Prevalence and determinants of low birth weight and prematurity among rural, urban, and indigenous tribal communities in India.

Abstract

Background: Birth weight and gestational age are important determinants of child survival and development. Developing countries like India have been recording very high prevalence (30-40%) of low birth weight (LBW) and a relatively low prevalence of prematurity (~10%). Aim: Examine the role of multiple environmental factors on neonatal outcomes in India. Methods: Utilizing a population-based, 6884 mother-baby cohort spread across rural, tribal, and urban areas of Odisha, we have recently launched the IMMENSE (Impact of Maternal Environmental and Socio Economic - status on child health and development) study where data are being collected on maternal variables and on type of household cooking fuel, direct smoke and ETS, drinking water, alcohol use, and exposure to occupational/industrial/ and mining and pesticides and fertilizers, New births are also being added to this cohort. Results: Average gestational age in this population was 32 weeks and birth weight was 2.53 kg. A total of 28% babies were premature; 13.3% ? 35 weeks, and an additional 14.8% between 36-40 weeks of gestation. The decrements in birth weight were attenuated using multivariate analyses after adjusting the maternal and socioeconomic factors. The environmental factors significantly associated with LBW were biomass fuel/household air pollution (OR-2.51), drinking water (OR-2.34), proximity to industry/highway (OR-1.98), domestic/agricultural pesticide use (OR-1.91), smoking/ETS (OR-1.85), and alcohol use (OR-1.39). Although small in number, newborns in households using liquid petroleum gas did not seem to have better outcomes. Conclusions: This study demonstrates an unexpected shift from low birth weight preponderance to an increase in prematurity in India (similar to the western countries). While improved maternal health over the decades might have contributed to reduction in LBW, new and significant environmental pollution may be contributing to preterm births. The IMMENSE study was funded by a grant from the University of Nebraska Foundation.