Proportion Of Low Birth Weight Infants Research Articles

Comparison of pregnancy outcomes between 4th day morula and 5th day blastocyst after embryo transfer: a retrospective cohort study

BackgroundThis study was designed to evaluate pregnancy outcomes between morulae transferred on day 4 (D4) and blastocysts transferred on day 5 (D5).MethodsFrom September 2017 to September 2020, 1963 fresh transfer cycles underwent early follicular phase extra-long protocol for assisted conception in our fertility center were divided into D4 (324 cases) and D5 (1639 cases) groups, and the general situation and other differences of patients in both groups were compared. To compare the differences in pregnancy outcomes, the D4 and D5 groups were further divided into groups A and B based on single and double embryo transfers. Furthermore, the cohort was divided into two groups: those with live births (1116 cases) and those without (847 cases), enabling a deeper evaluation of the effects of D4 or D5 transplantation on assisted reproductive outcomes.ResultsIn single embryo transfer, there was no significant difference between groups D4A and D5A (P > 0.05). In double embryo transfer, group D4B had a lower newborn birthweight and a larger proportion of low birthweight infants (P < 0.05). The preterm delivery rate, twin delivery rate, cesarean delivery rate, and percentage of low birthweight infants were lower in the D5A group than in the D5B group (P < 0.05). Analysis of factors influencing live birth outcomes further confirmed the absence of a significant difference between D4 and D5 transplantation in achieving live birth (P > 0.05).ConclusionWhen factors such as working life and hospital holidays are being considered, D4 morula transfer may be a good alternative to D5 blastocyst transfer. Given the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) success rate and risk of twin pregnancy, D4 morula transfer requires an adapted decision between single and double embryo transfer, although a single blastocyst transfer is recommended for the D5 transfer in order to decrease the twin pregnancy rate. In addition, age, endometrial thickness and other factors need to be taken into account to personalize the IVF program and optimize pregnancy outcomes.

Predictors of low birthweight and comparisons of newborn birthweights among different groups of maternal factors at Rev. John Chilembwe Hospital in Phalombe district, Malawi: A retrospective record review.

Birthweight has an impact on newborn's future health outcomes. Maternal factors, including age, delivery mode, HIV status, gestational age, parity and obstetric complications (preeclampsia or eclampsia [PE], antepartum hemorrhage [APH] and sepsis), however, have been shown as risk factors of low birthweight (LBW) elsewhere. For data-guided interventions, we aimed to identify predictors of LBW and compare newborn birthweights between different groups of maternal factors at Rev. John Chilembwe Hospital in Phalombe district, Malawi. Using a retrospective record review study design, we extracted data from maternity registers of 1244 women and their newborns from October, 2022 to March, 2023. Data were skewed. Median test was used to compare median birthweights. Chi-square or Fisher's exact tests were used to compare proportions of LBW among different groups of maternal factors. Multivariable logistic regression with stepwise, forward likelihood method was performed to identify predictors of LBW. Median birthweight was 2900.00g (interquartile range [IQR]: 2600.00g to 3200.00g). Prevalence of LBW was 16.7% (n = 208). Proportions of LBW infants were higher in women with PE, APH, including women with sepsis than controls (10 [47.6%] of 21 vs 7 [58.3%] of 12 vs 191 [15.8%] of 1211, p < .001). Lower in term and postterm than preterm (46 [5.5%] of 835 vs 2 [3.7%] of 54 vs 160 [45.1%] of 355, p < .001). The odds of LBW infants were higher in preterm than term (AOR = 13.76, 95%CI: 9.54 to 19.84, p < .001), women with PE (AOR = 3.88, 95%CI: 1.35 to 11.18, p = .012), APH, including women with sepsis (AOR = 6.25, 95%CI: 1.50 to 26.11, p = .012) than controls. Prevalence of LBW was high. Its predictors were prematurity, PE, APH and sepsis. Interventions aimed to prevent these risk factors should be prioritized to improve birthweight outcomes.

