Maternal Mid-upper Arm Circumference Research Articles

Mid-arm muscle area and anthropometry predict low birth weight and poor pregnancy outcomes in Tanzanian women with HIV

BackgroundAn observational study was conducted to examine the role of maternal anthropometry, including mid-arm muscle area (MAMA) and others, as risk factors for low birth weight (LBW), small for gestational age (SGA) and preterm births in human immunodeficiency virus (HIV) infected pregnant women. HIV-positive women (N = 2369), between 12 and 32 weeks gestation were followed through delivery in Tanzania, from 2003 to 2008. Participants were women enrolled in a randomized, double-blind, placebo-controlled, clinical trial who delivered live births.MethodsBinomial regression analysis was used to evaluate the association of maternal nutritional indicators of MAMA, mid-upper arm circumference (MUAC), body mass index (BMI) and maternal weight with LBW, SGA and preterm in multivariate analysis.ResultsHigher MAMA was associated with a 32% lower risk of LBW compared to lower measurements (RR = 0.68, 95% CI = 0.50–0.94). Similar protective associations were noted for higher BMI (RR = 0.58, 95% CI = 0.42–0.79); maternal weight (RR = 0.50, 95% CI = 0.36–0.69) and MUAC (RR = 0.62, 95% CI = 0.45–0.86). Higher MAMA was also associated with lower risk of SGA (RR = 0.78, 95% CI = 0.68–0.90) and marginally associated with preterm (RR = 0.85, 95% CI = 0.69–1.04). Beneficial associations of MUAC, BMI and maternal weight with SGA and preterm were also observed.ConclusionMAMA performs comparably to MUAC, maternal weight and BMI, as a predictor of LBW and SGA in HIV-infected women. The possible role of MAMA and other indicators in screening HIV positive women at risk of adverse pregnancy outcomes should be investigated.

Maternal Body Mass Index (BMI) and Mid-Upper Arm Circumference (MUAC) in Early Pregnancy as Predictors of Low Birth Weight Infants

Low birth weight is one of the determinants of infant mortality, morbidity, and disability, which can even have an impact on the future. Several studies have suggested that the condition of low birth weight (LBW) infants is influenced by the lack of maternal nutritional status in early pregnancy. Moreover, the prevalence of malnutrition in Indonesia is still high. Therefore, this study attempted to analyze the relationship of maternal nutritional status in early pregnancy as a predictor of LBW infants. Using a cross-sectional study design, this study involved 62 pregnant patients aged 20–35 years who had antenatal visits and a term delivery at Puskesmas Kecamatan Cakung. The measurements of body mass index (BMI) and mid-upper arm circumference (MUAC) in early pregnancy are used to determine the maternal nutritional status. Pregnant women with BMI <18.5 or MUAC <23.5 cm are considered to have less nutritional status. Meanwhile, LBW infants are defined as babies with birth weight <2500 grams. This study proves that the risk of birth of LBW infants is increased in pregnant women with BMI <18.5 (underweight) (OR 5.37) and less MUAC (OR 20.4).

English

Maternal nutrition plays a major role in influencing fetal growth and birth outcomes. It is a modifiable risk factor which drags a significant public health consideration to avert adverse birth outcomes, specially, in low and middle income countries. Suboptimal dietary and nutritional characteristics and low birth weight are prevalent in the present study setting. This study was conducted to assess the association of maternal dietary and nutritional characteristics and newborn birth weight among pregnant mother who delivered in health institutions. Institution based cross sectional study was conducted among 541 pregnant mothers who delivered in Health Institutions of Jimma Town from March 1st, 2017 to April 30th, 2017. Data were entered into EPI data version 3.1 and analyzed using SPSS for windows, version 20.0; SPSS. Bivariate analysis was used to assess the association between birth weight and list of independent variables and to test significance of the association at p-value <0.25 for multivariable linear regression. Multivariable linear regression model was used to recognize the important predictors by controlling for possible confounding variables and statistical significance was measured at p-value <0.05. Majority of newborns had normal birth weight (91.0%). The mean birth weight of the newborns was 3224.6 ± 438.5 grams while low birth weight was 2%. In Multivariable linear regression analyses, birth weight was found to have increased by 13.5 grams (β=13.5, P=0.04), for every centimeter increment in maternal mid-upper arm circumference (MUAC). Similarly, with each increase in parity of the mother an increase in birth weight increased by 96.81 grams (β=96.81, P=0.01) was observed. Wealth index was also found to have a positive association with birth weight (β=49.04, P=0.01). Maternal MUAC, parity and wealth index were found to have a positive association with birth weight. Intervention directed on nutrition of pregnant mothers through nutrition counseling should be the major priority in addition to economic measure. Key words: Newborn birth weight, nutritional characteristics, mid-upper arm circumference.

