Predictors Of Low Birth Weight Research Articles

Effects of Antenatal Depression and Antenatal Characteristics of Pregnant Women on Birth Outcomes: A Prospective Cohort Study

This study was done to evaluate the effects of antenatal depression on birth outcomes. The participants were 255 pregnant women who were followed in a prospective study. Of these, 197 cases were examined included birth weight, Apgar scores at 5 minute, premature contraction, complication of labor, delivery types and laboratory data. Descriptive statistics, ANOVA, Chi square test of linear by linear association, Kruskal Wallis test, Relative Risk, univariate and adjusted multiple logistic regression were used for data analysis with SPSS/Win. Level of antenatal depression was associated with low birth weight (χ²=7.69, p=.010). High risk pregnancy was a predictor of low birth weight (OR=6.98 [1.21-40.30]) and baby's weight (OR=2.12, [1.05-4.28]). Prepregnancy body mass index (BMI) was a predictor of complications in labor (OR=3.59, [1.03-12.48]). But there were no significant effects of antenatal depression on other birth outcomes. The results of this study indicate that women with antenatal depression, high risk pregnancy, prepregnancy BMI≥23 kg/M² should be monitored and managed to ensure favorable birth outcomes.

Predictability of offspring birth weight using simple parental anthropometrics in a government hospital in Lagos, Nigeria

Background : Birth weight is of interest to quantitative geneticists and to obstetricians being one of the most important complex traits that determine perinatal outcome. Moreover, It is a predictor of mother’s and baby’s health later in life. Accuracy of prediction of baby’s birth weight is therefore central to perinatal success and the quality of life of the baby in adulthood. Current intrauterine procedures including ultrasonography are of inadequate predictive values. The possibility of combining parental anthropometric data with already existing predictive methods such as ultrasonography may increase accuracy of birth weight prediction for better peri- and postnatal management of low or high birth weight. Aim : The aim is to determine the parental anthropometric predictors of baby’s birth weight in Lagos, Nigeria. Using parental explanatory variables to predict baby’s weight could complement the already existing predictive methods such as ultrasonography for more accurate prediction of birth weight. Methods and Materials : Parental parameters such as weight, height, BMI and other anthropometric attributes were obtained from 250 couples. Baby’s birth weight was taken immediately after birth. Results : Only three parental factors were needed to substantially predict offspring birth weight. These include mid-paternal weight which was the most explanatory variable, followed by parity, and then maternal weight. Conclusion : Complementing ultrasonographic and other data with information from parental variables, especially mid-paternal weight, parity and maternal weight might improve accuracy of prediction of low birth weight or macrosomic babies and therefore a reduction in perinatal failure. Keywords : Birth weight, anthropometrics, macrosomia, predictability, Nigeria

Is There a Role for Isofurans and Neuroprostanes in Pre-Eclampsia and Normal Pregnancy?

Pre-eclampsia is a complex disorder of pregnancy that adversely affects the mother and baby. Arachidonic acid and docosahexaenoic acid are essential for fetal development and can undergo free radical oxidation to F(2)-isoprostanes (F(2)-IsoPs) and isofurans (IsoFs); and F(4)-neuroprostanes (F(4)-NeuroPs), respectively. These metabolites may be relevant to pre-eclampsia and fetal development. We examined IsoFs, F(4)-NeuroPs, and F(2)-IsoPs in maternal plasma and cord blood plasma of 23 women with pre-eclampsia and 21 normal pregnancies. Women with pre-eclampsia had significantly elevated maternal IsoFs and F(4)-NeuroPs, but not F(2)-IsoPs. Cord blood F(4)-NeuroPs were elevated among neonates of women with pre-eclampsia. In women with pre-eclampsia, birth weight was predicted by gestation at delivery. The latter was also true in normal pregnancy, but birth weight was negatively related to maternal F(2)-IsoPs, IsoFs, and F(4)-NeuroPs. We have shown that in women with pre-eclampsia, IsoFs and F(4)-NeuroPs are elevated, and cord blood F(4)-NeuroPs are increased. The inverse relationship between maternal F(2)-IsoPs, IsoFs, and F(4)-NeuroPs and birth weight may be relevant as predictors of low birth weight in normal pregnancy. Future studies should examine whether these markers in maternal blood at early stages of pregnancy relate to subsequent maternal, fetal, and neonatal complications.