Risk Factors Influencing the Incidence of Low Birth Weight Infants at Wangaya Regional General Hospital, Denpasar City, Bali

Background. One of the main indicators of a child’s health status is the infant mortality rate. Indonesia ranks among the top 10 nations with the highest mortality rate for children under the age of 5. Every year, 72% of toddlers and infants died, and low birth weight (LBW) stands out as a significant contributing factor. The mortality rate for LBW infant is 20-35 times greater than that of infants with normal birth weight. Methods. This research uses a cross-sectional analytic observational study which was done in January 2023 at Wangaya Regional Hospital in Bali, Indonesia. Research subject were all of the newborns at Wangaya Hospital. Inclusion criteria including subject must be hospitalized in NICU, PICU, or Mother-Infant unit between September and December 2022. Sampling method used was total sampling. Bivariate analysis was done using chi squared test, and multivariate analysis was done using logistic regression test. Result. Amongst 317 samples taken, the proportion of LBW infants is 13.2%. Risk factors which lead to LBW including presence of antenatal care visit (p= 0.021), number of parities (p= 0.012), and maternal anemia (p= 0.026). It was also identified that mothers who did not undergo any antenatal care are at a higher risk of giving birth to a LBW infant (p= 0.024, OR 5.128 (95% CI 1.242 - 21.169). Conclusion. The risk of LBW can be reduced by pregnant mother doing regular antenatal care visits, taking blood supplement and foods that can increase hemoglobin level and limiting the number of pregnancies. Keywords: Low Birth Weight, Risk Factors, Antenatal Care, Anemia, Number of parities

Antenatal Care Services and Incidence of Low Birth Weight: A Comparison of Demographic and Health Surveys in 4 ASEAN Countries.

This study aimed to assess the effect of complete coverage and content of available antenatal care (ANC) on the incidence of low birth weight (LBW) in 4 countries belonging to the Association of Southeast Asian Nations (ASEAN). Measures of complete coverage and content of ANC services included the frequency of ANC visits and the seven service components (blood pressure measurement, iron supplementation, tetanus toxoid immunization, explanations of pregnancy complications, urine sample test, blood sample test, and weight measurement). The complete coverage and content of ANC services were assessed as high if more than 4 ANC visits and all seven components were delivered. Multivariable logistic regression with complex survey designs was conducted using Demographic Health Survey data from the 4 ASEAN countries in question from 2014 to 2017. The proportion of LBW infants was higher in the Philippines (13.8%) than in Indonesia (6.7%), Cambodia (6.7%), or Myanmar (7.5%). Poor ANC services were associated with a 1.30 times higher incidence of LBW than a high level of complete coverage and content of ANC services (adjusted odds ratio [aOR], 1.30; 95% confidence interval [CI], 1.11 to 1.52). In addition, the risk of LBW was higher in the Philippines than in other countries (aOR, 2.25; 95% CI, 2.01 to 2.51) after adjusting for mothers' demographic/socioeconomic factors, health behaviors, and other factors. In sum, complete coverage and content of ANC services were significantly associated with the incidence of LBW in Indonesia, Cambodia, and Myanmar. The Philippines did not show statistically significant results for this relationship, but had a higher risk of LBW with poor ANC.

A study to assess clinico-epidemiological profile and outcome of low birth weight babies admitted to neonatal intensive care unit of a tertiary care hospital

Background: Low birth weight (LBW) contributes substantially to neonatal, infant and childhood morbidity as well as mortality. Across the world neonatal mortality is 20 times more likely for low birth weight babies compared to heavier babies (&gt;2.5 kg). Proportion of LBW babies at birth in Rajasthan is 14%. The present study is proposed to explore the determinants of LBW in babies admitted at tertiary care hospital. The objective of the study was to study the clinic-epidemiological profile and outcome of LBW neonates; to study various factors associated with LBW.Methods: This study was a hospital based descriptive cross-sectional study, carried out at NICU of MBGH, R.N.T Medical College, Udaipur, Rajasthan. The study population comprised of all LBW babies delivered in medical college attached hospital and admitted in NICU, for duration of one year from September 2019 to august 2020. Total 350 babies were enrolled in study as per calculated sample size.Results: LBW was found to be associated with low maternal age, low level of mother education, maternal anemia, less BMI, stature of mothers, number of ANC visits, poor maternal weight gain during pregnancy, per-capita income, etc. Most common cause of mortality was found in LBW was septicemia and of morbidity was RDS.Conclusions: The identified risk factors in our study were modifiable and many were preventable. Maternal age, education of mothers, nutrition of mothers, anaemia status, number of ANC visits by mothers are preventable causes. Demographic profile, socio-economic status; many medical and obstetric factors are modifiable.

Differences in the birthweight of infants born to patients with early- or mid-to-late-detected gestational diabetes mellitus who underwent guideline-based glycemic control.