Risk factors associated with poor health outcomes for children under the age of 5 with moderate acute malnutrition in rural fagita lekoma district, Awi Zone, Amhara, Ethiopia, 2016

BackgroundLeft untreated, moderate acute malnutrition (MAM) in children can lead to severe acute malnutrition, stunting, developmental delays, and death. Despite recent progress the prevalence of malnutrition remains high throughout Ethiopia. The ability to make accurate prognoses and develop effective treatment strategies for children with MAM is currently limited and, as result, a significant proportion of children with MAM fail to recover even with treatment. We seek to address this limitation by assessing the risk factors for poor outcomes among children under the age of 5 with MAM in a rural area of Ethiopia’s Amhara Region. This region is considered relatively food secure and does not have food supplementation treatment programs.MethodsWe conducted a prospective cohort study of 404 randomly sampled children, 0–59 months old stratified by household food security status. We followed the study children for approximately 2 months, assessing their health status; and used bivariate and multivariate Cox-proportional hazard regression models to identify risk factors for poor health outcomes.ResultsHousehold food security was significantly associated with low recovery from MAM: 191 (60%) of children in food-insecure and 129 (40%) of children in food-secure households had poor health outcomes. The risk factors found to be significantly associated with poor health outcomes included the duration of exclusive breastfeeding (AHR 1.50, 95%CI: 1.05, 2.15), dietary diversity (AHR 1.74, 95%CI: 1.18, 2.54), and maternal mid-upper arm circumference (AHR=1.36, 95% CI: 1.04, 1.86). Children from pregnancies that were wanted but unplanned had 80% higher incidence of poor health outcomes than others, and children from pregnancies that were both unwanted and unplanned had more than double the incidence of poor health outcomes compared to their counterparts.ConclusionWe found that without treatment, the majority of children from food insecure households and over a third of children from food secure households did not recover from MAM. Maternal factors particularly the mother’s ability to plan her pregnancy were the main determinants of recovery in this study. Together these findings support arguments for targeting of nutrition support programs to vulnerable households regardless of regional food security status, and for closely integrating robust family planning, and antenatal care services with nutrition interventions.

Correlation between maternal mid upper arm circumference and neonatal anthropometry

Introduction: An infant’s birth weight has been identified as the best marker of optimal fetal growth and development. Maternal anthropometry (weight, height and Mid-Upper Arm Circumference) have been identified to influence an infant’s birth weight and length. If MUAC can be established as a surrogate marker for neonatal anthropometric parameters it will help to plan the timely intervention for improvement of health of pregnant female. Aim: To study the correlation between maternal mid upper arm circumference and neonatal anthropometry. Material and Methods: A cross sectional study conducted in Dr. B R Ambedkar Memorial Hospital & Pt. JNM Medical college Raipur, Chhattisgarh since January 2015 to September 2016. Sample size was 232. Materials like weighing machine, measuring tape, Infantometer, were used. Data was expressed as percentage and correlation was established using Spearman's chi square test (p<0.05). Data was analyzed using SSPS (version 16.0). Result: Significant correlation exists between maternal MUAC and birth Weight and length of neonates. Low birth weight is higher in female neonates. Birth length is higher in male neonates. MUAC of mother is a good predictor of risk of low birth weight as compared with other classic anthropometric measurements. Conclusion: Maternal MUAC is a significant predictor of neonatal anthropometry and can be used instead of pre- pregnancy weight to assess maternal nutritional status especially in resource poor setting.

