ASSOCIATION BETWEEN MATERNAL SERUM LIPID PROFILE AND NEONATAL MACROSOMIA IN HEALTHY PREGNANT WOMEN: A PROSPECTIVE COHORT STUDY FROM SOUTH INDIA

Abstract

Background: Neonatal macrosomia (birth weight ≥ 4000 g) complicates 5–20% of pregnancies worldwide and is associated with substantial maternal and neonatal morbidity. Although gestational diabetes mellitus is the classical risk factor, 50–70% of macrosomic infants are born to non-diabetic mothers, suggesting that maternal dyslipidaemia — independent of glycaemic status — may contribute to excessive fetal growth. Data from healthy, rigorously screened Indian women remain limited. Objective: To determine the association between maternal serum lipid profile and neonatal macrosomia in healthy pregnant women, and to compare lipid parameters between mothers of macrosomic and non-macrosomic neonates between 24 and 34 weeks of gestation. Methods: This prospective cohort study enrolled 400 antenatal women aged 24–34 weeks of gestation attending the Obstetrics and Gynaecology outpatient department of a tertiary care hospital in Chennai, India, between July 2024 and December 2025. Women with singleton pregnancies and pre-pregnancy BMI 18–24 kg/m² were included after rigorous exclusion of gestational/pre-gestational diabetes, hypertensive and thyroid disorders, and other metabolic comorbidities. Fasting total cholesterol (TC), triglycerides (TG), HDL-C, LDL-C and VLDL-C were measured, and participants were followed until delivery. Neonatal macrosomia was defined as birth weight ≥ 4000 g. Associations were assessed using the chi-square test, Spearman’s correlation and multivariable logistic regression with bootstrap-derived 95% confidence intervals; receiver operating characteristic (ROC) curve analysis evaluated diagnostic performance. Results: The prevalence of macrosomia was 19.0% (76/400). Elevated TC (≥250 mg/dL; OR 1.77, 95% CI 1.07–2.93, p=0.035) and elevated TG (≥200 mg/dL; OR 1.85, 95% CI 1.04–3.28, p=0.048) were significantly associated with macrosomia. Triglycerides showed the strongest correlation with birth weight (Spearman ρ=0.315, p<0.001) and the highest diagnostic accuracy (AUC 0.638). Conclusion: Maternal hypertriglyceridaemia in the second and early third trimesters is significantly and independently associated with neonatal macrosomia in healthy, euglycaemic women, even after rigorous exclusion of gestational diabetes. Routine mid-trimester triglyceride screening may help identify pregnancies at risk of fetal overgrowth in settings where ultrasonography is not readily available.