan BB, Kac G, Schmidt MI. Association of second and third trimester weight gain in pregnancy with maternal and fetal outcomes. PLOS ONE. 2013;8:e54704.	21/22^b b Cross-sectional and cohort study.	95.4
21	Silva and Macedo⁴⁰40 Silva DG, Macedo NB. Association between gestational weight gain and pregnancy outcome. Sci Med. 2014;24:229-36.	16/22^b b Cross-sectional and cohort study.	72.7
22	Baggenstoss et al.²⁷27 Baggenstoss R, Petzhold SV, Willemann IKM, Pabis FS, Gimenes P, De Souza BV, et al. Study of polymorphism G54D of MBL2 gene in gestational diabetes mellitus. Arq Bras Endocrinol Metabol. 2014;58:900-5.	20/28^c c Case-control study.	71.4
23	Fonseca et al.⁴⁷47 da Fonseca MR, Laurenti R, Marin CR, Traldi MC. Ganho de peso gestacional e peso ao nascer do concepto: estudo transversal na região de Jundiaí, São Paulo, Brasil. Cienc Saude Colet. 2014;19:1401-7.	16/22^b b Cross-sectional and cohort study.	72.7
24	Padilha et al.⁵⁰50 Padilha C, Barros DC, Campos AB, Ayeta AC, Queiroz JA, Saunders C. Performance of an anthropometric assessment method as a predictor of low birthweight and being small for gestational age. J Hum Nutr Diet. 2014;28:292-9.	17/22^b b Cross-sectional and cohort study.	77.3
25	Carniello et al.⁵⁴54 Carniello LV, Guarnieri GU, Venâncio JA, Cruz FL, Rodrigues EC, Augusto CC, et al. Resultado perinatal dos recém-nascidos em relação ao índice de massa corpórea (IMC) materno no momento do parto em um hospital terciário da Baixada Santista. Rev UNILUS Ensino Pesqui. 2015;12:79-85.	19/22^b b Cross-sectional and cohort study.	86.4
26	Trujillo et al.⁵⁶56 Trujillo J, Vigo A, Duncan BB, Falavigna M, Wendland EM, Campos MA, et al. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res Clin Pract. 2015;108:288-95.	13/22^b b Cross-sectional and cohort study.	59.1
27	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.	17/22^b b Cross-sectional and cohort study.	77.3
28	Vernini et al.⁵²52 Vernini JM, Moreli JB, Magalhães CG, Costa RA, Rudge MV, Calderon IM. Maternal and fetal outcomes in pregnancies complicated by overweight and obesity. Reprod Health. 2016;13:100.	16/22^b b Cross-sectional and cohort study.	72.7
29	Leal et al.⁵⁷57 Leal RC, Santos CN, Lima MJ, Moura SK, Pedrosa AO, Costa AC. Maternal-perinatal complications in high risk pregnancy. J Nurs UFPE on line. 2017;11:1641-9.	17/22^b b Cross-sectional and cohort study.	77.3
30	Madi et al.²⁵25 Madi SR, Garcia RM, Souza VC, Rombaldi RL, Araujo BF, Madi JM. Effect of obesity on gestational and perinatal outcomes. Rev Bras Ginecol Obstet. 2017;39:330-6.	17/22^b b Cross-sectional and cohort study.	77.3
31	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.	20/22^a a Cross-sectional prevalence study.	90.9
32	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.	21/22^b b Cross-sectional and cohort study.	95.4
33	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.	19/22^b b Cross-sectional and cohort study.	86.4

Variables	Outcome	OR, RR, and PR (95% CI)	Adjustment variables	p-value^a a p-value from the chi-square test. When p-value for OR, RR or PR was present, it was added. WHO, World and Health Organization; IADPSG, Association of Diabetes in Pregnancy Study Groups; ADA, American Diabetes Association. NB, newborn; INPS/IPESC, National Institute of Social Security/Institute of Social Security of Santa Catarina; BMI, body mass index; RR, relative risk; PR, prevalence ratio; OR, odds ratio; GWG, gestational weight gain; DM, diabetes mellitus; GDM, gestational diabetes mellitus; LDL-c, low-density lipoprotein cholesterol; HDL-c, high-density lipoprotein cholesterol; GP, glycemic profile; GTT, glucose tolerance test; IB, daily hyperglycemia - GTT 100 g normal and altered glycemic profile; IIA, altered GTT 100 g and normal GP; IIB, altered GTT 100 g and GP; N, North; S, South; SE, Southeast; NE, Northeast; MW, Midwest.	Region	Author
Gestational weight gain
>12 kg	≥4000 g			<0.001	SE	Lizo et al.³²32 Lizo CL, Azevedo-Lizo Z, Aronson E, Segre CA. Relação entre ganho de peso materno e peso do recém-nascido. J Pediatr (Rio J). 1998;74:114-8.