To examine the effects of strict glycemic control on the birthweight of infants born to Japanese patients with early- or mid-to-late-detected gestational diabetes mellitus (ed- or md-GDM). We retrospectively examined the characteristics of 101 patients with GDM who underwent guideline-based glycemic control. A 75-g oral glucose tolerance test was conducted to diagnose GDM at gestational weeks 11-15 (ed-GDM subgroup) and 24-28 (md-GDM subgroup). Infant birthweight was significantly lower in the ed-GDM subgroup (n = 25) than in the md-GDM subgroup (n = 76) (2688.3 ± 470.4 g vs. 3052.4 ± 383.1 g, p < 0.05), and the proportion of low-birthweight infants (<2500 g) was significantly higher in the ed-GDM subgroup than in the md-GDM subgroup (32.0% vs. 5.3%, p < 0.005). Fasting plasma glucose (FPG) levels during early treatment and before delivery were significantly lower in the ed-GDM subgroup than in the md-GDM subgroup (76.1 ± 10.4 mg/dL vs. 85.5 ± 9.6 mg/dL, p < 0.001; 80.5 ± 10.4 mg/dL vs. 90.4 ± 10.3 mg/dL, p < 0.0001). Patients with ed-GDM showed significantly lower FPG levels during treatment compared to those with md-GDM, presumably indicating an association with the delivery of low-birthweight infants.

Trends and Changes of Maternal Age at Live Birth and Related Statistics in Korea (1981–2019)

Objective: To investigate the changing trends of maternal age at birth in Korea over the past 40 years and related statistics to identify the aging trend. Methods: Population and birth statistics between 1981 and 2019 were obtained from the Statistics Korea. Birth data including total number of births, crude birth rate (CBR), total fertility rate (TFR), and maternal statistics including women''s first marriage age, number of women of childbearing potential, distribution of maternal age at birth, maternal age by birth order, and birth weight by maternal age were reviewed. Results: There was a decrease in the total number of births, CBR and TFR. The average age of women at first marriage increased from 23.2 to 30.6 years and the number of women of childbearing potential decreased from 17.6 million to 15.86 million. The number of advanced maternal age women increased from 3.9% to 33.4% and the number of newborns born to advanced maternal age mothers increased threefold from 33 thousands to 100 thousands. The proportion of low-birth weight infants by maternal age increased among mothers under the age of 20 and mothers of advanced maternal age. Conclusion: We found significant trends in low birth rate, decreased number of women of childbearing potential, later first marriage age and increasing maternal age over 40 years in Korea. In terms of perinatal management, this study intended to provide basic data, aiming at overcoming a rising trend in low birth rate and advanced maternal age.

Recurrence risk of preterm birth in a subsequent singleton pregnancy after a spontaneous preterm triplet delivery

ObjectiveHistory of prior preterm birth (PTB) represents one of the strongest risk factors for recurrent PTB. Nevertheless, whether the occurrence of PTB in multifetal gestation is associated with increased risk of PTB in subsequent pregnancies remains unclear. We aimed to determine the recurrence risk of PTB in a subsequent singleton pregnancy after a previous spontaneous preterm triplet delivery. Study designA retrospective matched case-control study. The study group comprised all women with spontaneous preterm trichorionic triplet delivery who had a subsequent singleton pregnancy during 2006–2017 at two university hospitals. A control group of women with spontaneous preterm dichorionic twin delivery and a subsequent singleton pregnancy, was established by matching, four-to-one, according to maternal age, parity, gestational age at delivery, and delivery year. ResultsData from 170 women were analyzed, 34 with preterm triplet delivery and 136 matched control women with preterm twin delivery. Gestational age at the subsequent singleton delivery was higher in those with preterm triplet delivery than in those with preterm twin delivery (median 39 vs 38 weeks, P = 0.02). Women with prior triplet PTB had a significantly lower rate of recurrent PTB as compared with women with prior twin PTB (5.9 % vs. 25.0 %; OR [95 % CI]: 0.19 (0.04, 0.82), P = 0.02) with lower proportions of low-birth weight infants (<2500 g) (0 % vs. 11.8 %, P = 0.04). ConclusionsThe risk of recurrent PTB following spontaneous PTB in triplet pregnancy was low compared to preterm twin delivery. These data provide reassurance for those who experienced preterm triplet delivery and suggest the need for further studies to understand the mechanisms contributing to PTB in multifetal pregnancies.

