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Indian Journal of Community Medicine

Risk Factors Associated with Low Birth Weight in Newborns

Author(s): H.S. Joshi1, S.H. Subba2, S.B. Dabral1, S. Dwivedi1, D. Kumar1, S. Singh1

Vol. 30, No. 4 (2005-10 - 2005-12)

Introduction:

Babies with a birth weight of less than 2500 gms, irrespective of the period of their gestation are termed as Low Birth Weight (LBW) babies1. In India 30-35% babies are LBW and more than half of these LBW newborns are full term babies2. LBW being one of the global indicators of community health, it is imperative that periodic monitoring be undertaken to evaluate the impact of preventive health services. The present study was designed to find out the effect of various socio-economic and maternal factors on the birth weight of institutionally delivered newborns.

Materials and Methods:

This study was conducted in the Department of Gynaecology and Obstertrics, SRN Hospital, MLN Medical College, Allahabad, during the period of June 2001 to May 2002. The study population comprised of mothers along with newborns delivered at SRN Hospital during the study period. It is noted from the literature that LBW infants represent about 33% of all live birth in India2. The required sample size for the study was estimated to be 233 with a permissible error of 20%. A cross-sectional study design was adopted to study various factors affecting birth weight in newborns. A pretested schedule was used to record the information regarding mothers. Birth weight was taken within 24 hrs of the birth and sex of the new born was recorded. In order to test for association between two variables, a Chi-square and Normal test for proportion were applied.

Results:

Overall mean birth weight was found to be 2.64 + 0.444 kg (95% CI 2.59 - 2.69). Out of total 34.37% newborns were weighing less than 2.50 kg (95% CI 28.58-40.22). Among these LBW babies majority (27.73%) were in the weight group of 2.00-2.50 kg. Proportion of LBW was 32.59% in males and 36.37% in females, however this difference was not found to be statistically significant.

Maternal education (χ2 = 9.42, p < 0.05), occupation (χ2 = 8.14, p<0.02) and per capita income of the family per month (χ2 = 22.02, p<0.001) were found to be significantly associated with birth weight of the newborn. 45.45% of the babies born to illiterate mothers and 43.94% of babies born to mothers who were labourers by occupation were of LBW. Proportion of LBW babies was maximum (52.56%) in mothers of low income group (percapita income less than Rs. 150 per month). Association between religion and birth weight was found to be insignificant (χ2 = 4.12, p> 0.05).

The utilization of antenatal care was adequate (> 3 antenatal visits) in 58.20% mothers. Proportion of LBW was maximum (61.76%) in mothers who did not receive any antenatal care, followed by those who received inadequate care, in whom LBW proportion was 46.57%. There was significant association between birth weight and utilization of antenatal care by mothers (χ2 = 26.01, p < 0.001).

Out of 177 births, birth interval in relation to previous birth was found to be less than 3 years in 74.01% mothers. In these mothers 42.75% of newborns were LBW as compared to 19.57% in those with birth interval more than or equal to 3 years. Here the birth weight was found to be significantly associated with birth interval in relation to previous birth.

Proportion of babies born with LBW was 53.45% in mothers who were less than 20 years of age. In newborns of birth order fourth and above, 51.28% were LBW. In mothers with BMI less than or equal 20 (kg/m2) 47.25% newborns were LBW. Maternal age (χ2 = 10.19, p <0.01), Parity (χ2 = 13.4, p<0.01) and BMI (χ2 = 17.57, p<0.001) were found to be significantly associated with LBW.

Out of 256, 123 (48.05%) mothers had significant illness during their pregnancy. Of these mothers 51.22% delivered LBW babies. Out of 76 newborns delivered by anaemic mothers 61.84% were LBW. There is significant association between maternal illness and LBW (Z=5.75, p<0.001). Strength of association was maximum with severe anaemia (χ2 = 39.68, p< 0.001).

Out of the total, 71 (27.73%) mothers had some complication during the present pregnancy and 39 (54.93%) newborn delivered by them were LBW. 75% of newborns delivered by mothers suffering from pre-eclampsia and eclampsia during present pregnancy were LBW, followed by the Ante Partum Haemorrhage (53.85%) and Malpresentation (46.75%). The association between maternal complication during present pregnancy and LBW was found to be statistically significant (Z=4.22, p<0.001).

Discussion:

It was observed that 38.67% mothers were illitrate and 45.45% of them delivered LBW babies, it was in conformity with earlier reports3,7. This may be explained by increased awareness of educated women regarding health services.

The proportion of LBW was maximum (43.94%) in mothers who were labourers by occupation; same observation was documented in earlier studies3,7. The present study showed that there was no significant association between birth weight and religion (p>0.05). The proportion of LBW babies decreased with increase in the percapita income of the family. These findings are in accordance with other studies3,7.

Results of the present study also show that young mothers (<20 years) have more number of LBW babies (53.45%), in accordance with similar findings from other studies.3,4,8 Primiparous women in this study also had more number (29.11%) of LBW babies as found in other studies3,8. An increase in LBW was found after fourth parity (51.28%). Makhija et al8 documented 39.7% LBW after 4th parity.

Present study showed that there is significant association between BMI of mother and LBW (χ2 = 17.57, p <0.001). These findings are in accordance with other studies5,7.

In the present study maternal illness (Z=5.75, p<0.001) and complication (Z=4.22, p<0.001) during the present pregnancy was significantly associated with LBW in newborns. Among all maternal illness proportion of LBW was maximum (61.84%) in mothers with severe anaemia (Hb < 7gm %). Similar finding observed by Idris et al6, Deswal et al5 and Anand et al3.

Conclusion:

The present study suggests that improvement in maternal nutrition during pregnancy, avoiding close birth spacing, delayed child bearing in young females (<20 years), universal coverage of adequate antenatal care, early recognition of maternal illness and compications are essential for reducing the LBW in newborns. This can be achieved by including health education component for adolescents (both males and females) and pregnant mothers in RCH program, specially in rural areas where literacy rate is very low by utilizing grass route level health workers already existing in community.

References:

  1. Kramer MS. Determinants of LBW, Methodological assessment and meta analysis. WHO Bull, 1987; 65: 663- 737.
  2. WHO Bridging the gaps, The World Health Report, 1995, Report of the Director General.
  3. Kiran A, Garg B S. A study of factors affecting LBW. Indian Journal of Community Medicine 2000; 25: 57-61.
  4. Theodre K, Abel K, Kumar S. Epidemiological correlates of LBW in rural Tamil Nadu. Indian Journal Pediatric 1990; 59: 299-304.
  5. Deswal B S, Singh J V., Kumar D. A. study of risk factors for LBW. Indian Journal of Community Medicine 1999; 25: 127- 31.
  6. Idris MZ, Gupta A, Mohan U, Srivastava AK, Das V. Maternal health and LBW among institutional deliveries. Indian Journal of Community Medicine 2000; 25: 156-60.
  7. Mavalankar DV, Gray RH, Trivedi CR. Risk factors for preterm and term LBW in Ahmedabad. International Journal of Epidemiology, 1992; 21 : 263-72.
  8. Makhija K, Murthy GVS, Kapoor SK, Lobo J. Socio-biological determinants of birth weight. Indian Journal Pediatric 1989; 56: 639-43.
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