Excess	≥4000 g	RR = 2.80 (0.80-7.70)		0.070	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
Excess	≥4000 g	PR = 6.90 (2.90-16.90)			NE	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.
Excess	≥4000 g			<0.001	NE	Rodrigues et al.⁴⁴44 Rodrigues PL, Oliveira CL, Brito AD, Kac G. Determinant factors of insufficient and excess gestational weight gain and maternal-child adverse outcomes. Nutrition. 2010;26:617-23.
9-12 kg	≥4000 g	OR = 1.30 (0.70-2.40)		0.030	S	Gonçalves et al.⁴⁵45 Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome. Rev Bras Ginecol Obstet. 2012;34:304-9.
13-16 kg	≥4000 g	OR = 1.10 (0.60-2.30)		0.030	S	Gonçalves et al.⁴⁵45 Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome. Rev Bras Ginecol Obstet. 2012;34:304-9.
≥17 kg	≥4000 g	OR = 1.70 (0.80-3.40)		0.030	S	Gonçalves et al.⁴⁵45 Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome. Rev Bras Ginecol Obstet. 2012;34:304-9.
Excess	≥4000 g			0.010	MW	Costa et al.⁴⁶46 Costa BM, Paulinelli RR, Barbosa MA. Association between maternal and fetal weight gain: cohort study. Sao Paulo Med J. 2012;130:242-7.
Excess	≥4000 g			0.044	NE	Silva and Macedo⁴⁰40 Silva DG, Macedo NB. Association between gestational weight gain and pregnancy outcome. Sci Med. 2014;24:229-36.
Excess	≥4000 g	OR = 1.75 (0.76-4.04)		0.260	SE	Fonseca et al.⁴⁷47 da Fonseca MR, Laurenti R, Marin CR, Traldi MC. Ganho de peso gestacional e peso ao nascer do concepto: estudo transversal na região de Jundiaí, São Paulo, Brasil. Cienc Saude Colet. 2014;19:1401-7.
>16 kg	>90th percentile	OR = 1.79 (1.23-2.60)		0.020	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Excess	>90th percentile	RR = 4.70 (1.60-14.00)		0.009	NE	Santos et al.³⁴34 Santos EM, Amorim LP, Costa OL, Oliveira N, Guimarães AC. Profile of gestational and metabolic risk in the prenatal care service of a public maternity in the Brazilian Northeast. Rev Bras Ginecol Obstet. 2012;34:102-6.
Excess 2nd trimester	>90th percentile	RR = 1.64 (1.16-2.31)			S, SE, N, NE	Drehmer et al.⁴⁸48 Drehmer M, Duncan BB, Kac G, Schmidt MI. Association of second and third trimester weight gain in pregnancy with maternal and fetal outcomes. PLOS ONE. 2013;8:e54704.
Excess	>90th percentile	RR = 2.12 (1.55-2.89)			S, SE, N, NE	Drehmer et al.⁴⁸48 Drehmer M, Duncan BB, Kac G, Schmidt MI. Association of second and third trimester weight gain in pregnancy with maternal and fetal outcomes. PLOS ONE. 2013;8:e54704.
Excess	>90th percentile	OR = 0.95 (0.48-1.86)	Smoking, parity, number of prenatal consultations, nutritional assistance	0.891	SE	Padilha et al.⁵⁰50 Padilha C, Barros DC, Campos AB, Ayeta AC, Queiroz JA, Saunders C. Performance of an anthropometric assessment method as a predictor of low birthweight and being small for gestational age. J Hum Nutr Diet. 2014;28:292-9.
Excess	>90th percentile	PR = 2.26 (1.21-4.24)	Maternal age, family income, pre-gestational BMI, GWG, cholesterol	0.011	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Excess	>90th percentile			0.013	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Excess	>90th percentile	OR = 2.11 (1.27-3.15)	Schooling, family income, smoking during pregnancy, age of first child, pre-gestational BMI, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Pre-gestational BMI
Pre-obese	>90th percentile	OR = 1.61 (1.30-2.00)			S, SE, N, NE	Nucci et al.⁵¹51 Nucci LB, Schmidt MI, Duncan BB, Fuchs SC, Fleck ET, Britto MM. Nutritional status of pregnant women: prevalence and associated pregnancy outcomes. Rev Saude Publica. 2001;35:502-7.