674: Recurrence risk of preterm birth in a subsequent singleton pregnancy after a preterm triplet delivery

History of prior preterm birth (PTB) represented one of the strongest risk factors for recurrent PTB. Nevertheless, whether the occurrence of PTB in multifetal gestation is associated with increased risk of PTB in subsequent pregnancies remains unclear. We aimed to determine the recurrence risk of PTB in a subsequent singleton pregnancy after a previous spontaneous preterm triplet delivery. A retrospective matched case-control study. The study group comprised all women with spontaneous preterm trichorionic triplet delivery who had a subsequent singleton pregnancy during 2006-2017 at two university hospitals. A control group of women with spontaneous preterm dichorionic twin delivery and a subsequent singleton pregnancy, was established by matching, four-to-one, according to maternal age, parity, gestational age at delivery, and delivery year. Data from 170 women were analyzed, 34 with preterm triplet delivery and 136 matched control women with preterm twin delivery. Gestational age at the subsequent singleton delivery was higher in those with preterm triplet delivery than in those with preterm twin delivery (median 39 vs 38 weeks, P=0.02). Women with prior triplet PTB had a significantly lower rate of recurrent PTB as compared with women with prior twin PTB (5.9% vs. 25.0%; OR [95% CI]: 0.19 (0.04, 0.82), P=0.02) with lower proportions of low-birth weight infants (< 2,500 grams) (0% vs. 11.8%, P=0.04). The risk of recurrent PTB following spontaneous PTB in triplet pregnancy was low compared to preterm twin delivery. These data provide reassurance for those who experienced preterm triplet delivery and suggest the need for further studies to understand the mechanisms contributing to PTB in multifetal pregnancies.

Support during pregnancy for women at increased risk of low birthweight babies.

Background Studies consistently show a relationship between social disadvantage and low birthweight. Many countries have programs offering special assistance to women thought to be at risk for giving birth to a low birthweight infant. These programs may include advice and counseling (about nutrition, rest, stress management, alcohol, and recreational drug use), tangible assistance (e.g., transportation to clinic appointments, household help), and emotional support. The programs may be delivered by multidisciplinary teams of health professionals, specially trained lay workers, or combination of lay and professional workers. Objectives The primary objective was to assess effects of programs offering additional social support compared with routine care, for pregnant women believed at high risk for giving birth to babies that are either preterm or weigh less than 2500 gm, or both, at birth. Secondary objectives were to determine whether effectiveness of support was mediated by timing of onset (early versus later in pregnancy) or type of provider (healthcare professional or lay woman). Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2010). Selection criteria Randomized trials of additional support during at-risk pregnancy by either a professional (social worker, midwife, or nurse) or specially trained lay person, compared to routine care. We defined additional support as some form of emotional support (e.g., counseling, reassurance, sympathetic listening) and information or advice or both, either in home visits or during clinic appointments, and could include tangible assistance (e.g., transportation to clinic appointments, assistance with care of other children at home). Data collection and analysis Two review authors evaluated methodological quality. We performed double data entry. Main results We included 17 trials (12,264 women). Programs offering additional social support for at-risk pregnant women were not associated with improvements in any perinatal outcomes, but there was a reduction in the likelihood of antenatal hospital admission (three trials; n = 737; RR 0.79, 95% CI 0.68 to 0.92) and caesarean birth (nine trials; n = 4522; RR 0.87, 95% CI 0.78 to 0.97). Authors' conclusions Pregnant women need the support of caring family members, friends, and health professionals. While programs which offer additional support during pregnancy are unlikely to prevent the pregnancy from resulting in a low birthweight or preterm baby, they may be helpful in reducing the likelihood of antenatal hospital admission and caesarean birth.

Socio-demographic factors associated with low birth weight in a tertiary care hospital of Odisha

Background: World Health Organization has defined low birth weight (LBW) as birth weight less than 2,500 grams. Giving birth to a LBW infant is influenced by several factors. Objective of the study was to measure the proportion of low birth weight babies delivered in V.S.S medical college and hospital, Burla and its association with socio-demographic factors.Methods: Hospital based cross -sectional study comprising of 1030 postnatal women who delivered single live baby in V.S.S Medical College and Hospital, Burla. Selection of study participants was done by systematic random sampling in the study period October 2012 to September 2014. Chi-square test was used to measure association between LBW and socio-demographic factors.Results: The proportion of LBW was found to be 27.76%. The proportion of LBW babies was high and significant in extremes of age i.e. teenage (44.19%) and 30 years and above age group (39.56%) and Muslim mothers (36.36%), illiterate mothers (53.52 %), manual labourer (67.14%), socioeconomic class IV and V (32.98%), consanguinity history (60.58%), smoky fuel (30.02%), consumption of tobacco (49.11%).Conclusions: The proportion of LBW (27.76%) was found to be higher than national average (21.5%).

Effect of individualised dietary education at medical check-ups on maternal and fetal outcomes in pregnant Japanese women.

