Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Indian Journal of Community Medicine

Effect of the Maternal Bio-Social Determinants on the Birth Weight in a Slum Area of Greater Mumbai

Author(s): Sumedha M. Joshi*, (Mrs.) N.P. Pai**

Vol. 25, No. 3 (2000-07 - 2000-09)

Deptt. of Preventive and Social Medicine *Padmashree Dr. D.Y. Patil Medical Collage, Mumbai **Somaiya Medical Collage, Mumbai

Abstract:

Research question: what is the effect of maternal biosocial determinants on birth weight of the newborn?

Hypothesis: Low socio-economic status and illiteracy has a detrimental effect on birth weight of the newborn.

Objective: To co-relate maternal age, education, parity and socio-economic status with low birth weight.

Study-design: Community based longitudinal study.

Participants: 290 pregnant women followed up till delivery.

Statistical analysis: Chi-Square test, Co-relation co-efficient.

Results: Incidence of low birth weight was higher in teenage pregnancies, with high parity and low socio-economic status. Incidence of low birth weight was also seen to be high in illiterate females.

Conclusions: Maternal age, parity and literacy have a significant effect on the birth weight of the newborn.

Keywords: Maternal, Biosocial, Birth weight.

Introduction:

The birth weight is an indicator which gives us an idea about the quality of life, the socio-economic status, health awareness and nutritional status of the community. The birth weight in all population groups is the single most determinant of the chances of the newborn to survive and experience normal growth and development. As a multi-factorial relationship exists between various maternal determinants and birth weight of the newborn, only the bio-social determinants were included in this study.

Material and Methods:

The study was conducted in an organized slum where systematic sampling technique was used, the sampling unit being a household. The study was conducted for a period of six months and woman with confirmed pregnancy were followed up till the time of their delivery. Cases of twin pregnancy, abortion and non co-operation were excluded from the study. The women's age, address, education was recorded as told by the women. The socio-economic status of the women was also recorded. Information regarding their age at marriage and at first pregnancy was sought along with details of their previous pregnancies. The birth weight of the newborn was noted from the child's birth records. The birth weight was then co-related with various variables mentioned above using standard statistical tests.

Results:

In the study 290 pregnant women were followed up during their pregnancy and the birth weight of their infants was noted. The incidence of low birth weight in the study group was 32.5%. The average weight of low birth weight infants was 2.23 Kg. ±0.22 Kg., while that in the normal birth weight infants was 2.83 Kg. ±0.3 Kg.

Age of the mother:

Table I: Relationship between mother's age and birth weight of the newborn.

Mother's age
in yrs.
No. of women Birth weight >2500 grams Birth weight <2500 grams
15-19 43 23 (53%) 20 (47%)
20-24 122 80 (66%) 42 (34%)
25-29 83 59 (71%) 24 (29%)
30+ 42 34 (81%) 8 (19%)
Total 290 196 (67.5%) 94 (32.5%)

r=-0.97; p<0.001; highly significant

It was seen that the incidence of low birth weight was higher in teenage pregnancies (47%). The birth weight improved with an increase in maternal age. The percentage of low birth weight was 34% in the 20-24 years age group. The percentage of low birth weight steadily decreased in the age group 25-29 years (29%) and in the 30+ age group (19%). Maternal age was found to be significantly associated with low birth weight.

Education of the mother:

Table II: Profile of maternal education and birth weight of the newborn.

Education No. of women Birth weight >2500 grams Birth weight <2500 grams
Illiterate 107 51 (48%) 56 (52%)
Primary 48 35 (73%) 13 (27%)
Secondary 129 104 (81%) 25 (19%)
Higher 6 6 (100%) - -
Total 290 196 (67.5%) 94 (32.5%)

r2=49.53; p<0.001; highly significant

It was observed that education had a significant effect on the birth weight of the newborn. The percentage of low birth weight was as much as 52% in illiterate women. The incidence of low birth weight decreased rapidly in women who were educated up to secondary level (19%) and higher.

Socio-economic status of the mother:

Table III: Relationship of socio-economic class to the birth weight of the newborns.

Socio-economic
class
No. of
women
Birth weight
>2500 grams
Birth weight
<2500 grams
I 4 4 (100%) - -
II 30 22 (73.3%) 8 (26.7%)
III 107 83 (77.5%) 24 (22.5%)
IV 118 67 (56.8%) 51 (43.2%)
V 31 20 (64.5%) 11 (35.5%)
Total 290 196 (67.5%) 94 (32.5%)

r=0.77; p<0.05; significant

It was found that the incidence of low birth weight decreased with an increase in the socio-economic status. The co-relation between birth weight and socio-economic status was found to be significant.

Mother's age at marriage:

Table IV: Relation between mother's age at marriage with the birth weight of the newborn.
Age in yrs.
at marraige
No. of
women
Birth weight
>2500 grams
Birth weight
<2500 grams
<16 28 14(50%) 14(50%)
16-20 213 141(66%) 72(34%)
>20 49 41(84%) 8(16%)
Total 290 196(67.5%) 94(32.5%)

X2=10.23; p<0.01; significant

It was seen that mother's age at marriage was significantly associated with birth weight. This may be due to the fact that an early marriage usually leads to early (teenage) pregnancy, when the body is still in the process of biological growth. Also early marriage leads to larger number of pregnancies with inadequate spacing, which may also lead to low birth weight babies.

Parity of the mother:

Table V: Relationship between birth order and the birth weight of the newborn.