Designing Colour-coded Measuring Tapes based on Mid-arm and Chest Circumference to Predict Low Birth weight in the Field

In developing countries, 80% of the births take place in the community. Birthweight, mid-arm and chest circumferences were measured in 294 newborns admitted in a tertiary-level hospital in Kolkata between April and August 2010. Colour-coded measuring tapes were devised using receiver operating characteristic curves to calculate the most sensitive and specific cut-off values to identify birthweight <2.5 and 1.8 kg. There is no significant difference in accuracy of Mid-arm circumference (MAC) and Chest circumference (CC) for prediction of low birth weight and birthweight <1.8 kg. The tape has three zones, green [weight (wt) > 2.5 kg, MAC > 8.4 cm, CC > 30 cm], yellow (wt 2.5-1.8 kg, MAC 8.4-6.7 cm, CC 30-25.5 cm) indicating some risk, and red (wt < 1.8 kg, MAC < 6.7 cm, CC < 25.5 cm) indicating babies needing referral and admission in Level II neonatal care unit.

Anthropometric measurements at birth as predictor of low birth weight

In developing countries, low birth weight (BW < 2500 grams) accounts for 60% - 80% of neonatal deaths. Early identification and referral of LBW babies for extra essential newborn care is vital in preventing neonatal deaths. Studies carried out in different populations have suggested that the use of newborn anthropometric surrogates of birth weight may be a simple and reliable method to identify LBW babies. previous studies reported correlation between birth weight to several anthropometric measurements and their predictive value. We aimed to evaluate the correlation between birth length, head, chest, and mid arm circumferences to birth weight. Methods: A cross sectional study has been conducted in SHARIATI Hospital in Tehran, from September 2008 to February 2009. All Consecutive full-term. Single ton, live born babies were included and anthropometric measurements carried out within 48 hours after birth by authors. Birth weight was measured by digital scale within the first 24 hours after delivery. Birth length by somatometer and head, chest, mid arm circumferences were measured 2 times by using plastic measuring tape. Result: Out of 500 newborn studied. 52.2% were male and 47.8% were female. The mean birth weight was 3195.4 ± 399.9 gram and 3.8% of newborns were low birth weight. It was evident a positive correlation of birth weight to all such anthropometric measurements with the highest correlation coefficient for chest circumference (r: 0.74). By ROC- AUC analyses, chest circumference (AUC = 0.91, 95% CI 0.84 to 0.97) and arm circumference (AUC = 0.87, 95% CI 0.79 to 0.95) were identified as the optimal surrogate indicators of LBW babies. The optimal cut-points for chest circumference and arm circumference to identify LBW newborns were ≥31.2 cm and ≥10.2 cm respectively. Conclusions: Chest and mid arm circumferences were the best anthropometric surrogates of LBW among studied Iranian population. Further studies are needed in the field to cross-validate our results. anthropometric values are simple, practicable, quick and reliable indicator for predicting LBW newborns in the community and can be easily measured by paramedical workers in developing nation.

