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Peer-reviewedCC BY 4.0Archives of Gynecology and Obstetrics

Association between birth order and birthweight percentile: population-level and within-mother analyses in a large birth cohort

  • Shanny Kolp-Asis1,2
  • Oshrit Shtossel3,4
  • Roi Yozevitch5
  • Karin Edut1,2
  • Ariel Lasry1,2
  • Avinoam Tzabari1,2
  • Nissim Arbib2,6
6 affiliations
  1. 1Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Barak, Israel
  2. 2Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
  3. 3Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel
  4. 4Department of Computer Science, College of Management, Rishon LeZion, Israel
  5. 5Department of Computer and Software Engineering, Ariel University, Ariel, Israel
  6. 6Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
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Abstract

Background: Parity is associated with differences in birthweight, but the magnitude and consistency of this association when expressed as birthweight percentiles remain incompletely characterized.

Objective: To evaluate the association between birth order and birthweight percentile at both the population-level and within mothers across successive pregnancies.

Methods: This retrospective cohort study included 130,718 singleton live births from 55,057 women delivering at a single tertiary medical center between 2012 and 2024. Birthweight percentiles were calculated using a national sex-specific reference. Linear mixed-effects models with a random intercept for mother were used to evaluate the association between birth order and birthweight percentile, adjusting for maternal age, infant sex, and maternal diabetes. Complementary longitudinal within-mother analyses evaluated changes in birthweight percentile across successive pregnancies.

Results: Higher birth order was associated with higher birthweight percentile (β ≈ 0.074 SD per birth order increment, p < 0.001), corresponding to an average increase of approximately 3 percentile points per birth. The largest increase occurred between the first and second births, followed by progressively smaller but persistent increases with advancing birth order. This pattern was consistent across subgroup analyses and complementary within-mother analyses.

Conclusions: Higher birth order was consistently associated with higher birthweight percentile both across the population and within mothers. The association followed a distinct nonlinear pattern, with the largest increase occurring between the first and second pregnancies and progressively smaller but persistent increases thereafter. These findings provide a more nuanced understanding of parity-associated variation in fetal growth across successive pregnancies.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00404-026-08551-8.

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Cite

BibTeXRIS
BibTeX
@article{kolpasis2026association,
  title = {{Association between birth order and birthweight percentile: population-level and within-mother analyses in a large birth cohort}},
  author = {Shanny Kolp-Asis and Oshrit Shtossel and Roi Yozevitch and Karin Edut and Ariel Lasry and Avinoam Tzabari and Nissim Arbib},
  journal = {Archives of Gynecology and Obstetrics},
  year = {2026},
  month = aug,
  doi = {10.1007/s00404-026-08551-8},
  url = {https://doi.org/10.1007/s00404-026-08551-8},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Association between birth order and birthweight percentile: population-level and within-mother analyses in a large birth cohort
AU  - Shanny Kolp-Asis
AU  - Oshrit Shtossel
AU  - Roi Yozevitch
AU  - Karin Edut
AU  - Ariel Lasry
AU  - Avinoam Tzabari
AU  - Nissim Arbib
PY  - 2026
DA  - 2026/08/13
JO  - Archives of Gynecology and Obstetrics
DO  - 10.1007/s00404-026-08551-8
UR  - https://doi.org/10.1007/s00404-026-08551-8
AB  - Background: Parity is associated with differences in birthweight, but the magnitude and consistency of this association when expressed as birthweight percentiles remain incompletely characterized.  Objective: To evaluate the association between birth order and birthweight percentile at both the population-level and within mothers across successive pregnancies.  Methods: This retrospective cohort study included 130,718 singleton live births from 55,057 women delivering at a single tertiary medical center between 2012 and 2024. Birthweight percentiles were calculated using a national sex-specific reference. Linear mixed-effects models with a random intercept for mother were used to evaluate the association between birth order and birthweight percentile, adjusting for maternal age, infant sex, and maternal diabetes. Complementary longitudinal within-mother analyses evaluated changes in birthweight percentile across successive pregnancies.  Results: Higher birth order was associated with higher birthweight percentile (β ≈ 0.074 SD per birth order increment, p < 0.001), corresponding to an average increase of approximately 3 percentile points per birth. The largest increase occurred between the first and second births, followed by progressively smaller but persistent increases with advancing birth order. This pattern was consistent across subgroup analyses and complementary within-mother analyses.  Conclusions: Higher birth order was consistently associated with higher birthweight percentile both across the population and within mothers. The association followed a distinct nonlinear pattern, with the largest increase occurring between the first and second pregnancies and progressively smaller but persistent increases thereafter. These findings provide a more nuanced understanding of parity-associated variation in fetal growth across successive pregnancies.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00404-026-08551-8.
SN  - 0932-0067
SN  - 1432-0711
ER  -