Is head to chest circumference ratio a better detector of macrosomia in infants of diabetic mothers as compared to birth weight >4000g?

Priya Jose, Jenifer Vani, Peter Prasanth Kumar Kommu, Satish Korah Kuruvila, Lalitha Krishnan


Background: In populations with a high incidence of low birth weight, a macrosomia index (ratio of head /chest circumference) may better detect infants of diabetic mothers rather than a birth weight of ≥4000g. The objective of this study was to correlate Macrosomia Index ≤1 (MI) with maternal HbA1c at delivery.

Methods: Prospective cross-sectional study in a Medical College Hospital in South India from November 2012 to March 2014.  Study subjects were 715 term consecutive, mother/neonate pairs, booked, inborn and singleton deliveries. Birth weight, head and chest circumference of neonates, and maternal HbA1c at delivery were measured. The calculated macrosmia index (MI) was correlated with maternal HbA1c. Pearson correlation and odd’s ratio were calculated.

Results: Of 715 mothers, 68.3% (488/715) had HbA1c >5.4% (range 4.2 to 10.5%), although only 32.7% (234/715) were categorized as gestational diabetics in pregnancy. Odds of Macrosomia Index ≤1 in neonates with maternal HbA1c > 5.4% was 7 times (95%CI: 3.2-15.4) as compared to that of neonates of mothers with HbA1c ≤ 5.4 (p<0.001). 13.4% (96/715) of neonates had MI ≤1 but only 1.4% (10/715) had birth weight of ≥4000g.

Conclusions: MI ≤1 correlated with an HbA1c of >5.4% at delivery. Hence, in addition to birth weight ≥4000g, MI ≤1 should also be used to detect macrosomia in infants of diabetic mothers.



Chest circumference ratio, Infant of diabetic mother, Macrosomia index

Full Text:



Henriksen T. The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand. 2008; 87:134-45.

Thomas N, Chinta AJ, Sridhar S, Kumar M, Kuruvilla KA, Jana AK. Perinatal outcome of infants born to diabetic mothers in a developing country--comparison of insulin and oral hypoglycemic agents. Indian Pediatr. 2013;50:289-93.

Li G, Kong L, Li Z, Zhang L, Fan L, Zou L, et al. Prevalence of macrosomia and its risk factors in china: a multicentre survey based on birth data involving 101,723 singleton term infants. Pediatr Perinat Epidemiol. 2014;28:345-50.

Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S. Births: final data for 2004. Natl Vital Stat Rep. 2006 Sep 29;55(1):1-101.

He X-J, Qin F-Y, Hu C-L, Zhu M, Tian C-Q, Li L. Is gestational diabetes mellitus an independent risk factor for macrosomia: a meta-analysis? Arch Gynecol Obstet. 2015;291:729-35.

Katon J, Williams MA, Reiber G, Miller E. Antepartum A1C, maternal diabetes outcomes, and selected offspring outcomes: an epidemiological review. Paediatr Perinat Epidemiol. 2011;25:265-76.

Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M et al. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu): a community based study. J Assoc Physicians India. 2008;56:329-33.

Neelakandan R, Sethu PS. Early universal screening for gestational diabetes mellitus. J Clin Diagn Res. 2014;8:OC12-14.

Gopalakrishnan V, Singh R, Pradeep Y, Kapoor D, Rani AK, Pradhan S, et al. Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria. J Postgrad Med. 2015;61:155-8.

Kumar A, Kalra S, Unnikrishnan AG. Metabolic state of the nation: Results of the national family health survey-4. Indian J Endocrinol Metab. 2016;20:429-31.

Abena Obama MT, Shasha VW, Fodjo J, Bonongkaho F, Mbede J, Kamdom Moyo J. Foetal macrosomia in Cameroon: prevalence, risk factors and complications. West Afr J Med. 1995;14:249-54.

Pasupathy D, McCowan LME, Poston L, Kenny LC, Dekker GA, North RA, et al. Perinatal outcomes in large infants using customised birthweight centiles and conventional measures of high birthweight. Paediatr Perinat Epidemiol. 2012; 26:543-52.