Maternal Anthropometry as a Predictor of Birth Weight

Maternal nutritional status is closely associated with birth weight of the newborn and perinatal morbidity and mortality. The usefulness of maternal anthropometric parameters i.e. maternal weight (WT), maternal height (HT) and maternal body mass index (BMI) as predictors of low birth weight (LBW) was studied in 563 full term babies selected from 2056 singleton live births. The sample included normotensive adult pregnant women who had their first visit to the clinics ≤13 weeks of gestation. Most of the pregnant mothers (80%) were between 20 and 34 years of age. Over one third of the mothers were nulliparous, while 12% were multiparous (parity ≥4). The incidence of LBW was 8.7% among the studied sample. The mean WT, HT and BMI of the sample were 53 kg, 155 cm and 22 kgm-2 respectively. Significant positive correlations were observed with birth weight (BW) and WT (r=0.27), BW and BMI (r=0.24) and BW and HT (r=0.11). Polynomial regression analysis predicted LBW significantly with the critical limits of WT, HT and BMI at 50.3 kg, 154 cm and 21.1 kgm^-2, with the sensitivity of 54%, 45% and 60% respectively. Logistic regression analysis showed the risk ratio (RR) for critical limits. Mothers with low WT (&lt;50.3 kg), HT (&lt;154 cm) and BMI (&lt;21.1 kgm^-2) showed 1.5, 1.4 and 1.8 fold LBW respectively than mothers having values above the cut-off. At the highest sensitivity of 80% WT, HT and BMI have a RR of 1.8, 0.9 and 2.1 respectively but only the BMI reached a significant level. The best predictor of birth weight with 80% sensitivity was BMI of 23.7 kgm^-2 at or below 13 weeks of gestation. <br /><br /> DOI: <a href="http://dx.doi.org/10.4038/tar.v21i1.2590">http://dx.doi.org/10.4038/tar.v21i1.2590</a> <br /><em>Tropical Agricultural Research</em> Vol. 21(1): 89-98 (2009)

Maternal smoking during pregnancy and socioeconomic factors as predictors of low birth weight in term pregnancies in Nis

Low birth weight (LBW) is a result of preterm birth or intrauterine growth retardation, and in both cases is the strongest single factor associated with perinatal and neonatal mortality. It is considered that socioeconomic factors, as well as mothers bad habits, play the most significant role in the development of LBW, which explains notable number of researches focused on this particular problem. The aim of this study was to characterize socioeconomic factors, as well as smoking habits of the mothers, and their connection with LBW. The questionnaire was carried out among mothers of 2 years old children (n = 956), born after 37 gestational weeks. The characteristics of mothers who had children with LBW, defined as < 2,500 g, (n = 50), were matched with the characteristices of mothers who had children > or = 2,500 g, (n = 906). For defining risk factors, and protective factors as well, we used univariant and multivariant logistic modeles. As significant risk factors for LBW in an univariant model we had education level of the mothers, smoking during pregnancy, smoking before pregnancy, the number of daily cigarettes, the number of cigarettes used during pregnancy, paternal earnings and socioeconomic factors. In a multivariant model the most significant factors were socioeconomic factors, education level of the mothers, paternal earnings and mothers smoking during pregnancy. Smoking during pregnancy and socioeconomic factors have great influence on LBW. Future studies should be carried out in different social groups, with the intention to define their influence on LBW and reproduction, as well. This should be the proper way of adequate health breeding planning for giving up smoking, the prevention of bad habits and melioration of mothers and children health, as the most vulnerable population.

Maternal Social Support and Neighborhood Income Inequality as Predictors of Low Birth Weight and Preterm Birth Outcome Disparities: Analysis of South Carolina Pregnancy Risk Assessment and Monitoring System Survey, 2000–2003

Effects of income inequality on health and other social systems have been a subject of considerable debate, but only a few studies have used multilevel models to evaluate these relationships. The main objectives of the study were to (1) Evaluate the relationships among neighborhood income inequality, social support and birth outcomes (low birth weight, and preterm delivery) and (2) Assess variations in racial disparities in birth outcomes across neighborhood contexts of income distribution and maternal social support. We evaluated these relationships by using South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS) survey for 2000-2003 geocoded to 2000 US Census data for South Carolina. Multilevel analysis was used to simultaneously evaluate the association between income inequality (measured as Gini), maternal social relationships and birth outcomes (low birth weight and preterm delivery). The results showed residence in neighborhoods with medium levels of income inequality was independently associated with low birth weight (OR: 2.00; 95% CI 1.14-3.26), but not preterm birth; low social support was an independent risk for low birth weight or preterm births. The evidence suggests that non-Hispanic black mothers were at increased risks of low birth weight or preterm birth primarily due to greater exposures of neighborhood deprivations associated with low income and reduced social support and modified by unequal income distribution.