Obese	>90th percentile	OR = 1.53 (1.08-2.17)			S, SE, N, NE	Nucci et al.⁵¹51 Nucci LB, Schmidt MI, Duncan BB, Fuchs SC, Fleck ET, Britto MM. Nutritional status of pregnant women: prevalence and associated pregnancy outcomes. Rev Saude Publica. 2001;35:502-7.
≥25 kg/m²	>90th percentile	OR = 1.83 (1.27-2.64)		0.003	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Overweight/obesity	>90th percentile			0.020	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
≥25 kg/m²	>90th percentile	PR = 1.88 (1.05-3.36)		0.033	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Obesity	>90th percentile			0.021	SE	Vernini et al.⁵²52 Vernini JM, Moreli JB, Magalhães CG, Costa RA, Rudge MV, Calderon IM. Maternal and fetal outcomes in pregnancies complicated by overweight and obesity. Reprod Health. 2016;13:100.
<25 kg/m²	>90th percentile			0.677	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Overweight	>90th percentile	OR = 1.00 (0.54-1.79)	Schooling, family income, smoking during pregnancy, age of first child, GWG, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Obesity	>90th percentile	OR = 1.15 (0.56-2.36)	Schooling, family income, smoking during pregnancy, age of first child, GWG, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
≥25 kg/m²	>90th percentile			0.042	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Overweight/obesity	≥4000 g	RR = 3.70 (1.80-9.20)		0.010	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
Overweight/obesity	≥4000 g	PR = 2.80 (1.00-7.80)			NE	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.
Overweight	≥4000 g	OR = 3.40 (0.40-26.10)		0.001	S	Gonçalves et al.⁴⁵45 Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome. Rev Bras Ginecol Obstet. 2012;34:304-9.
Obesity	≥4000 g	OR = 6.70 (0.90-52.50)		0.001	S	Gonçalves et al.⁴⁵45 Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome. Rev Bras Ginecol Obstet. 2012;34:304-9.
Obesity	≥4000 g			0.037	SE	Vernini et al.⁵²52 Vernini JM, Moreli JB, Magalhães CG, Costa RA, Rudge MV, Calderon IM. Maternal and fetal outcomes in pregnancies complicated by overweight and obesity. Reprod Health. 2016;13:100.
Obesity	≥4000 g	OR = 1.20 (1.44-2.32)	Hyperglycemic Disorder	<0.010	S	Madi et al.²⁵25 Madi SR, Garcia RM, Souza VC, Rombaldi RL, Araujo BF, Madi JM. Effect of obesity on gestational and perinatal outcomes. Rev Bras Ginecol Obstet. 2017;39:330-6.
BMI ≥25 kg/m ² on the last consultation	≥4000 g	PR = 4.90 (2.00-12.50)			NE	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.
BMI during pregnancy
≥25 kg/m²	>90th percentile	RR = 1.90 (1.20-3.00)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
Overweight/obesity	>90th percentile			0.030	SE	Carniello et al.⁵⁴54 Carniello LV, Guarnieri GU, Venâncio JA, Cruz FL, Rodrigues EC, Augusto CC, et al. Resultado perinatal dos recém-nascidos em relação ao índice de massa corpórea (IMC) materno no momento do parto em um hospital terciário da Baixada Santista. Rev UNILUS Ensino Pesqui. 2015;12:79-85.
Overweight/obesity	>90th percentile			0.340	S	Leal et al.⁵⁷57 Leal RC, Santos CN, Lima MJ, Moura SK, Pedrosa AO, Costa AC. Maternal-perinatal complications in high risk pregnancy. J Nurs UFPE on line. 2017;11:1641-9.
≥25 kg/m²	>4000 g	RR = 2.00 (0.90-4.00)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
Obesity at the moment of delivery	>90th percentile	OR = 3.60 (1.10-11.70)	Smoking, diagnosis of arterial hypertension, DM, GWG, pre-gestational BMI, BMI at the end of pregnancy, classification of maternal nutritional status by pre-gestational BMI and at the end of pregnancy	0.040	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
BMI ≥25 kg/m ² at the beginning of pregnancy	≥4000 g			<0.010	SE	Fonseca et al.⁴⁷47 da Fonseca MR, Laurenti R, Marin CR, Traldi MC. Ganho de peso gestacional e peso ao nascer do concepto: estudo transversal na região de Jundiaí, São Paulo, Brasil. Cienc Saude Colet. 2014;19:1401-7.