A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response

There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries. We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods (RUSFs) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau. A 3-month cluster-randomized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants (6-23 months) and children (24-59 months) from 13 villages. The RUSFs contained either 478 (mothers, children) or 239 kcal/d (infants) with 15% or 33% of protein from dairy and were distributed at community health centers 5 d/wk. Controls were wait-listed to receive RUSF. Primary outcomes were mid-upper arm circumference (MUAC) in mothers, and weight-for-age and height-for-age z-scores (WAZ and HAZ) in infants and children. There was a significant effect of the RUSF-33% on MUAC in mothers ( P = .03). The WAZ and HAZ increased substantially, by ≈1 z-score, in infants and children ( P < .01) independent of group randomization. In children, but not infants, baseline WAZ and change in maternal MUAC were associated with change in WAZ (β = .07, P = .02). Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers, supporting a comparable recent finding in preschool children. In addition, supplementation of children <2 years resulted in improved growth independent of family nutritional status, whereas success in older children was associated with change in maternal nutrition, suggesting the need for community-level education about preventing malnutrition in older, as well as younger, children.

Low Birth Weight is More Common in Food Insecure Pregnant Malawian Women with Moderate Malnutrition

AimTo determine if food insecurity for pregnant women with moderate malnutrition (MAM) affects gestational weight gain, infant weight and length.MethodsThis randomized controlled trial enrolled 1872 pregnant women with MAM, defined as mid‐upper arm circumference (MUAC) between 20.6 and 23.0 cm. Women aged 16 to 45 years enrolled at approximately 24 weeks gestation. Household Food Insecurity Access Scale (HFIAS) survey was obtained at enrollment. Women returned every two weeks for measurements and received supplemental foods; each provided ~900 kcals, 35 g protein, and ~2 times the recommended dietary allowance for micronutrients daily. HFIAS score was determined by adding each subject's responses to 9 questions with numerical values (0 = no, 1 = rarely, 2 = sometimes, 3 = often); sum of scores range from 0 to 27. The subjects were categorized by their severity of food insecurity (secure, mild, moderate, or severe) according to Food and Nutrition Technical Assistance (FANTA III) guidelines. Maternal anthropometric measurements (weight, height, MUAC) were taken at enrollment, during follow‐up, and at delivery; hemoglobin was measured at enrollment. Infant measurements (head circumference, length, weight, MUAC) were taken at birth, 6 weeks, and 3 months; z‐scores were calculated to determine low birth weight (LBW) and stunting. Maternal and infant measurements were compared independently against HFIAS categories and questions.ResultsMean sum of HFIAS scores was 10.0 ± 0.05. Most mothers (1318 or 70.4%) were severely food insecure [95 (5.1%) food secure, 81 (4.3%) mildly and 377 (20.2%) moderately food insecure]. Gestational weight gain before delivery, low weekly maternal weight gain, BMI and MUAC were not different by HFIAS category. There was a trend towards less anemia in the most food insecure group (78.5%, 75.3%, 75.1%, 69.8% in secure, mild, moderate and severe, respectively; p = 0.07). LBW was more common in the severely food insecure group (27.0%, 20.9%, 22.7%, 30.4% in secure, mild, moderate, and severe; p=0.0289); there was a trend toward worse birth stunting in the secure group (28.6%, 25.0%, 18.6%, 25.6% in secure, mild, moderate, and severe; p=0.07). Birth length was slightly different amongst groups (46.9 cm, 47.1 cm, 47.4 cm, and 46.9 cm in secure, mild, moderate, and severe; p=0.047). There was no difference between HFIAS category and infant birth MUAC, weight, or head circumference. Infant measures at 6 weeks were no different by HFIAS category, however, infant weight at 3 months was lowest in the severely food insecure families (5.52 kg, 5.60 kg, 5.64 kg, 5.49 kg in secure, mild, moderate, and severe, respectively; p=0.043).ConclusionThe majority of pregnant women with MAM were severely food insecure. Maternal anthropometric measures were not significantly different by HFIAS group. Although all mothers received food and micronutrient supplements during part of pregnancy, low birth weight infants were more common from severely food insecure mothers. The impact of food insecurity during pregnancy continued to impact infant weight at three months.Support or Funding InformationUSAID (FHI360), USAID Feed the Future (Peanut and Micotoxin Innovation Lab), Cal Poly San Luis Obispo Agriculture Research Initiative, US Dairy Export Council, Dairy Research Initiative

Biopsychosocial and Economic Determinants of Low Birth Weight in Jambi, South Sumatera: Path Analysis