The performance of various anthropometric assessment methods for predicting low birth weight in pregnant women

OBJECTIVES: to assess the performance of various anthropometric methods for the evaulation of the nutritional status of pregnant women as a means of predicting low birth weight (LBW). METHODS: a descriptive cross-cutting study carried out among 433 pregnant women (&gt;20 years) attending a Public Maternity Hospital in Rio de Janeiro, Brazil. The adequacy of the weight gain at the end of the pregnancy was evaluated in accordance with the proposals of the Institute of Medicine and the Brazilian Ministry of Health. The sensitivity, specificity and accuracy of the adequacy of weight gain at the end of the pregnancy or nutritional state of mother as a predictor of low birth weight were calculated. RESULTS: the sensitivity of the various methods varied from 63.1% to 68.4% and the specificity from 71.2% to 75.1%. The adapted Institute of Medicine proposal drawn up by the Brazilian Ministry of Health, according to the classification of the pre-delivery nutritional status of the mother according to the World Health Organization cutoff points showed itself to be the most accurate (74.5%), this being the most adequate method for nutritional triage for reason of its association with low birth weight (OR=4.10; 95%CI=1.53-10.92). CONCLUSIONS: the best proposals for this population are those of the Institute of Medicine and the Brazilian Ministry of Health. Further studies aiming to ascertain the most appropriate methods of anthropometric evaluation for different populations should be encouraged.

The predictive value of 18 and 22 week uterine artery Doppler in patients with low first trimester maternal serum PAPP‐A

To determine if the addition of uterine artery (UA) Doppler pulsatility index (PI) at 18 and 22 weeks of gestation improves the predictive accuracy of low first trimester pregnancy associated plasma protein A (PAPP-A) in the detection of adverse obstetrical outcomes. This was a prospective interventional study. All women undergoing first trimester combined screening (FTS) at a single center, with a low maternal serum PAPP-A level (<0.4 MoM), were included. Patients underwent bilateral UA Doppler assessments at 18 and 22 weeks of gestation. A positive test was defined as a mean PI > 1.45. Primary outcomes were obtained from chart review, and logistic regression analysis was used to compare outcomes with positive and negative tests. Positive and negative predictive value, specificity and sensitivity were calculated. Between January and October 2007, 5359 women completed FTS. Among the low PAPP-A group (n = 289), 18 week UA Doppler was a significant predictor of low birth weight (OR = 2.28, p = 0.04) while 22 week UA Doppler significantly predicted preterm birth (OR = 12.6, p = 0.001), small for gestational age (OR = 8.24, p = 0.001) and low birth weight (OR = 2.28, p = 0.04). Test characteristics suggested improved positive and negative predictive value for Doppler at 22 versus 18 weeks for these outcomes. UA Doppler at 22 weeks is a useful adjunct in patients with low PAPP-A. However, a negative Doppler does not rule out all adverse outcomes and clinical judgment is advised in the management of these patients.

The investigation of missing paternal information in birth certificates and low birth weight

Objective. To determine if missing paternal information in birth certificates is associated with an increased risk of low birth weight (LBW).Methods. This was a retrospective single cohort analysis including all live births at our institution between April 1999 and May 2002. We created two study groups, one with father's information complete (FIC) and one with father's information missing (FIM). We utilised a three-tier approach (univariate analysis, multivariate analysis and propensity matching) to determine if FIM was related to LBW.Results. Univariate analysis showed a significant difference in LBW rates between the FIM and FIC groups (14.6 vs. 9.1%, p < 0.001). However, this difference was not observed in the multivariate (odds ratio = 1, p = 0.858, ns) or propensity matching analysis (13.9 vs. 13.8%, p = 0.954, ns).Conclusion. After controlling for LBW risk factors, FIM was not an independent predictor of LBW.

