Objective To describe the modes of delivery among confirmed cases of fetal macrosomia and compare maternal and obstetric outcomes between cases of macrosomia where labor was induced due to prenatal suspicion and cases of unexpected macrosomia with spontaneous labor. A secondary objective was to compare labor induction outcomes with expectant management as the control group.   Design Retrospective multicenter observational study.   Setting Three university hospital centers in a French region over a five-year period (2017–2023).   Population or Sample Women delivering singleton babies at term (>37 weeks of gestation) with a birth weight exceeding 4,000 grams and complete electronic medical records.   Methods Statistical analyses included Chi-square, Student’s t-test, and multivariate logistic regression to adjust for confounders, with significance set at p < 0.05. Maternal data (age, BMI, parity, diabetes) and fetal data (sex, birth weight, APGAR score, umbilical cord pH, complications such as shoulder dystocia) were analyzed. Primary outcome: mode of delivery. Secondary outcomes: maternal complications (postpartum hemorrhage, perineal tears) and neonatal outcomes (APGAR, umbilical cord pH).   Main Outcome Measures Mode of delivery and associated maternal/neonatal outcomes.   Results Among 4,300 births with confirmed macrosomia, labor induction was associated with higher cesarean section risk (OR 4.46, 95% CI 3.9–5.1) and postpartum hemorrhage (OR 2.18, 95% CI 1.87–2.54) compared to spontaneous labor. Risk of cesarean was reduced when induction was compared with expectant management (ORs 2.43 and 1.85 at 38 and 39 weeks, respectively). Multiparity reduced cesarean and hemorrhage risks. No significant differences in perineal tears or shoulder dystocia were observed. Neonatal outcomes, including APGAR scores, were similar across groups.   Conclusions Labor induction in confirmed fetal macrosomia is associated with higher cesarean and maternal complication risks compared to spontaneous labor. However, these risks are reduced when compared with expectant management.   Funding No specific funding was declared for this study.   Key words induction of labor, macrosomia, multicentric