Background : Low birth weight (LBW) is one of the main risk factors of neonatal mortality and morbidity. It is an important public health issue particularly in developing countries. Worldwide, LBW shares around 15-20% of birth outcome. In Indonesia, LBW shares about 10.2% of birth outcome. In theory, the risk factors of LBW include not only biological aspect but also psychosocial and economic aspects. This study sought to estimate the biopsychosocial and economic determinants of LBW in Jambi, South Sumatera, using path analysis approach. Sub jects and Met hod: This was an analytic observational study with case-control design. The study was carried out at 20 community health centers in Jambi, South Sumatera, from December 2017 to January 2018. A total sample of 200 newborn infants consisting of 50 LBW and 150 normal birth weight newborn infants were selected for this study by fixed disease sampling. The dependent variable was birth weight. The independent variables were gestational age, infant sex, maternal mid-upper arm circumference (MUAC), maternal gestational stress, maternal education, family income at gestational period, and sanitation. Data on birth weight and MUAC were taken from obstetric record. The other data were collected by questionnaire. The data were analyzed by path analysis. Results: The risk of LBW directly decreased with gestational age ≥37 weeks (b= -5.06; 95% CI= -6.49 to -3.62; p<0.001), male sex (b= -0.99; 95% CI= -2.12 to -0.12; p= 0.081), low maternal stress (b= -2.35; 95% CI= 14.01 to -0.70; p= 0.005), and good sanitation (b= -1.04; 95% CI= -2.13 to -0.05; p= 0.062). Gestational age increased with family income (b= 1.74; 95% CI= 0.96 to 2.52; p<0.001). Low maternal stress was positively affected by high family income (b= 1.34; 95% CI= 0.197 to 2.50; p= 0.022). Good sanitation was positively affected by high family income (b= 0.71; 95% CI= 0.01 to 1.41; p= 0.046). High family income was positively affected by high education level (b= 1.37; 95% CI= 0.57 to 2.18; p= 0.001) Conclusion: The risk of LBW directly decreases with gestational age ≥37 weeks, male sex, low maternal stress, and good sanitation. LBW is indirectly affected by maternal education and family income. Keywords : biopsychosocial, economic, determinant, LBW Correspondence: Iga Trisnawati. Masters Program in Public Health, Uiversitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: trisnawatiiga27@gmail.com. Mobile: +6282377277992 Journal of Maternal and Child Health (2018), 3(1): 385-394 https://doi.org/10.26911/thejmch.2017.03.01.01

Analysis of Life-Course Factors Influencing Growth and Development in Children under 3 Years Old of Early Marriage Women in Kediri

Background : Children is the future pillar of our nation. As such, children need is important to be fulfilled. Physical, mental, and emotional conditions of mothers during gestation period play an important role in growth and development of children. This study aimed to determine life-course factors influencing growth and development in children under 3 years old of early marriage women. Subjects dan M et hod : This was an analytic observational study with retrospective cohort design. This study was conducted at Sukorame and Campurejo Health Center, Kediri, East Java, on March, 2017. A sample of 120 children under 3 years old were selected for this study by fixed exposure sampling. The dependent variable was child growth (weight for age) and development. The independent variables were marital age, maternal mid upper arm circumference (MUAC) during pregnancy, gestational age of birth delivery, family stimulation, maternal education, and family income. The data of child weight were measured by scales and recorded in maternal and child health book. The data of other variables were measured by a set of questionnaire. The data were analyzed by path analysis. Results : Child growth (weight for age) was affected by birthweight (b= 0.07; SE= 0.02; p< 0.001) and family income (b= 0.04; SE= 0.02; p= 0.07). Birthweight was affected by maternal education (b= 2.11; SE= 1.83; p= 0.248), gestational age of birth (b= 0.67; SE= 0.22; p= 0.002), maternal MUAC (b= 1.46; SE= 0.24; p= 0.002), and family income (b= 0.22; SE= 0.09, p= 0.012). Family income was affected by marital age (b= 0.68; SE= 0.073; p<0.001). Maternal MUAC during pregnancy was affected by marital age (b= 0.12, SE= 0.03, p<0.001). Maternal education was affected by marital age (b=0.01; SE=0.001; p= 0.002). Family stimulation was affected by family income (b= 0.75, SE= 0.26, p= 0.003). Child development was affected by marital age (b= 0.07, SE= 0.02, p= 0.001), family stimulation (b= 0.02; SE= 0.01; p<0.001), and birthweight (b<0.001; SE<0.001; p= 0.373). Conclusion : Child growth of under 3 years old (weight for age) is directly affected by birthweight and family income, and indirectly affected by some other factors. Child development is directly affected by marital age, family stimulation, and birthweight, and indirectly affected by some other factors. Keywords : life-course, growth, development, children under 3 years old Correspondence: Umianita Risca Wulandari. Masters Program in Public Heath, Sebelas Maret University, Surakarta. Email: umianita03@gmail.com. Mobile: +6285736404487. Journal of Maternal and Child Health (2017), 2(2): 137-149 https://doi.org/10.26911/thejmch.2017.02.02.05

