Protocol - Birth Weight - Measured Weight at Birth

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Measured weight at birth

Specific Instructions

Several overarching, critical issues for high-quality data collection of anthropometric measures that optimize the data in gene-environment etiologic research include: (1) the need for training (and retraining) of study staff in anthropometric data collection; (2) duplicate collection of measurements, especially under field conditions; (3) use of more than one person for proper collection of measurements where required; (4) accurate recording of the protocols and the measurement units of data collection; and (5) use of required and properly calibrated equipment.


For any measurement taken during pregnancy, maternal or fetal complication recorded, or measurement relating to a pregnancy outcome at delivery, such as maternal weight, gestational diabetes, preeclampsia, preterm delivery, or birth weight, the Working Group strongly advises collecting and recording a measure of gestational age at diagnosis and/or delivery. This entails recording the following from the medical records: (1) the gestational age in weeks at which the measurement or diagnosis was made, or the gestational age at delivery; (2) the type of gestational age (e.g., menstrual, conception, embryonic), although "gestational age" technically denotes menstrual age only; and (3) the source of the gestational age estimate, such as the recalled date of the mother’s last normal menstrual period (LMP), date of embryo transfer, fetal biometry from a first or second trimester ultrasound, fundal height, or neonatal physical examination. If linking with electronic vital records, care should be taken to research the history and definition of gestational age before use because criteria are likely to have evolved over time, and gestational ages estimated from different sources can significantly affect incidence and prevalence rates of important prenatal and perinatal categorizations, such as preterm delivery and small (SGA) and large for gestational age (LGA). Alternatively, depending on the source, the components for calculating gestational age could be recorded for estimating gestational age later, if necessary, although a clinician’s estimate of gestational age from a medical chart or vital records is preferred.

The presumed normal or optimal length of gestation, from the LMP date to the estimated date of delivery (EDD; sometimes denoted as estimated date of confinement, EDC), is 280 days (40 weeks) and 266 days from date of conception. Gestational age is generally recorded in medical charts in completed weeks; for example, a gestational age of 36 weeks represents the interval of 36 weeks, 0 days (written 36+0) to 36 weeks, 6 days (36+6). A pregnancy delivered before 37 completed weeks is considered preterm ("too early") and after 42 completed weeks is considered post-term ("too late"). By medical history, clinicians will first date a pregnancy using Naegele’s rule, which is done by calculating the EDD by counting back 3 months from the LMP and adding 7 days. This rule assumes that the gravida has a 28-day menstrual cycle with fertilization occurring on day 14. However, if the LMP is unknown, uncertain, or inconsistent with maternal symptoms, fetal size, and/or maturation, gestational age may be estimated by imaging (obstetric ultrasound) in the first trimester or up to 20 weeks. Afterward, the estimation may be by maternal examination, measurement, or examination of the fetus by ultrasound, or a physical examination of the neonate. Because there is greater variation in fetal size and timing of maturation as gestation progresses, EDD and gestational age estimates made early in gestation (first trimester) are more reliable and preferred.

Conventional indices derived using birth weight, in the absence of information on gestational age at delivery, include low birth weight (LBW; fewer than 2,500 g), very low birth weight (VLBW; fewer than 1,500 g), extremely low birth weight (ELBW; fewer than 1,000 g or fewer than 500 g), and high birth weight (HBW; greater than or equal to 4,000 g or greater than or equal to 4,500 g). About two-thirds of LBW infants are preterm by dates, and all term LBW infants are considered to be growth restricted. HBW can be termed "macrosomia," but that term is usually reserved to refer specifically to infants of diabetic mothers. If gestational age is available, the preferred indices are SGA, or small for dates, which is defined variously as less than 2nd, 3rd, 5th, or 10th percentile of a birth weight for gestational age reference, and LGA, or large for dates, which is defined as greater than or equal to 98th, 97th, 95th, or 90th percentile. The "normal" comparison within the percentile cutoffs is appropriate for gestational age. There is no universal birth weight for gestational age reference or standard for defining SGA and LGA, so the Working Group advises that each study operationally define these indices based on a thoughtful consideration of the available local, national, or international references. To index proportionality, neonates can be described as asymmetrically (wasted, less than -2 standard deviations weight for length or ponderal index) or symmetrically (stunted, less than -2 standard deviations length for gestational age, with a normal ponderal index) growth restricted.

For infants measured at birth, use the protocol titled Measured Weight at Birth (Global Network for Women’s and Children’s Health Research). For all others, the preferred method is abstraction from the birth certificate or medical record (protocol titled Measurement: Birth Weight Abstracted from Medical Records [National Vital Statistics System]). If this is not available, the self- or proxy-reported birth weight can be used (protocol titled Question: Proxy-Reported Birth Weight [National Health and Nutrition Examination Survey]). In all instances, the investigator should record the specific data source and specific protocol used.




Measured Weight at Birth: This protocol is for an examination study.

  • Use calibrated infant scale for weighing infant.
  • Naked weight of infant is preferred, but if the mother objects, wrap naked infant in study blanket for procedure. Record on form whether infant is weighed with a study blanket. Note: If the infant urinates in the blanket, repeat the measurement using a dry blanket.
  • Place the infant on the scale so that weight is distributed equally about the center of the pan.
  • Record the weight on form.
  • Remove the infant from the scale, then replace and weigh a second time.
  • Record the second weight on form.
  • If the difference in the two weights is greater than 100 grams, obtain a third measurement.
  • Note the weight of the blanket and subtract the weight of the blanket from the total weight of the infant plus blanket to estimate birth weight of the infant.
Personnel and Training Required

Personnel who are trained in handling newborns and in using calibrated scales

Equipment Needs

Digital scale (or beam balance)

Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Physical Measurement




Newborns, within 24 hours of birth

Selection Rationale

These protocols use methods that would be encountered in most research settings. These protocols encompass different periods when the measurement could be collected. The studies from which these protocols are derived also provide valid national comparison data. Ascertainment of birth weight is a high priority when feasible to obtain given the significant relationships that have been shown between birth weight and the risk of selected, important cardiovascular-renal diseases.


