Macrosomia is an emerging but neglected obstetric challenge in Africa, associated with potentially life-threatening complications to both the mother and the fetus, including maternal and neonatal morbidity and mortality. This study aimed to determine the pooled prevalence, associated risk factors, and neonatal and maternal outcomes of macrosomia by performing a systematic review and meta-analysis.

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

We conducted a comprehensive search of PubMed, EMBASE and Web of Science to extract data from those that have investigated various aspects of the prevalence, risk factors and outcomes of macrosomia from the earliest records to 26 August 2025. Appropriate search terms were used for each database.

We included observational studies that examined the prevalence, risk factors and outcomes of macrosomia in Africa.

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool and the Newcastle-Ottawa Quality Assessment Scale. Meta-analyses were performed using random-effects models to estimate the pooled prevalence of macrosomia. The I² statistic was used to examine statistical heterogeneity. Egger’s test and Funnel plot were used to evaluate publication bias. Grading of Recommendations Assessment, Development and Evaluation to assess the quality of the meta-analysis.

A total of 29 studies comprising 269 934 mother–infant pairs from 9 African countries were included. The pooled prevalence of macrosomia in Africa was 6.35% (95% CI 5.22% to 7.48%), with substantial heterogeneity (I²=94.9%). Sensitivity analysis excluding one outlier study reporting a prevalence of 35.89% produced a similar pooled estimate (6.02%, 95% CI 4.94% to 7.10%). Significant risk factors for macrosomia included male neonate (OR=1.58, 95% CI 1.05 to 2.11), gestational age ≥40 weeks (OR=1.54, 95% CI 1.11 to 1.97) and history of macrosomia (OR=5.44, 95% CI 1.82 to 9.06). With respect to outcomes, macrosomia was associated with an increased risk of shoulder dystocia (OR=2.07, 95% CI 1.12 to 3.03), and a reduced risk of postpartum haemorrhage (OR=0.86, 95% CI 0.82 to 0.91), while no significant associations were observed for gestational diabetes mellitus, caesarean delivery, neonatal mortality or maternal mortality.

Macrosomia remains a significant public health concern in Africa, with a pooled prevalence of 6.35%. There are multiple risk factors associated with macrosomia in Africa, including the male sex, prolonged gestation and a prior history of macrosomia. Also, macrosomia increases the likelihood of shoulder dystocia and other delivery complications. Preventive strategies and targeted interventions are needed to reduce the burden of macrosomia in Africa. At the same time, enhanced obstetric preparedness for macrosomic deliveries is essential to mitigate the associated adverse perinatal outcomes. However, our study is limited by high heterogeneity and publication and language biases, which should be addressed in future studies.

CRD42023485419.

Shared decision-making (SDM) requires that individuals are correctly and smoothly supported to make decisions. However, in Japan, development of decision aids (DAs) to support implementation of SDM is lagging behind Western countries, and there are few reports focused on breast reconstruction. Thus, it is unclear if SDM using a DA in the context of the unique national character and medical culture in Japan is useful in decision-making for breast reconstruction, including whether or not to undergo reconstruction. The aim of this multicentre collaborative study is to investigate the clinical effectiveness of SDM using a DA for patients with breast cancer considering reconstruction, from the perspectives of decisional conflict and postoperative quality of life.

A multisite trial will be conducted at 12 facilities certified by the Japanese Society of Breast Oncoplastic Surgery. A cluster-randomised controlled trial is planned at centres that have implemented SDM with DAs and those that have not implemented SDM, but use a conventional surgical explanation and informed consent to make decisions about reconstruction methods. The study participants will be female patients aged ≥20 years with newly diagnosed stage 0–III breast cancer who are interested in breast reconstruction. Data collection includes baseline and follow-up patient surveys and medical record review. The effectiveness of the DA at reducing conflict and regret in decision-making (primary outcome) will be evaluated using the decision conflict scale.

This protocol has been approved by the Kyoto University Central Institutional Review Board, and permission for performance of the study has been obtained from the Ethics Review Board at each participating centre. We plan to disseminate the findings through journal publications and national meetings, including a presentation of the research results at the Japanese Society of Breast Oncoplastic Surgery. Our findings will advance the science of medical decision-making and have the potential to reduce socioeconomic health disparities.

UMIN000052161.

This study validates the previously tested Screening for Poverty And Related social determinants to improve Knowledge of and access to resources (‘SPARK Tool’) against comparison questions from well-established national surveys (Post Survey Questionnaire (PSQ)) to inform the development of a standardised tool to collect patients’ demographic and social needs data in healthcare.

Cross-sectional study.

Pan-Canadian study of participants from four Canadian provinces (SK, MB, ON and NL).

192 participants were interviewed concurrently, completing both the SPARK tool and PSQ survey.

Survey topics included demographics: language, immigration, race, disability, sex, gender identity, sexual orientation; and social needs: education, income, medication access, transportation, housing, social support and employment status. Concurrent validity was performed to assess agreement and correlation between SPARK and comparison questions at an individual level as well as within domain clusters. We report on Cohen’s kappa measure of inter-rater reliability, Pearson correlation coefficient and Cramer’s V to assess overall capture of needs in the SPARK and PSQ as well as within each domain. Agreement between the surveys was described using correct (true positive and true negative) and incorrect (false positive and false negative) classification.

There was a moderate correlation between SPARK and PSQ (0.44, p60), SPARK correctly classified 90.5% (n=176/191).

SPARK provides a brief 15 min screening tool for primary care clinics to capture social and access needs. SPARK was able to correctly classify most participants within each domain. Related ongoing research is needed to further validate SPARK in a large representative sample and explore primary care implementation strategies to support integration.