This retrospective case--control study analyses the prevalence and outcome of macrosomia in a part of the underdeveloped world. Out of 6,093 deliveries at a large tertiary care centre, 234 (3.8%) were macrosomic. Maternal risk factors associated with the condition included age over 35, obesity, grand multiparity, postmaturity and impaired glucose tolerance. Operative deliveries were more common as was shoulder dystocia, birth trauma, fetal distress, the need for neonatal intensive care and perinatal loss.