Chinese, English, Spanish

Logical Observation Identifiers Names and Codes (LOINC) Birth Weight - Measured 8339-4 LOINC
Human Phenotype Ontology Abnormality of body weight HP:0004324 HPO
caDSR Form PhenX PX020202 - Measured Weight At Birth 5792267 caDSR Form
Derived Variables

Ponderal Index (PI, neonates and infants), Weight-for-Length (W/L, birth to 36 months), Body Mass Index (BMI, 2 years to adults, but some references from birth)

Process and Review

The Expert Review Panel #1 reviewed the measures in the Anthropometrics, Diabetes, Physical Activity and Physical Fitness, and Nutrition and Dietary Supplements domains.

Guidance from the ERP includes:

• Revised descriptions of measure

Back-compatible: no changes to Data Dictionary

Previous version in Toolkit archive (link)

Protocol Name from Source

Krebs, N. F., et al. Complementary feeding: A Global Network cluster randomized controlled trial manual of operations, BMC PEDIATR, 2011


Krebs, N. F., Hambidge, K. M., Mazariegos, M., Westcott, J., Goco, N., Wright, L. L., . . . McClure, E. (2011). Complementary feeding: A Global Network cluster randomized controlled trial manual of operations. BMC Pediatrics, 11 (Art. No. 4).

Certification for the Spanish translation can be found here.

General References

Allen, M. C. (2005). Assessment of gestational age and neuromaturation. Mental Retardation and Developmental Disabilities Research Review, 11(1), 21-33.

Hall, E. S., Folger, A. T., Kelly, E. A., & Kamath-Rayne, B. D. (2014). Evaluation of gestational age estimate method on the calculation of preterm birth rates. Maternal and Child Health Journal, 18, 755-762.

Wier, M. L., Pearl, M., & Kharrazi, M. (2007). Gestational age estimation on United States livebirth certificates: A historical overview. Paediatric and Perinatal Epidemiology, 21(Suppl. 2), 4-12.

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX020202010201 Weight of the blanket used for weighing N/A
PX020202010203 Weight of the blanket used for weighing N/A
PX020202010202 Weight of the blanket used for weighing N/A
PX020202020201 Weight of the blanket used for weighing N/A
PX020202020203 Weight of the blanket used for weighing N/A
PX020202020202 Weight of the blanket used for weighing N/A
PX020202030201 Weight of the blanket used for weighing N/A
PX020202030203 Weight of the blanket used for weighing N/A
PX020202030202 Weight of the blanket used for weighing N/A
PX020202010301 weight at birth measurement 1 N/A
PX020202010303 weight at birth measurement 1 N/A
PX020202010302 weight at birth measurement 1 N/A
PX020202020301 weight at birth measurement 2 N/A
PX020202020303 weight at birth measurement 2 N/A
PX020202020302 weight at birth measurement 2 N/A
PX020202030301 weight at birth measurement 3 N/A
PX020202030303 weight at birth measurement 3 N/A
PX020202030302 weight at birth measurement 3 N/A
PX020202040100 Average weight at birth N/A
PX020202040300 Average weight at birth N/A
PX020202040200 Average weight at birth N/A
PX020202010100 whether infant is weighed with a study blanket N/A
PX020202020100 whether infant is weighed with a study blanket N/A
PX020202030100 whether infant is weighed with a study blanket N/A
Measure Name

Birth Weight

Release Date

March 27, 2009


Birth weight (measured, recalled, or vital records/chart abstraction) is the weight of the infant in grams or pounds and ounces at birth. Birth weight is directly related to gestational age.


Birth weight is associated not only with the health status of the infant/child, but has also been linked to later-life conditions such as obesity, hypertension, kidney disease, diabetes, and other chronic conditions. Birth weight is influenced by genetics, maternal health, prenatal health, pregnancy complications, environmental factors, multiple-gestation births, and other factors. Low birth (LBW) poses significant health risks. Birth weights, collected as part of a comprehensive reproductive history, may also be linked to later-life conditions in the mother. For example, large infant size may indicate undiagnosed gestational diabetes and an increased risk for adult-onset diabetes in the mother.


Anthropometrics, gestational age, ponderal index, NHANES

Measure Protocols
Protocol ID Protocol Name
20201 Birth Weight - Birth Weight Abstracted from Medical Records
20202 Birth Weight - Measured Weight at Birth
20203 Birth Weight - Proxy Reported Birth Weight

Chen, L. W., et al. (2020) Implication of gut microbiota in the association between infant antibiotic exposure and childhood obesity and adiposity accumulation. International Journal of Obesity. 2020 July; 44(7): 1508-1520. doi: 10.1038/s41366-020-0572-0

Bastain, T. M., et al. (2019) Study Design, Protocol and Profile of the Maternal And Developmental Risks from Environmental and Social Stressors (MADRES) Pregnancy Cohort: a Prospective Cohort Study in Predominantly Low-Income Hispanic Women in Urban Los Angeles. BMC Pregnancy & Childbirth. 2019 March; 19(1): N.PAG. doi: 10.1186/s12884-019-2330-7

Chen, L. W., et al. (2018) Which anthropometric measures best reflect neonatal adiposity? Int J Obes (Lond). 2018 March; 42(3): 501-506. doi: 10.1038/ijo.2017.250