Association of pre-gestational BMI and GWG
Low/normal weight and excess GWG	>90th percentile	OR = 2.08 (1.10-3.95)	Schooling, family income, smoking during pregnancy, age of first child, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Overweight and appropriate GWG	>90th percentile	OR = 0.46 (0.13-1.64)	Schooling, family income, smoking during pregnancy, age of first child, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Overweight and excess GWG	>90th percentile	OR = 2.54 (1.27-5.10)	Schooling, family income, smoking during pregnancy, age of first child, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Obesity and appropriate GWG	>90th percentile	OR = 1.94 (0.72-5.25)	Schooling, family income, smoking during pregnancy, age of first child, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Obesity and excess GWG	>90th percentile	OR = 1.54 (0.58-4.08)	Schooling, family income, smoking during pregnancy, age of first child, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Diabetes mellitus
Present	>90th percentile			0.050	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Present	>90th percentile	OR = 20.2 (5.30-76.80)	Smoking, diagnosis of arterial hypertension, DM, GWG, pre-gestational BMI, BMI at the end of pregnancy, maternal nutritional status classification by pre-gestational BMI and at the end of the pregnancy	<0.001	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
Present	>90th percentile			0.580	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Present	>90th percentile	OR = 1.08 (0.47-2.51)			S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Present	≥4000 g	OR = 4.20 (2.70-6.40)		<0.050	S	Madi et al.²⁵25 Madi SR, Garcia RM, Souza VC, Rombaldi RL, Araujo BF, Madi JM. Effect of obesity on gestational and perinatal outcomes. Rev Bras Ginecol Obstet. 2017;39:330-6.
Present	≥4000 g	PR = 8.90 (4.10-19.40)			SE	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.
Presence of GDM
	≥90th percentile	ADA, RR = 1.29 (0.73-2.18)	Ethnicity, maternal height, pre-gestational BMI, GWG, and NB gender.		S, SE, N, NE	Schmidt et al.²⁶26 Schmidt MI, Duncan BB, Reichelt AJ, Branchtein L, Matos MC, Costa e Forti A, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24:1151-5.
	≥90th percentile	WHO, RR = 1.45 (1.06-1.95)	Ethnicity, maternal height, pre-gestational BMI, GWG, and NB gender.		S, SE, N, NE	Schmidt et al.²⁶26 Schmidt MI, Duncan BB, Reichelt AJ, Branchtein L, Matos MC, Costa e Forti A, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24:1151-5.
	≥90th percentile			0.100	S	Leal et al.⁵⁷57 Leal RC, Santos CN, Lima MJ, Moura SK, Pedrosa AO, Costa AC. Maternal-perinatal complications in high risk pregnancy. J Nurs UFPE on line. 2017;11:1641-9.
	>90th percentile			0.050	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
	≥90th percentile	IADPSG, RR = 1.40 (1.15-1.70)			S, SE, N, NE	Trujillo et al.⁵⁶56 Trujillo J, Vigo A, Duncan BB, Falavigna M, Wendland EM, Campos MA, et al. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res Clin Pract. 2015;108:288-95.
	≥90th percentile	WHO, RR = 1.67 (1.30-2.15)			S, SE, N, NE	Trujillo et al.⁵⁶56 Trujillo J, Vigo A, Duncan BB, Falavigna M, Wendland EM, Campos MA, et al. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res Clin Pract. 2015;108:288-95.
	≥90th percentile	ADA, RR = 1.50 (0.95-2.34)			S, SE, N, NE	Trujillo et al.⁵⁶56 Trujillo J, Vigo A, Duncan BB, Falavigna M, Wendland EM, Campos MA, et al. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res Clin Pract. 2015;108:288-95.
	≥4000 g	PR = 12.0 (6.0-24.2)			NE	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.