Birth
order
No. of
women
Birth weight
>2500 grams
Birth weight
<2500 grams
I 86 66 (77%) 20 (23%)
II 107 70 (65.5%) 37 (34.5%)
III 53 35 (66%) 18 (34%)
IV 30 19 (63%) 11 (37%)
V 11 5 (45%) 6 (55%)
VI 3 1 (33%) 2 (67%)
Total 290 196 (67.5%) 94 (32.5%)

r=0.94; p<0.001; highly significant

It was seen that the percentage of low birth weight increased with an increase in parity. It was observed that among the 86 primipara mothers, 20(23%) had low birth weight babies. Out of the Para 2-4, the percentage of low birth weight was between 34-37%. The percentage of low birth weight in Para 5 and 6 increased to 55% and 67% respectively.

Discussion:

In the present study, majority of the population was Muslim. It was observed that the incidence of low birth weight was slightly more in Hindus than in Muslims, however the difference was not statistically significant.

It was found that 36.9% of the study population was illiterate. Most of the women who were educated had not finished their schooling. One supposes that due to the urban social structure the daughters are sent to school though they may not be encouraged to complete their education. Social taboos prevent parents from giving education due importance. In this study, it was seen that education played a significant role to prevent low birth weight with more than half (52%) of the illiterate mothers giving birth to low birth weight babies. The birth weight increased with an increase in literacy as better education leads to an increased number of antenatal visits with better antenatal care and health education.

Studies conducted by M. Bhattacharya et al2 and Ferraz Gray et al4 also found that the mean birth weight of babies was lowest in women who were illiterate.

It was found that socio-economic status was significantly associated with low birth weight. This may be due to the fact that in a lower socio-economic class the women are over burdened with work and also there is associated malnutrition, which contributes to a large number of women delivering low birth weight infants.

Similar findings were also seen in studies conducted by Iceberg et al7 and Gawade et al6.

The percentage of teenage pregnancy was found to be 14.8%. The incidence of low birth weight was high in these cases. The birth weight improved with an increase in maternal age.

These results corroborate findings from other studies by Hugh S Miller et al10, BK Dass et al3 and R Aras et al1.

It was observed that mother's age at marriage was significantly associated with birth weight of the newborn. This may be due to the fact that early marriages may give rise to teenage pregnancies, when the girl is not fully developed. Also marriage at an early age would lead to a larger number of pregnancies with inadequate spacing, which may also contribute to low birth weight.

In this study it was observed that parity and low birth weight were co-related. Incidence of low birth weight increased with an increased in parity. This may be due to the fact that a large number of children are born without adequate spacing, leading to depletion in the woman's nutritional status and health, leaving her incapable of producing a healthy baby.

These findings are consistent with the findings by earlier workers like AMA Ferreira et al5, Enrique Regidor et al11, Silvia de Saryose et al12, Mavalankar et al9 and Kamala Das et al8.

Hence, it is concluded that improving female literacy and socio-economic status of the masses will help to improve the birth weight of the infants. Increasing the age at marriage, along with family planning and adequate spacing would go a long way to decrease the incidence of low birth weight in our country.

References:

  1. Aras R, Pai N, Baliga A: Pregnancy at teenage - Risk factor for low birth weight. Indian Pediatrics, August 1990; Vol. 26: 823-5.
  2. Bhattacharya M, Joshi PL et al: Predictor variables of birth weight. 32nd All India Conference, Indian Public Health Association, Feb. 1988: 5-7.
  3. Das BK, Mishra OP: Outcome of teenage pregnancy. Indian Journal of Preventive and Social Medicine, July-Sept. 1993; 24(3): 111-4.
  4. Ferraz EM, Gray RH, Cunha TM: Determinants of pre-term delivery and intrauterine growth retardation in North-East Brazil. Int. J. Epidemiology, March 1990; 19(1): 101-8.
  5. Ferreira AMA, Hari Kumar P: Maternal determinants of birth weight. Journal of Community Medicine, July-Sept. 1991; Vol. XVI, No. 3: 106-10.
  6. Gawade UH, Pimpalgaonkar MS, Bethariya SH: Bio-social determinants of birth weight in rural urban Nagpur. Indian Journal of Community Medicine, April-Dec. 1994; Vol. XIX, No. 2-4: 64-7.
  7. Iceberg AJ, Settlage R, Hodgman J, et al: Journal of Perinatology, Sept. 1989; 9(3): 291-5.
  8. Kamaladas T, Abel R, Sampathkumar V: Epidemiological co-relates of low birth weight in rural Tamil Nadu. Indian Journal of Pediatrics. May-June 1992: 52(3): 299-304.
  9. Mavalankar DV, Gray RH, Trivedi CR: Risk Factors for preterm and term low birth weight in Ahmedabad. Ind. J. Epidemiology, April 1992; 21(2): 263-72.
  10. Miller Hugh S, Karen B Lesser, Kathryn Reed: Adolescence and very low birth weight - A disproportionate association. Journal of Obstetrics and Gynecology, May 1996; 87(1).
  11. Regidor Enrique, Juan L, Guetierrez Fisao et al: Low birth weight in Spain associated with socio demographic factors. Journal of Epidemiology and Community Health, Feb. 1995: 49-52.
  12. Silvia De Saryose, Eve Roman: Low birth weight preterm and small for gestational age babies in Scotland. Journal of Epidemiology and Community Health, Sept. 1991; 45(3): 207-10.
Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica