Association of maternal socio-demographic factors, maternal anthropometric measurements, and foetal sex with LGA newborns in Sri Lanka

Abstract

Introduction: There is an increased trend of delivering large for gestational age (LGA) newborns globally, which has already caused significant impact on health, nutrition, economics, and social aspects. LGA newborns are more vulnerable for complications developed from intrauterine life to adulthood and it is becoming additional burden to the health care and economic state of the country. However, we lack published data on incidence, trend and factors affecting LGA newborns in Sri Lanka. Determination of risk factors associated with LGA newborns would help to formulate and implement effective preventive measures. Method: A case control study was carried out at obstetrics and gynaecology unit, Teaching Hospital Kandy from 01.01.2016 to 31.12.2016. Systematic sample technique was used, and study sample was consisted of 44 cases and 132 controls. Pretested interviewer administered questionnaire was used for data collection. Significance of associations between dependent and independent variables was estimated using probit regression model. Probit coefficient was estimated to assess the significance and respective marginal effects were estimated to assess the magnitude of significance. STATA software was used for analysis. Ethical clearance was obtained from ethical review committee, Teaching Hospital Kandy. Results: According to probit regression estimates of socio-demographic factors, maternal parity of two (Coefficient 1.89: 95% CI 0.75-3.03: P <0.05) or more (Coefficient 2.37: 95% CI 0.92-3.82: P <0.05), Monthly family income of more than 30,000/= rupees (Coefficient 2.28: 95% CI 0.92-3.63: P<0.05) and Tamil ethnicity (Coefficient 2.10: 95% CI 0.69-3.52: P<0.05) were statistically significant risk factor. In the analysis, maternal age (Coefficient 0.09: 95% CI -0.05-0.23: P>0.05), mother’s occupation (Coefficient 0.08: 95% CI -1.01-1.17: P>0.05) and maternal educational level (Coefficient 1.68: 95% CI -0.30-3.66: P>0.05) were not significant risk factors at 5% significance level. Considering the maternal anthropometric measurements, maternal weight gain during pregnancy (Coefficient 0.77: 95% CI 0.50-1.03: P<0.05) was a significant risk factor. Maternal BMI at booking visit (Coefficient 1.76: 95% CI -0.34-3.85: P>0.05), maternal weight at booking visit (Coefficient -0.63: 95% CI -1.5-0.26: P>0.05) and maternal height (Coefficient 0.56: 95% CI -0.08-1.2: P>0.05) were not significant risk factors in the analysis at 5% significance level. Foetal sex (Coefficient -0.69: 95% CI -1.5-0.13: P>0.05) was not a significant causative factor at 5% significance level. Conclusions: Among maternal socio-demographic factors, high monthly family income, parity of 2 or more and Tamil ethnicity were determined as statistically significant risk factors for LGA newborns. Among maternal anthropometric measurements, increased weight gain during pregnancy was determined as significant modifiable risk factor for LGA newborns. Maternal weight gain during pregnancy should be monitored throughout the antenatal period from the booking visit to identify mothers at risk. Effective interventions should be designed to minimize the negative impact on mothers at risk.