History of DM
Any	>90th percentile			0.262	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Family	>90th percentile			0.073	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Personal	>90th percentile	OR = 1.56 (1.05-2.31)		0.003	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Obstetric	>90th percentile			<0.001	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
History of GDM
	>90th percentile	RR = 0.40 (0.10-2.60)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
	>4000 g	RR = 0.90 (0.10-6.60)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
Groups of Rudge IB, IIA + IIB	>90th percentile			0.030	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Total blood glucose mean ≥120 mg/dL	>90th percentile	OR = 1.78 (1.13-2.80)		0.000	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Fasting blood glucose (mg/dL)
≥90	>90th percentile			0.069	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
≥90	>90th percentile	RR = 1.10 (0.70-1.70)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
80.0-175.0	≥4000 g	RR = 1.70 (0.50-4.80)		0.380	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
≥90	>4000 g	RR = 0.90 (0.40-2.00)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
Postprandial blood glucose ≥130 mg/dL	>90th percentile			0.012	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Maternal age group (years)
>35	>4000 g	RR = 1.00 (0.50-2.20)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
20-30	≥4000 g			<0.001	NE	Santos et al.⁵⁸58 Santos JB, Silva JB, Silva MG, Lopes MN, Dantas PN, Lopes CM. Newborn birth weight, maternal age group and delivery method. Rev Bras Enferm. 2001;54:517-27.
>30	≥4000 g			<0.001	NE	Santos et al.⁵⁸58 Santos JB, Silva JB, Silva MG, Lopes MN, Dantas PN, Lopes CM. Newborn birth weight, maternal age group and delivery method. Rev Bras Enferm. 2001;54:517-27.
>30	≥4000 g			0.048	S	Araujo and Sant'Ana⁵⁹59 Araujo SG, Sant'Ana DM. Relação entre a idade materna e o peso ao nascer: um estudo da gravidez na adolescência no município de Umuarama, PR, Brasil em 2001. Ciênc Cuid Saúde. 2003;2:155-60.
25-29	>4000 g			0.420	NE	Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.
30-39	≥4000 g	RR = 2.40 (0.90-4.80)		0.050	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
≥25	≥4000 g	PR = 1.20 (0.60-2.40)			NE	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.
≥20	≥4000 g			<0.001	SE	Paula et al.²³23 Paula HA, Salvador BC, Barbosa L, Cotta RM. Peso ao nascer e variáveis maternas no âmbito da promoção da saúde. Rev APS. 2011;14:67-74.
≥25	>90th percentile			0.086	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
>35	>90th percentile	RR = 1.10 (0.70-1.80)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
<20	>90th percentile			0.496	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
20-30	>90th percentile	OR = 0.73 (0.39-1.35)			S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
≥30	>90th percentile	OR = 0.94 (0.47-1.85)			S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
≤30	>90th percentile			0.545	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Maternal age	>90th percentile	PR = 1.04 (1.0-1.09)		0.073	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Parity (number of children)
≥2	≥4000 g			0.700	NE	Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.
≥2	≥4000 g	RR = 3.80 (1.10-9.90)	Age, marital status, parity, NB gender, pre-gestational BMI, GWG	0.030	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
≥2	≥4000 g	PR = 1.00 (0.50-2.00)			NE	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.
≥3	>90th percentile			0.136	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
0	>90th percentile			0.400	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
≥2	>90th percentile	PR = 1.41 (0.72-2.78)		0.317	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
≥3	>90th percentile	OR = 1.30 (0.77-2.19)			S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
≥1	>90th percentile			0.137	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Child's gender
Male	>4000 g			<0.001	SE	Siqueira et al.³⁹39 Siqueira AA, Areno FB, Almeida PA, Tanaka AC. The relationship among infant birth weight and sex, and type of delivery. Rev Saude Publica. 1981;15:283-90.
Male	≥4000 g	RR = 7.50 (1.00-37.60)	Age, marital status, parity, NB gender, pre-gestational BMI, GWG	0.050	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
Male	≥4000 g			0.014	SE	Paula et al.²³23 Paula HA, Salvador BC, Barbosa L, Cotta RM. Peso ao nascer e variáveis maternas no âmbito da promoção da saúde. Rev APS. 2011;14:67-74.
Female	>90th percentile			0.674	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Male	>90th percentile			0.269	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Female	>90th percentile	OR = 0.93 (0.60-1.44)			S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Maternal height (m)
>1.5	≥4000 g			0.001	NE	Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.
1.6-1.8	≥4000 g	RR = 1.80 (0.60-4.80)		0.280	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
Previous macrosomia
	>90th percentile	OR = 2.37 (1.60-3.50)		<0.001	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
	>90th percentile	RR = 2.00 (1.20-3.40)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
	>4000 g	RR = 3.20 (1.50-6.60)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
Arterial hypertension
	>90th percentile			0.126	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
	>90th percentile	RR = 0.80 (0.50-1.30)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
	>90th percentile			0.100	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
	>90th percentile			0.800	S	Leal et al.⁵⁷57 Leal RC, Santos CN, Lima MJ, Moura SK, Pedrosa AO, Costa AC. Maternal-perinatal complications in high risk pregnancy. J Nurs UFPE on line. 2017;11:1641-9.