First‐trimester combined screening for Down syndrome: prediction of low birth weight, small for gestational age and pre‐term delivery in a cohort of non‐selected women

To establish the relationship between the first-trimester screening markers [pregnancy-associated plasma protein A (PAPP-A), free human chorionic gonadotrophin-beta (beta-hCG), nuchal translucency (NT)], the Down syndrome (DS) risk estimate, and the adverse outcomes such as low birth weight, small for gestational age (SGA) and pre-term delivery. A retrospective cohort study including 1,734 non-selected singleton pregnancies consecutively enrolled into the programme of first-trimester combined screening for DS in a 12-month period at a single centre. Data from the Prenatal Patient Registry in ASTRAIA were combined with the Danish National Newborn Screening Registry and Danish Birth Registry. There was a significant relation between low PAPP-A MoM, low beta-hCG MoM, increased risk estimate for DS and low birth weight and SGA. Low PAPP-A MoM and increased NT showed a significant relation to pre-term and spontaneous pre-term delivery. Low PAPP-A MoM showed a significant relation to early pre-term delivery. First-trimester screening markers exhibited a significant relation to low birth weight, SGA and to some extent, to pre-term and early pre-term delivery. The screening performance of individual markers was poor.

Maternal anthropometry as a predictor of birth weight

To determine whether maternal anthropometry predicted birth weight, and if so, to identify which cut-offs provided the best prediction of low birth weight (LBW) in a field situation. Community-based longitudinal study. A rural union of Bhaluka Upazila, Mymensingh, located 110 km north-west of Dhaka, the capital of Bangladesh. A total of 1104 normotensive, non-smoking pregnant women who attended community nutrition centres were studied from first presentation at the centre until delivery of their child. Most of the pregnant mothers were between 20 and 34 years of age. Over one-third of the women were nulliparous, while 12.8% were multiparous (parity >/= 4). Most (93%) mothers registered between the 3rd and 5th month of pregnancy. The frequency of LBW ( < 2500 g) was 17%. Polynomial regression analyses showed that the best predictors of birth weight (based on adjusted R2 values) were in general weight at registration and weight at month 9, with adjusted R2 ranging from 2.5% to nearly 20%. Sequential regression analyses with height and weight showed that there was a significant effect of height after removing the weight variables, and adjusted R2 increased in all analyses. Weight and height at registration month continued to be the best predictors of LBW. Sensitivity and specificity curves were drawn for each registration month, body mass index and different weight gain groups, and using different weight and height combinations. The results showed that, for registration month 3-5, a combination of weight ( </= 45 kg) and height ( </= 150 cm) gave the highest sensitivity, which was 50%. However, maternal weight </= 43 kg in pregnancy month 3-5 alone gave the highest sensitivity of 80%. The best predictor of birth weight as a continuous variable was maternal weight at registration, each 1 kg increase in weight at registration being associated with an increase in birth weight of about 260 g. Maternal weight </= 43 kg in pregnancy month 3-5 alone gave the highest sensitivity of 80%. A combination of initial weight and height of the mother was not as good a predictor of LBW as weight alone.

Influence of maternal and social factors as predictors of low birth weight in Italy

BackgroundThe purpose of this study is to provide insight into the determinants of low birth weight (LBW) in Italy.MethodsThe study was carried out in a non-teaching hospital in Catanzaro (Italy). All LBW and very LBW newborns (200) were included in the study and a random sample of 400 newborns weighing ≥ 2500 g was selected. Data were collected from the delivery certificates during one year. Smoking activity of mother and familiar and/or social support during pregnancy was gathered through telephone interviews.ResultsOverall annual LBW rate was 11.8%. Among LBW newborn there were 125 preterm and 75 term. Younger mothers, those who smoked during pregnancy, and had fewer prenatal care visits were more likely to deliver a LBW child; moreover, preterm newborns, delivered by caesarean section, and twin or multiple birth were significantly more likely to have a LBW. The comparison of very LBW (<1500 g) to LBW newborns showed that a very LBW was significantly more likely in newborns delivered by less educated mothers, those who work outside the home, live in smaller towns, and had less echographies; moreover, as expected, very LBW newborns were more likely to be preterm.ConclusionSeveral modifiable factors affect the risk of LBW, even when universal access to health care is freely available, but socio-economic status appears to correlate only to very LBW.

