Perinatal outcomes in a South Asian setting with high rates of low birth weight.

Kuryan George,David S Albert,Shanthidani Minz,Jyothi Jayaraman,Jayaprakash Muliyil,Jasmin Prasad,Daisy Singh,Michael S Kramer,K S Joseph

doi:10.1186/1471-2393-9-5

Abstract

BackgroundIt is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference.MethodsPopulation-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA) live births were identified using both a recent Canadian and an older Indian fetal growth standard.ResultsThe low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and < 1% in Nova Scotia when the Indian standard was used. In Kaniyambadi, low birth weight, preterm birth and perinatal mortality rates did not decrease between 1990 and 2005. SGA rates in Kaniyambadi declined significantly when SGA was based on the Indian standard but not when it was based on the Canadian standard. Maternal mortality rates fell by 85% (95% confidence interval 57% to 95%) in Kaniyambadi between 1986–90 and 2001–05. Perinatal mortality rates were 11.7 and 2.6 per 1,000 total births and cesarean delivery rates were 6.0% and 20.9% among live births ≥ 2,500 g in Kaniyambadi and Nova Scotia, respectively.ConclusionHigh rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories.

Highlights

It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration
Births to teen mothers declined in both Kaniyambadi and in Nova Scotia, absolute rates were much higher in Kaniyambadi (Table 2)
A temporal decline was observed in Small-forgestational age (SGA) rates based on the Indian fetal growth standard but there was no significant change in low birth weight, preterm birth, SGA rates based on the Canadian standard and perinatal mortality rates between 1990 and 2005

Summary

Introduction

It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. It is not known whether the traditional focus on preventing low birth weight has been successful. Some studies [4,5] show that the high rates of low birth weight in developing countries occur because of poor fetal growth, whereas other studies suggest that preterm birth (< 37 completed weeks) rates are high as well [6,7] This is not merely an academic issue; from both an etiologic and prognostic viewpoint, low birth weight due to fetal growth restriction is very different from low birth weight due to a short pregnancy duration [8]. The distinction has important implications for developing and testing preventive interventions

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Discussion

Conclusion