Maternal anthropometry in relation to birth weight of newborn: A prospective hospital based study

Background: Birth weight of neonate is probably the most important factor that affects the future survival and quality of life of the neonates. Objective: To study the maternal anthropometric parameters in relation to birth weight of neonate. Methods: This observational case-control study was conducted in a tertiary care teaching hospital in central India from March 2013 to September 2014. Low birth weight (LBW) neonates (&lt;2.5 kg) and their mothers were taken as cases, and normal birth weight (NBW) neonates (?2.5 kg) and their mothers were taken as controls. Data regarding demographic profile, maternal and neonatal anthropometry, antenatal, and natal events were recorded. Results: Of total 600 subjects, 300 neonates were LBW (cases) and 300 were NBW (controls). Mean birth weight was 2.05±0.252 kg (in cases) and 2.9±0.295 kg (in control). The weight of 59.3% mothers in the case group was below 50 kg (odds ratio [OR] - 3.4) and height was &lt;150 cm (OR - 1.22). Mean maternal body mass index (BMI) in study and control group was 21.73±0.25 and 22.06±0.87, respectively (p&lt;0.0677). BMI ranged from 21.5 to 22 in 85% of NBW and 19% of LBW neonates, and from 22.1 to 22.9 in 81% of LBW and 15% of NBW babies. Mean maternal mid-upper arm circumference (MUAC) in this study and control group were 20±2.13 cm and 25.5±1.36 cm, respectively (p&lt;0.0001). Maternal MUAC was 19-23 cm in 81% of LBW babies and 23-27 cm in mothers of NBW babies (OR - 24). Conclusion: MUAC can be used as an easy cost-effective tool to identify mother at risk of delivering LBW babies so that they can be subjected appropriate care intervention at hospital and home to improve the perinatal outcome.

Effects Of Two Ready to Use Supplementary Foods (RUSF) Containing Different Levels Of Dairy Protein On Mother's Nutritional Status In Rural Guinea‐Bissau

Food insecurity and micronutrient deficiencies in Guinea‐Bissau are widespread. This Cluster Randomized Control Trial (RCT), funded by the United States Department of Agriculture, was the first such study in Guinea‐Bissau and tested the effectiveness of 2 RUSF in rural village mothers over 12 weeks.497 mothers were randomly assigned to one of two intervention arms (92g sachets containing 500 kcal/sachet and either 15% or 33% of protein from a dairy source, provided 5 days per week at a supplement distribution center in the village) or to a control group that received no supplements. Weight, height, mid upper arm circumference (MUAC), hemoglobin, and retinol‐binding protein (RBP) were measured at baseline and endline.Randomization to either of the intervention group resulted in improvements in maternal weight, height, body‐mass‐index (BMI), and MUAC. The intervention was correlated with reduction in self‐reported sick days. Mothers in the intervention groups experienced a smaller decrease in hemoglobin compared to control mothers (‐0.38±1.45 vs. ‐0.87±1.21, p&gt;0.05). Study mothers are especially vulnerable to iron deficiency due to seasonal food shortages and higher iron needs among reproductive age women. The supplement appeared to have a protective effect on iron status. &#x0D; Overall, the supplementation may be helpful in improving anthropometric status, preventing iron status decline, and reducing number of sick days in non‐pregnant mothers.