	≥4000 g	PR = 2.90 (1.10-7.90)			NE	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.
	>4000 g	RR = 1.60 (0.60-3.00)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
Cesarean delivery
	>90th percentile			0.100	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
	>90th percentile			0.023	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
	≥4000 g			<0.001	SE	Paula et al.²³23 Paula HA, Salvador BC, Barbosa L, Cotta RM. Peso ao nascer e variáveis maternas no âmbito da promoção da saúde. Rev APS. 2011;14:67-74.
Marital status
Common-law marriage	≥4000 g			0.980	NE	Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.
Married	≥4000 g	RR = 3.00		0.030	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
Single/other	≥4000 g			0.004	SE	Paula et al.²³23 Paula HA, Salvador BC, Barbosa L, Cotta RM. Peso ao nascer e variáveis maternas no âmbito da promoção da saúde. Rev APS. 2011;14:67-74.
Single/other	>90th percentile	PR = 0.87 (0.40-1.87)		0.717	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Married	>90th percentile			0.173	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Single/other	>90th percentile	OR = 0.61 (0.32-1.16)			S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Per capita income <1 MW	≥4000 g			0.350	NE	Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.
Total family income (MW)
≥1	≥4000 g	RR = 1.50 (0.50-4.20)		0.450	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
≥3	≥4000 g			0.447	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
<3	≥4000 g	OR = 0.73 (0.44-1.23)	Schooling, smoking during pregnancy, age of first child, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Total family income	>90th percentile	PR = 1.01 (1.00-1.01)	Schooling, maternal age, pre-gestational BMI, GWG, total cholesterol	0.014	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Prenatal consultations
≥6	≥4000 g			0.970	NE	Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.
≥7	≥4000 g			0.001	SE	Paula et al.²³23 Paula HA, Salvador BC, Barbosa L, Cotta RM. Peso ao nascer e variáveis maternas no âmbito da promoção da saúde. Rev APS. 2011;14:67-74.
<6	>90th percentile	OR = 0.69 (0.39-1.20)			S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Social security affiliation INPS/IPESC	≥4000 g			<0.01	S	Souza et al.⁶¹61 Souza ML, Tanaka ACA, Siqueira AA, Santana RM. Live births at maternity hospitals. 1. Birth weight, sex, delivery type and the mother's health insurance. Rev Saude Publica. 1988;22:489-93.
Age at first delivery <20 years	>90th percentile	OR = 1.90 (1.14-3.17)	Schooling, family income, smoking during pregnancy, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Anemia	>90th percentile	RR = 3.40 (1.40-8.10)		0.040	S	Gonçalves et al.⁴⁵45 Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome. Rev Bras Ginecol Obstet. 2012;34:304-9.
Level of schooling
<4 years	≥4000 g			0.570	NE	Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.
≤4 years	≥4000 g	RR = 1.80 (0.50-5.30)		0.360	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
None	≥4000 g			0.661	SE	Paula et al.²³23 Paula HA, Salvador BC, Barbosa L, Cotta RM. Peso ao nascer e variáveis maternas no âmbito da promoção da saúde. Rev APS. 2011;14:67-74.
9-12 years	>90th percentile			0.285	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
<8 years	>90th percentile	OR = 0.62 (0.32-1.20)	Family income, smoking during pregnancy, age of first child, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
>8 years	>90th percentile			0.519	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Interpregnancy interval (years)
≥5	≥4000 g			0.660	NE	Lima and Sampaio⁶⁰60 Lima GS, Sampaio HA. Influência de fatores obstétricos, socioeconômicos e nutricionais da gestante sobre o peso do recém-nascido: estudo realizado em uma maternidade em Teresina, Piauí. Rev Bras Saude Matern Infant. 2004;4:253-61.
≥2	>90th percentile			0.459	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Family history of macrosomia
	>90th percentile	RR = 1.50 (0.90-2.30)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
	>4000 g	RR = 1.00 (0.50-2.20)			SE	Rehder et al.⁵³53 Rehder PM, Pereira BG, Silva JL. Resultados gestacionais e neonatais em mulheres com rastreamento positivo para diabetes mellitus e teste oral de tolerância à glicose - 100 g normal. Rev Bras Ginecol Obstet. 2011;33:81-6.