Djelmis J, Buković D, Pfeifer D, Ivanisević M. Ponderal index and disproportionate fetal growth in IDDM pregnancies. Coll Antropol. 1998;22:491-5.

Song Y, Zhang S, Song W. Significance of neonatal body indices in identifying fetal macrosomia. J Perinatol. 2013;33:103-6

Song Y, Zhang S, Song W. Correlation between macrosomia body indices and maternal fasting blood glucose. J Obstet Gynecol. 2014;34:289-92.

Duran A, Sáenz S, Torrejón MJ, Bordiú E, Del Valle L, Galindo M, Perez N, Herraiz MA, Izquierdo N, Rubio MA, Runkle I. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care. 2014 Sep 1;37(9):2442-50.

Khalafallah A, Phuah E, Al-Barazan AM, Nikakis I, Radford A, Clarkson W, et al. Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus. BMJ open. 2016 Apr 1;6(4):e011059.

McFarland MB, Trylovich CG, Langer O. Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers. J Matern Fetal Med. 1998;7:292-5.

Nte A, Eneh AU, Peterside IE, Oruamabo RS, Ebong DW. Anthropometric indices in singleton term neonates and their possible value in predicting some metabolic problems: a preliminary study. Afr J Med Med Sci. 1997;26:171-3.

Nasrat H, Abalkhail B, Fageeh W, Shabat A, el Zahrany F. Anthropometric measurement of newborns of gestational diabetic mothers: does it indicate disproportionate fetal growth? J Matern Fetal Med. 1997;6:291-5.

Salim R, Hasanein J, Nachum Z, Shalev E. Anthropometric parameters in infants of gestational diabetic women with strict glycemic control. Obstet Gynecol. 2004;104:1021-4.

Dhar B, Mowlah G, Nahar S, Islam N. Birth-weight status of newborns and its relationship with other anthropometric parameters in a public maternity hospital in Dhaka, Bangladesh. J Health Popul Nutr. 2002; 20:36-41.

Johnson TS, Engstrom JL, Gelhar DK. Intra- and interexaminer reliability of anthropometric measurements of term infants. J Pediatr Gastroenterol Nutr. 1997;24:497-505.

Pomeroy E, Stock JT, Cole TJ, O’Callaghan M, Wells JCK. Relationships between Neonatal Weight, Limb Lengths, Skinfold Thicknesses, Body Breadths and Circumferences in an Australian Cohort. Rogers LK, ed. PLoS ONE. 2014;9(8):e105108.

Mansani FE, Caltabiano M, Ceruti M, Condemi V, Bertoncini P. Blood levels of maternal glycosylated hemoglobin (HbA1) in the 3d day of the puerperium and neonatal anthropometric parameters. Acta Bio-Medica Ateneo Parm Organo Della Soc Med E Sci Nat Parma. 1982;53:295-9.

Mikkelsen MR, Nielsen SB, Stage E, Mathiesen ER, Damm P. High maternal HbA1c is associated with overweight in neonates. Dan Med Bull. 2011;58:1-6.

Balaji V, Madhuri BS, Ashalatha S, Sheela S, Seshiah V. A1C in Gestational Diabetes Mellitus in Asian Indian Women. Diabetes Care. 2007;30:1865-7.

McCloskey L, Bernstein J, Winter M, Iverson R, Lee-Parritz A. Follow-up of gestational diabetes mellitus in an urban safety net hospital: missed opportunities to launch preventive care for women. J Womens Health 2002. 2014;23:327-34.

Moore TR. Fetal growth in diabetic pregnancy. Clin Obstet Gynecol. 1997;40:771-86.

VanHaltren K, Malhotra A. Characteristics of infants at risk of hypoglycaemia secondary to being infant of a diabetic mother. J Pediatr Endocrinol Metab. 2013;26:861-5.

Opati P, Zheng R, Wang J, Xin Y, Zhao H, Bi D. Comparison of neonatal outcomes in macrosomic infants of diabetic and non-diabetic mothers. J Neonatal-Perinat Med. 2015;8:9-13.

Ballard JL, Rosenn B, Khoury JC, Miodovnik M. Diabetic fetal macrosomia: significance of disproportionate growth. J Pediatr. 1993;122:115-9.