Influencing variables for fetal growth in malnourished mothers: A nested case-control study

Abstract

ObjectiveMaternal malnutrition, inadequate weight gain in pregnancy, and maternal anemia are the modifiable variables commonly implicated for intrauterine growth retardation in the community. We aimed to evaluate the frequency of growth retardation and iron deficiency among babies born to malnourished mothers and its association with maternal anthropometry, hemoglobin, and ferritin. MethodsA nested case-control study was carried out as analysis of subset data with subjects enrolled for a randomized controlled trial(CTRI Trial no.2018/04/013096)in government facilities of Kasturba Medical College, Mangalore, affiliated to Manipal Academy of Higher Education from May to August 2018. Eighty-eight newborns born to malnourished primigravidae by vaginal delivery were included. Neonatal anthropometry and cord blood ferritin along with maternal hemoglobin and ferritin was measured. The maternal pre-pregnancy body mass index (BMI) and weight gain in pregnancy were calculated using documented pre-pregnancy weight, height, and present weight. ResultsThe average birth weight was 2.6 kg. (95% CI, SD = 0.5). Fifty-eight percent of babies were appropriate for gestational age(AGA). The number of AGA babies born to mothers who had weight gain 7 kg, and above was significantly higher.[Correlation:0.41,p = 0.0001]. Nine babies had depleted iron stores, three babies being small for gestational age(SGA). (RR:0.77,95% CI = 0.29–2.05,p = 0.72).Thirty-four percent mothers were anemic who had higher chance of having SGA babies.[RR = 1.47,95% CI 0.91–2.38,p = 0.12].Thirteen mothers had low ferritin levels and 5 of them had SGA babies[RR = 1.51,95% CI = 0.68–3.4,p = 0.33]. Fifty mothers had pre-pregnancy BMI <18.5, out of which 19 had SGA babies. [RR:0.80,95% CI = 0.49–1.31,p = 0.38]. ConclusionAdequate weight gain in pregnancy can help achieve desired fetal growth in malnourished and anemic mothers.