MICROSCOPIC AND SUB-MICROSCOPIC PLASMODIUM FALCIPARUM INFECTION, BUT NOT INFLAMMATION CAUSED BY INFECTION, IS ASSOCIATED WITH LOW BIRTH WEIGHT

Pregnancy-associated malaria is one of the leading causes of low birth weight in malaria endemic areas. In this study, 145 parturient women residing in areas endemic for Plasmodium falciparum in Lambaréné, Gabon, were recruited into the study after delivery, and the association of maternal P. falciparum infection, inflammatory response, and birth weight was studied. At delivery, 10% (15) of the mothers (12 were positive in both peripheral and placental blood smears, 1 was positive in peripheral blood only, and 2 were positive in placenta blood only) were positive for P. falciparum by microscopy and 23% (30) by real-time polymerase chain reaction (PCR). The level of C-reactive protein (CRP) was significantly elevated in microscopically P. falciparum-positive pregnant women (34 mg/L; 95% CI: 3-458) but not in those with sub-microscopic infections (6 mg/L; 95% CI: 1-40) compared with those free of P. falciparum infection (7 mg/L; 95% CI: 1-43). In a multivariate analysis, the presence of microscopic (adjusted OR = 28.6, 95% CI = 4.8-169.0) or sub-microscopic (adjusted OR = 13.2, 95% CI = 2.4-73.0) P. falciparum infection in pregnant women and age of mothers < 21 years (adjusted OR = 9.7 CI = 1.0-89.7), but not CRP levels, were independent predictors for low birth weight. This finding may have important operational implications and emphasizes the need for appropriate diagnostic methods in studies evaluating the outcome of pregnancy-associated malaria.

Social factors and pregnancy weight gain in relation to infant birth weight: a study in public health centers in Rasht, Iran

This study aimed to examine the relationship between total pregnancy weight gain, maternal educational level, working status and infant birth weight among mothers and infants in urban health centers in Rasht, Iran. Pregnant women from six different public health centers in urban areas were studied in a prospective design. Data on women's age, parity, level of education, working status, infant birth weight, mothers' height, and prepregnancy weight and total weight gain during pregnancy were collected. The subjects were grouped based on their prepregnancy BMI and according to Institute of Medicine (IOM) recommendation for total pregnancy weight gain. The subjects were also categorized based on their years of schooling as less, intermediately and highly educated. In this study women were considered as either housewives or employed. Public health centers in urban areas in Rasht, Iran. A total of 1914 pregnant women were studied. These data showed that pregnancy weight gain was not different between women with normal prepregnancy weight and underweight when educational levels and working status were taken into account. Besides, pregnancy weight gain was positively related to the level of education. Analysis of variance showed that infant birth weights were not similar in mothers who gain weight less, within and above recommended ranges. In all, 60% of the normal weight women and 56.7% of the underweight women had weight gain less than the lower cutoffs of IOM recommendation. Results of logistic regression analysis showed that low level of mother's education was the only predictor for low birth weight (LBW) (>12 y education OR = 0.27(0.10-0.69)) and 5-12 y education OR = 0.62 (0.2-0.94). These results showed that pregnancy weight gain lower recommended ranges are highly prevalent in Iranian women in public health centers in urban areas in Rasht. Moreover, mother's level of educational level may be considered as the most important determinant of birth weight and LBW in this population.