RISIKO KURANG ENERGI KRONIS (KEK) PADA IBU HAMIL DI INDONESIA

CHRONIC ENERGY DEFICIENCY AMONG PREGNANT WOMEN IN INDONESIA Maternal mid-upper arm circumference (MUAC) is a potential indicator of maternal nutritional status. It can serve as a predictor of low birth weight and other health related indicators. It is used in Indonesia to select woman of reproductive age and pregnant woman for nutrition intervention. However, there are few studies in Indonesia to examine risk factors associated with low MUAC. The objective of the study is to determine characteristics of areas, family, pregnant woman, and morbidity associated with low MUAC (&lt; 23.5 Cm), as a predictor of chronic energy deficiency. Data used for the analysis is Riskesdas (Baseline Health Research) 2007. A total of 8187 pregnant women were used for the analysis. The result showed that the prevalence of low MUAC in Indonesia was 21.6%, varied from 11.8% in Riau to 32.4% in East Nusa Tenggara. The prevalence is higher in rural than that in urban areas. The result also showed that high prevalence of low MUAC is associated with family characteristics (pregnant woman as dependent in the family, smaller and bigger household members, and poor quintiles of expenditure per capita). There was a negative association between the prevalence of low MUAC with age, education attainment, and height of mother. High prevalence of low MUAC was found for single mother, jobless, farmer, unskilled labor. There was no clear difference between low MUAC and morbidity or out-patient attendance in different type of health facilities. Keywords : pregnant woman, upper-arm circumference

A cross-sectional study of antenatal depression and associated factors in Malawi

Depression, and disabling levels of mixed depressive, anxious and somatic symptoms, termed common mental disorder, occurring in the perinatal period are an important health problem in low- and middle-income countries. In this cross-sectional study, pregnant women were recruited from a district hospital antenatal clinic in Malawi. Symptoms of depression and anxiety, and non-specific somatic symptoms commonly associated with distress, were measured using validated local versions of the Self Reporting Questionnaire (SRQ). In a sub-sample, Diagnostic Statistical Manual (DSM)-IV diagnoses of major and minor depressive disorders were made using the Structured Clinical Interview for DSM-IV. Maternal socio-demographic and health variables were measured, and associations with SRQ score and depression diagnosis were determined. Of 599 eligible women, 583 were included in the analysis. The adjusted weighted prevalence of current major depressive episode and current major or minor depressive episode were 10.7% (95% CI 6.9-14.5%) and 21.1% (95% CI 15.5-26.6%), respectively. On multivariate analysis, SRQ score was significantly associated with lower perceived social support, experience of intimate partner violence, having had a complication in a previous delivery, higher maternal mid-upper arm circumference and more years of schooling. Major depressive episode was associated with lower perceived social support and experience of intimate partner violence. This study demonstrates that antenatal depression/CMD is common in Malawi and is associated with factors that may be amenable to psychosocial interventions.

Maternal mid‐upper arm circumference (MUAC) is associated with lower birth weight among HIV‐exposed but not unexposed infants in a peri‐urban antenatal clinic in northwestern Tanzania

Women in rural and semi‐urban areas of Africa face additional healthcare access barriers affecting birth outcomes and HIV‐exposed infants have a poorer prognosis compared to unexposed infants. Our objective was to characterize associations between maternal nutritional status during pregnancy and birth outcomes of HIV+ and HIV− women enrolled in a semi‐urban antenatal clinic cohort in northwestern Tanzania. Of the 46 HIV+ and 72 HIV−women enrolled, 21 HIV+ and 36 HIV− women delivered at/returned to clinic within 48 hours and were included in the analysis. Maternal anthropometrics were assessed at 20–36 weeks gestation, and HIV+ women were receiving antiretroviral therapy by delivery. Twenty nine percent of HIV+ and 22% of HIV−women had evidence of malnutrition (MUAC &lt;25cm), but neither MUAC nor tricep skinfold (TSF) thickness differed by HIV status. HIV‐exposed neonates had lower birth weight and length compared with unexposed infants. Despite similarities in maternal anthropometrics, maternal MUAC and TSF predicted infant birth weight only in HIV‐exposed infants. Findings suggest that in HIV+ pregnant women living in rural or semi‐urban areas, maternal nutritional status based upon simple‐to‐measure anthropometry is an important determinant of infant anthropometrics among HIV‐exposed infants, and maternal MUAC identifies HIV+ women at higher risk of delivering low birth weight infants in this setting.Grant Funding Source: Cornell University Unrestricted Grant

Determinants of low birthweight, small‐for‐gestational‐age and preterm birth in Lombok, Indonesia: analyses of the birthweight cohort of the SUMMIT trial