Smoking
No	>90th percentile			0.278	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
No	>90th percentile			0.060	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
Yes	>90th percentile	PR = 0.53 (0.17-1.66)	Schooling, family income, age of first child, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Yes	>90th percentile	OR = 0.64 (0.18-2.28)
No	>90th percentile			0.093	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Smoking before pregnancy
No	>90th percentile			0.079	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Yes	>90th percentile	OR = 0.58 (0.23-1.43)	Schooling, family income, age of first child, glycated hemoglobin		S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Alcohol consumption
Yes	>90th percentile	PR = 0.62 (0.23-1.16)		0.348	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
No	>90th percentile			0.806	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Use of insulin	>90th percentile			0.085	SE	Kerche et al.⁴²42 Kerche LT, Abbade JF, Costa RA, Rudge MV. Calderon IdM. Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária. Rev Bras Ginecol Obstet. 2005;27:580-7.
Previous miscarriage	≥4000 g	RR = 1.02 (0.30-3.10)		0.980	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
Gestational age (weeks)
35-40	≥4000 g	RR = 0.90 (0.20-3.70)		0.920	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
≥42	≥4000 g			0.565	SE	Paula et al.²³23 Paula HA, Salvador BC, Barbosa L, Cotta RM. Peso ao nascer e variáveis maternas no âmbito da promoção da saúde. Rev APS. 2011;14:67-74.
White skin color
	≥4000 g	RR = 1.90 (0.60-5.00)		0.230	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
	>90th percentile			0.500	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
	>90th percentile	PR = 1.38 (0.56-3.35)		0.481	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Age at menarche <13 years	≥4000 g	RR = 1.10 (0.40-3.30)		0.810	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
Sedentary lifestyle	≥4000 g	RR = 1.20 (0.20-3.10)		0.740	SE	Oliveira et al.²⁴24 Oliveira LC, Pacheco AH, Rodrigues PL, Schlussel MM, Spyrides MH, Kac G. Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. Rev Bras Ginecol Obstet. 2008;30:486-93.
Pre-gestational physical activity	>90th percentile			0.102	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Preeclampsia	≥4000 g	PR = 1.70 (0.60-4.70)			NE	Amorim et al.⁴³43 Amorim MM, Leite DF, Gadelha TG, Muniz AG, Mela AS, Rocha AM. Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil. Rev Bras Ginecol Obstet. 2009;31:241-8.
Number of pregnancies ≥3
	>90th percentile			0.642	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
	>90th percentile	OR = 1.45 (0.86-2.43)			S	Mastroeni et al.¹³13 Mastroeni MF, Czarnobay SA, Kroll C, Figueirêdo KB, Mastroeni SS, Silva JC, et al. The independent importance of pre-pregnancy weight and gestational weight gain for the prevention of large-for gestational age Brazilian newborns. Matern Child Health J. 2017;21:705-14.
Maternal heart disease	>90th percentile			0.600	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
Premature rupture of membranes	>90th percentile			0.100	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
Collagenosis	>90th percentile			0.700	SE	Nomura et al.⁴¹41 Nomura RM, Paiva LV, Costa VN, Liao AW, Zugaib M. Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco. Rev Bras Ginecol Obstet. 2012;34:107-12.
Maternal energy consumption (Kcal)	>90th percentile	PR = 1.00 (1.00-1.00)		0.842	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Fat consumption (mg/1000 kcal)
Saturated: 4th quartile (11.4-18.3)	>90th percentile	PR = 1.34 (0.71-2.51)		0.362	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Monosaturated: 4th quartile (7.7-20.0)	>90th percentile	PR = 1.34 (0.71-2.51)		0.362	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Polyunsaturated: 4th quartile (4.2-6.8)	>90th percentile	PR = 1.48 (0.80-2.73)		0.210	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Polymorphisms (allele)
Mutant G54D (maternal)	>90th percentile			0.149	S	Baggenstoss et al.²⁷27 Baggenstoss R, Petzhold SV, Willemann IKM, Pabis FS, Gimenes P, De Souza BV, et al. Study of polymorphism G54D of MBL2 gene in gestational diabetes mellitus. Arq Bras Endocrinol Metabol. 2014;58:900-5.