Trunk anthropometry of Hong Kong Chinese infants

Background Disturbed growth of the trunk may result in abnormal sternocostal relationship and a variety of pectus deformities. Aims The purposes of this study were to establish norms of trunk anthropometry for dysmorphology identification in the newborns and to evaluate chest circumference as a predictor for low birth weight for outborn infants where weighing scales were unavailable. Study design and subjects A total of 10,339 Chinese infants (5478 males, 4861 females) with gestation 24–42 weeks from 12 hospitals were included. The anthropometric measurements analyzed included chest circumference, inter-nipple distance, sternal length and abdominal circumference. Outcome measures The LMS method using maximum penalized likelihood was used to perform model fitting of the anthropometric centiles for these physical parameters. Results References tables of the four physical parameters for newborns were constructed. Chest circumference showed the highest correlation with birth weight (male: r = 0.866, female: r = 0.883). The cut-off points for chest circumference of 295 (male) and 299 mm (female) were the best predictor for low birth weight. There were also racial differences in these parameters. When compared with French infants, Chinese newborns had smaller chest circumference. Conclusion These physical parameters provide useful references and aid dysmorphology diagnosis in newborns of ethnic Chinese origin.

Maternal Anthropometry as Predictors of Low Birth Weight

The usefulness of maternal anthropometric parameters i.e. maternal weight (MWt), maternal height (MHt), maternal mid-arm circumference (MMAC) and maternal body mass index (MBMI) as predictors of low birth weight (LBW) was studied in 395 singleton pregnancies. The maternal anthropometric parameters were measured in the first trimester of pregnancy and were plotted against the birth weight of the newborns. Significant positive correlations were observed among MWt and birth weight (r=0.38), MHt and birth weight (r=0.25), MMAC and birth weight (r=0.30) and MBMI and birth weight (r=0.30). The most sensitive being MWt (t=7.796), followed by MMAC (t=5.759), MHt (t=4.706) and MBMI (t=5.89). For prediction of LBW, the critical limits of MWt, MHt, MMAC and MBMI were 45 kg, 152 cm, 22.5 cm, 20 kg/m2 respectively. From these observations, the use of colour-coded weighing machines, height rods and tapes may be devised for use by peripheral health workers and traditional birth attendants for detection of mothers at risk of delivering low birth weight babies (Table 5). Mothers who have anthropometric parameters in the 'red zone' are at risk of delivery LBW infants.

Fecundity and pregnancy outcome in a cohort with sickle cell‐haemoglobin C disease followed from birth

To compare pregnancy outcome in sickle cell-haemoglobin C (SC) disease with that in homozygous sickle cell (SS) disease and age-matched controls with a normal haemoglobin (AA) genotype. A cohort study followed from birth. Sickle Cell Clinic, University Hospital and other Jamaican hospitals. Ninety-five pregnancies in 43 patients with SC disease, 94 pregnancies in 52 patients with SS disease and 157 pregnancies in 68 controls. Systematic review of all pregnancies occurring in sample population. Kaplan-Meier analysis for interval to first pregnancy, and the t test, chi2 test or Fisher's exact test as appropriate; correction was made for multiple testing and multiple linear regression was used for analysis of determinants of birthweight. Age at menarche, interval to first pregnancy, outcome of pregnancy, maternal complications and possible predictors of low birthweight. Menarche was marginally delayed in SC disease compared with AA controls (median age 13.7 vs 13.0 years, P= 0.02) but age at first pregnancy was similar (median age 22.5 vs 20.1 years, P= 0.32). Pregnancy outcome in SC disease did not differ from AA controls but compared with SS disease there were marginally fewer miscarriages, more live deliveries and greater birthweight. The prevalence of pregnancy-induced hypertension, pre-eclampsia, antepartum or postpartum haemorrhage in SC disease did not differ from AA controls but the prevalence of sickle-related complications was similar to SS disease. Contrary to some claims, pregnancy outcome in SC disease is generally benign compared with SS disease.

Assessment of Risk Factors for Low Birth Weight Deliveries

Recognition of a higher than average incidence of low birth weight (LBW) deliveries in areas of Eastern Pennsylvania led to an analysis of more than 5,500 deliveries in one of the region's hospital systems to investigate the predictors of LBW in that population. Results of multivariate analysis indicate key variables that contribute to LBW: in particular, racial/ethnic background and specific medical problems during pregnancy, including preeclampsia, incompetent cervix, bleeding, low BMI and lack of adequate weight gain. Results were incorporated into training in best practices for prenatal care in the city's prenatal clinics.