To examine the determinants of low birthweight (LBW), small-for-gestation (SGA) and preterm births in Lombok, Indonesia, an area of high infant mortality. Data from The Supplementation with Multiple Micronutrient Intervention Trial (SUMMIT), a double-blind cluster-randomised controlled trial, were analysed. The odds ratio of factors known to be associated with LBW, SGA and preterm birth was assessed and adjusted for the cluster design of the trial using hierarchical logistic regression. Determinants included constitutional, demographic and psychosocial factors, toxic exposure, maternal nutrition and obstetric history and maternal morbidity during and prior to pregnancy. Population attributable risks of modifiable determinants were calculated. A cohort of 14,040 singleton births was available for analysis of LBW, with 13,498 observations for preterm births and 13,461 for SGA births. Determinants of LBW and SGA were similar and included infant's sex, woman's education, season at birth, mothers' residence, household wealth, maternal mid-upper arm circumference (MUAC), height and a composite variable of birth order and pregnancy interval. Socioeconomic indicators were also related to preterm births and included mother's education, residence and household wealth, while nutritional-related factors including low MUAC and birth order and interval were associated with preterm birth but not maternal height. Nausea was protective of preterm birth, while diarrhoea was associated with higher odds of preterm birth. Oedema during pregnancy was protective of SGA but associated with higher odds of preterm delivery. Around 33%, 13% and 13% of the determinants of LBW, SGA and preterm births were preventable. Women's education, maternal nutrition and household wealth and family planning are key factors to improving birth outcomes.

Wealth status, mid upper arm circumference (MUAC) and antenatal care (ANC) are determinants for low birth weight in Kersa, Ethiopia.

BackgroundLow Birth Weight (LBW) is one of the major risk factor for death in early life. However, little is known about predictors of LBW in sub-Saharan Africa. Therefore, the aim of this study was to measure the incidence and determinants of LBW in a rural population of Ethiopia.MethodsAn observational cohort study on pregnant women was conducted from December 2009 to November 2010. During the study period 1295 live birth were registered and the weights of 956 children were measured within 24 hours after birth. Socio-demographic, economic, maternal and organizational factors were considered as a predicators of LBW, defined as birth weight below 2500g. Logistic regression was used to analyze the data, odds ratio (OR) and confidence intervals (CI) are reported.ResultThe incidence of LBW was 28.3%. It is significantly associated with poverty [OR 2.1; 95% CI: 1.42, 3.05], maternal Mid Upper Arm Circumference (MUAC) less than 23 cm [OR 1.6; 95% CI: 1.19, 2.19], not attending ANC [OR 1.6; 95% CI: 1.12, 2.28], mother’s experience of physical violence during pregnancy [OR 1.7; 95% CI: 1.12, 2.48], and longer time to walk to health facility [OR 1.6; 95% CI: 1.11, 2.40].Conclusion and RecommendationThe incidence of LBW was high in Kersa. Babies born to women who were poor, undernourished, experienced physical violence during pregnancy and who had poor access to health services were more likely to be LBW in this part of the country.In this largely poor community where ANC coverage is low, to reduce the incidence of LBW, it is essential to improve access for maternal health care. The involvement of husbands and the community at large to seek collective action on LBW is essential.

Maternal mid-upper arm circumference is associated with birth weight among HIV-infected Malawians.

The authors examined the relationship of maternal anthropometry to fetal growth and birth weight among 1005 human immunodeficiency virus (HIV)-infected women in Lilongwe, Malawi, who consented to enrollment in the Breastfeeding, Antiretrovirals, and Nutrition Study (www.thebanstudy.org). Anthropometric assessments of mid-upper arm circumference (MUAC), arm muscle area (AMA), and arm fat area (AFA) were collected at the baseline visit between 12 and 30 weeks' gestation and in up to 4 follow-up prenatal visits. In longitudinal analysis, fundal height increased monotonically at an estimated rate of 0.92 cm/wk and was positively and negatively associated with AMA and AFA, respectively. These latter relationships varied over weeks of follow-up. Baseline MUAC, AMA, and AFA were positively associated with birth weight (MUAC: 31.84 g/cm(2), 95% confidence interval [CI], 22.18-41.49 [P < .01]; AMA: 6.88 g/cm(2), 95% CI, 2.51-11.26 [P < .01]; AFA: 6.97 g/cm(2), 95% CI, 3.53-10.41 [P < .01]). In addition, MUAC and AMA were both associated with decreased odds for low birth weight (LBW; <2500 g) (MUAC: odds ratio [OR] = 0.85, 95% CI, 0.77-0.94 [P < .01]; AMA: OR = 0.95, 95% CI, 0.91-0.99 [P < .05]). These findings support the use of MUAC as an efficient, cost-effective screening tool for LBW in HIV-infected women, as in HIV-uninfected women.

