Low birth weight trends in Organisation for Economic Co-operation and Development countries, 2000\u20132015: economic, health system and demographic conditionings

Diego Erasun,Jéssica Alonso-Molero,Inés Gómez-Acebo,José Schneider,Trinidad Dierssen-Sotos,Javier Llorca

doi:10.1186/s12884-020-03484-9

Abstract

BackgroundLow birth weight rates are increasing in both developed and developing countries. Although several maternal factors have been identified as associated with low birth weight, little is known of economic or organization factors influencing this increase. This study aims to ascertain the twenty-first century relationships between the contextual country factors and low birth weight rates.MethodsWe analyse trends of low birth weight rates in Organisation for Economic Co-operation and Development (OECD) countries. Data from 2000 to 2015 were obtained from the OECD data base. Their relationships with demographic and economic variables, health habits, woman-related preventive measures, health care system organization and funding, health care work force and obstetric care were analysed using random-effects linear regression.ResultsLow birth weight rates are higher in Southern Europe (7.61%) and lower in Northern Europe (4.68%). Low birth weight rates escalated about 20% in Southern Europe and to less extent in Easter Europe (7%) and Asian/Oceanian countries, while remained stable in America, Central Europe and Northern Europe. Investment in health care, private health system coverage, ratios of paediatricians and obstetricians, average length of admission due to pregnancy or birth and Caesarean section rate were associated with higher low birth weight rates. Factors associated with lower low birth weight rates were health care coverage, public health system coverage, hospitals per million inhabitants, and ratios of health care workers, physicians, midwives and nurses.ConclusionsIn OECD countries, LBW rates are related to contextual country characteristics such as GDP per capita, which is inversely related to LBW rate. Health care system factors, including health care coverage or investment in public health system, are directly associated with lower LBW rates.

Highlights

Low birth weight rates are increasing in both developed and developing countries
Random-effects models were used under the assumption that trends in Low birth weight (LBW) rates have two sources of variability, one related with the year and another related with the country; they would account for the existence of between-country different trends
Investment in health care escalated from 7.2% Gross Domestic Product (GDP) to 8.9% GDP, but trends in health care coverage were inconsistent

Summary

Introduction

Several maternal factors have been identified as associated with low birth weight, little is known of economic or organization factors influencing this increase. LBW is associated with maternal factors or pathological causes and with contextual country factors. Maternal factors associated with LBW are well known They include factors such as maternal age [6,7,8], race [9], high pre-gestational maternal weight or a great weight gain during pregnancy [10,11,12], smoking and alcohol consumption during pregnancy [13, 14], gestational diabetes, type of diet, as plant-based diet [15, 16], low socio-economic status or low maternal education [2, 17,18,19]. Prematurity and intrauterine growth retardation are the most prominent ones [20, 21]

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