ADIPOQ rs2241766 mutant (NB)	>90th percentile	OR = 2.01 (0.90-4.47)	Maternal age, schooling, family income, marital status, GWG, smoking before pregnancy, DM, NB gender, ADIPOQ rs2241766, LEP rs7799039, FTO rs9939609	0.087	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Wild LEP rs7799039 (NB)	>90th percentile	OR = 1.98 (1.05-3.74)	Maternal age, schooling, family income, marital status, GWG, smoking before pregnancy, DM, NB gender, ADIPOQ rs2241766, LEP rs7799039, FTO rs9939609	0.036	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Mutant FTO rs9939609 (NB)	>90th percentile	OR = 1.11 (0.59-2.11)	Maternal age, schooling, family income, marital status, GWG, smoking before pregnancy, DM, NB gender, ADIPOQ rs2241766, LEP rs7799039, FTO rs9939609	0.744	S	Kroll et al.²⁸28 Kroll C, Mastroeni SS, Veugelers PJ, Mastroeni MF. Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants. Am J Hum Biol. 2017;29:e22893.
Total cholesterol levels: mg/1000 kcal. 4th quartile (183.5-466.7)	>90th percentile	PR = 2.48 (1.31-4.66)	Maternal age, family income, pre-gestational BMI, GWG, total cholesterol	0.005	SE	Castro et al.⁴⁹49 Castro MB, Farias DR, Lepsch J, Mendes RH, Ferreira AA, Kac G. High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low-income women of Rio de Janeiro, Brazil. Matern Child Nutr. 2016;13:580-7.
Levels of HDL-c cholesterol according to gestational age	>90th percentile	OR = 0.02 (0.00-0.88)	Log of triglycerides, leptin and adiponectin, maternal age, schooling, parity, pre-gestational physical activity, blood glucose, GWG, and BMI at the beginning of the pregnancy	0.043	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Levels of LDL-c cholesterol according to gestational age	>90th percentile	OR = 1.52 (0.80-2.88)	Log of triglycerides, leptin and adiponectin, maternal age, schooling, parity, pre-gestational physical activity, blood glucose, GWG, and BMI at the beginning of the pregnancy	0.203	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Levels of triglycerides according to gestational age	>90th percentile	OR = 1.0e + 43 (0.00-9.5e + 88)	Log of triglycerides, leptin and adiponectin, maternal age, schooling, parity, pre-gestational physical activity, blood glucose, GWG, and BMI at the beginning of pregnancy	0.067	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Log of leptin concentration in the first trimester of pregnancy	>90th percentile	OR = 3.92 (1.18-12.95)	Log of triglycerides, leptin and adiponectin, maternal age, schooling, parity, pre-gestational physical activity, blood glucose, GWG, and BMI at the beginning of the pregnancy	0.025	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Log of adiponectin levels in the first trimester of pregnancy	>90th percentile	OR = 0.54 (0.16-1.83)	Log of triglycerides, leptin and adiponectin, maternal age, schooling, parity, pre-gestational physical activity, blood glucose, GWG, and BMI at the beginning of the pregnancy	0.321	SE	Farias et al.¹⁴14 Farias DR, Poston L, Franco-Sena AB, Silva AA, Pinto T, Oliveira LC, et al. Maternal lipids and leptin concentrations are associated with large-for-gestational-age births: a prospective cohort study. Sci Rep. 2017;7:84.
Presence of urinary tract infection	>90th percentile			0.220	S	Leal et al.⁵⁷57 Leal RC, Santos CN, Lima MJ, Moura SK, Pedrosa AO, Costa AC. Maternal-perinatal complications in high risk pregnancy. J Nurs UFPE on line. 2017;11:1641-9.
Presence of sexually transmitted disease	>90th percentile			0.370	S	Leal et al.⁵⁷57 Leal RC, Santos CN, Lima MJ, Moura SK, Pedrosa AO, Costa AC. Maternal-perinatal complications in high risk pregnancy. J Nurs UFPE on line. 2017;11:1641-9.

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[1] * Corresponding author. E-mail:marco.mastroeni@univille.br (M.F. Mastroeni).

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Predictors of excess birth weight in Brazil: a systematic review☆ ☆ Please cite this article as: Czarnobay SA, Kroll C, Schultz LF, Malinovski J, Mastroeni SS, Mastroeni MF. Predictors of excess birth weight in Brazil: a systematic review. J Pediatr (Rio J). 2019;95:128-54.

Abstract

Objective:

Data sources:

Data synthesis:

Conclusion:

Predictors of excess birth weight in Brazil: a systematic review^☆ ☆ Please cite this article as: Czarnobay SA, Kroll C, Schultz LF, Malinovski J, Mastroeni SS, Mastroeni MF. Predictors of excess birth weight in Brazil: a systematic review. J Pediatr (Rio J). 2019;95:128-54.