Associations Between Maternal Nutritional Characteristics and the Anthropometric Indices of Their Full-term and Pre-term Newborns

A retrospective descriptive study was designed to compare maternal nutritional characteristics with the anthropometric data of their full-term and pre-term newborns. 100 post-partum women and their newborns were selected from Government Hospital, Mumbai. The case records and hospital records were examined to gather information about the last known pre-pregnancy weight, gestational weight gain, placental weight, gestational age of mothers. Prenatal data with regard to maternal height, third trimester weight and hemoglobin concentration were recorded by the hospital. Postnatal data with regard to maternal mid upper arm circumference and neonatal birth weight, length, mid upper arm circumference, head circumference, chest circumference was recorded using standardized technique. The technique of three days diet recall was used to obtain the maternal third trimester dietary intake. Maternal third trimester daily nutrient intake among terms deliveries was significantly higher (with regard to energy (2254 kcal), protein (69.7 g), carbohydrate (320.3 g)) as compared to those with pre-term deliveries (energy (2048 kcal), protein (59.7 g), carbohydrate (285.4 g)) (p<0.05). Though not statistically significant, the average birth weight of ter m newborns (2849 g) was higher than pre-term newborns (2772 g) (p=0.444). Positive correlations were noted with maternal third trimester hemoglobin concentration and birth weight (r=0.587, p=0.001), length (r=0.347, p=0.044), mid upper arm circumference (r=0.387, p=0.028) and chest circumference (r=0.496, p=0.006) of pre-term newborns, after adjustments for pre-pregnancy weight, gestational age (weeks), parity. There was a significant correlation between maternal third trimester energy and carbohydrate intake with birth weight, length, head circumference, chest circumference of term babies. Maternal energy intake did not influence head circumference of pre-term. Protein intake was associated with birth weight of all deliveries. Regression analysis showed positive association between head circumference and fat intake among term delivery (r=0.357, p=0.002). In conclusion, this study showed that maternal third trimester hemoglobin concentration correlated with birth weight, length, mid upper arm circumference and chest circumference of pre-ter m newborns. This study highlights significant dietary influences on anthropometric indices among newborns. Hence nutritional status and hemoglobin concentration of the mothers was found to contribute significantly to the newborns size at birth.

Maternal Mid–Upper Arm Circumference Is Associated With Birth Weight Among HIV-Infected Malawians

Maternal Mid–Upper Arm Circumference Is Associated With Birth Weight Among HIV-Infected Malawians

Breastfeeding, HIV status and weights in South African children: a comparison of HIV-exposed and unexposed children

To examine growth of children by maternal and infant HIV status allowing for infant feeding mode. Women enrolled into a nonrandomized intervention cohort. Children of HIV-infected and uninfected women weighed and assessed for HIV status, monthly: from birth to 9 months; quarterly: 10-24 months. Daily infant feeding practices recorded at weekly intervals. Weight-for-age z-scores of children born to HIV-infected mothers compared with the reference population of children of HIV-uninfected mothers. Changes in z-scores over age were examined by HIV infection status and infant feeding practice using linear mixed effects models. The 1261 children of HIV-infected mothers grew as well as the reference group of 1061 children of HIV-uninfected mothers, irrespective of feeding mode. z-scores for HIV-infected children were consistently lower than those of HIV-exposed but uninfected children: a difference of 420 g for male children and 405 g for female children at 52 weeks of age. Breastfed HIV-infected infants had consistently higher z-scores for weight, especially during first 6 weeks (difference of 130 g for male children; 110 g for female children). In an adjusted regression analysis, maternal mid-upper arm circumference, CD4 cell count, infant birth weight and HIV status had the biggest impact on infant growth (z-score coefficient: 0.38 for mid-upper arm circumference > or =28.35 vs. <25.7 cm; P < 0.001; -0.32 for CD4 cell count <200 vs. > or =500; P = 0.001; -2.01 for birth weight <2500 vs. > or =2500 g; P < 0.001; -0.20 for infected vs. uninfected children; P < 0.001). Optimal early feeding practices ameliorate the effect of being born to an HIV-infected mother and strengthen the recommendation of exclusive breastfeeding for HIV-infected women in terms of long-term child health.