An increased prevalence of low maternal weight and insufficient pregnancy weight gain may be responsible for an increase in low birthweight infants in Japan. We aimed to examine the effects of individualised dietary education at medical check-ups on maternal/fetal outcomes in Japanese women. Four hundred and six underweight and normal weight singleton pregnant women, who attended check-ups at an obstetric facility until ≥30 weeks gestation and delivered at 36-41 weeks gestation, were selected for analyses. Weight gain was assessed at each check-up based on the official "Dietary Guidelines for Pregnant and Lactating Women". Individual dietary advice was provided by dieticians to those with insufficient or excess weight gain status around 28 weeks gestation. The medical records from uncomplicated singleton deliveries (36-41 weeks gestation) at the same facility from 2008-2010 were used (n=792) to examine the effect of dietary education on maternal/fetal outcomes. Pre-pregnancy underweight was present in >24% of women in both the intervention and non-intervention groups. Adequate weight gain occurred more frequently in the intervention group (p<0.01). There were no significant differences in mean birthweight or the proportion of low birthweight infants. However, the proportion of extremely small for gestational age infants (birthweight <3rd percentile) was lower in the intervention group (p=0.011). There were no differences in the frequency of caesarean delivery, pregnancy induced hypertension, or infant Apgar scores <7. Dietary education during pregnancy check-ups promotes adequate maternal weight gain and helps prevent extreme fetal growth restraint.

Pre-pregnancy body mass index as a predictor of low birth weight infants in Japan.

The prevalence of low birth weight (LBW) infants in Japan has doubled in the last several decades. The objective of this study was to examine the effects of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on LBW infants of Japanese women. This retrospective study was conducted using data on 1,336 mothers (mean age, 34.0 years)whose pre-pregnancy BMI was less than 23 kg/m2 and their singleton infants were born at full term between January and December in 2011. The outcome of interest was LBW infants (less than 2,500 g). The main exposure variables were pre-pregnancy BMI and GWG. The effects of these two variables on LBW were determined after adjusting for confounder variables such as maternal age, smoking, drinking, parity, gestational week at birth and infant gender. The proportion of LBW infants was 4.2% in total, 6.1% among underweight mothers (<18.5 kg/m2) and 3.5% among normal weight mothers (18.5-22.9 kg/m2).A stepwise multivariable logistic regression model showed that underweight mother were more likely [odds ratio (OR) 1.86, 95% confidence interval (CI), 1.04-3.31] than normal weight mother to deliver a LBW infant. Mothers with inadequate GWG <8.5 kg were more likely to deliver a LBW infant (OR 1.66, 95% CI: 0.80-3.45) compared with mothers who gained 10.5-12.4 kg (the third lowest quartile) but this did not reach statistical significance. This study demonstrated that mothers who were underweight before pregnancy were independently associated with the delivery of LBW infants.

Epidemiological determinants of birth weight in a metropolitan city

Background: One of the poor outcomes of pregnancy that has caught the attention of the World Health Organization is low birth weight (LBW). An infant’s weight at birth is an important indicator of maternal health and nutrition before and during pregnancy and a predictor of infant growth and survival. Objectives: (i) To find out the percentage of LBW of baby. (ii) To study the various maternal factors associated with LBW. Materials and Method: A prospective longitudinal study was conducted on pregnant women attending antenatal clinic in tertiary care hospital by convenience sampling method over a period of 2 years including 407 women after taking consent using semi-structured questionnaire and followed up after delivery and record birth weight of newborn from record. Results: The proportion of LBW in the present study was found to be 34.64%. 50% and 55.07% teenage and advanced age women delivered LBW babies, respectively. Nearly, 68.18% LBW babies were born to tobacco addicted women. Women having less than adequate antenatal care (ANC) visits had a higher proportion of LBW babies (46.77%). Women who registered late in pregnancy had more proportion of babies delivered with LBW (56.63%). Weight gain of mother in pregnancy and birth weight of newborn was found to be statistically significant (P < 0.01). 87.5% pre-term delivered babies were LBW. Conclusion: More emphasis should be given on ANC services to identify the various risk factors to reduce the incidence of LBW in the community.

Cost Implications for Subsequent Perinatal Outcomes After IVF Stratified by Number of Embryos Transferred: A Five Year Analysis of Vermont Data

In states in the USA without in vitro fertilzation coverage (IVF) insurance coverage, more embryos are transferred per cycle leading to higher risks of multi-fetal pregnancies and adverse pregnancy outcomes. To determine frequency and cost of selected adverse perinatal complications based on number of embryos transferred during IVF, and calculate incremental cost per IVF live birth. Medical records of patients who conceived with IVF (n=116) and delivered at >20weeks gestational age between 2007 and 2011 were evaluated. Gestational age at delivery, low birth weight (LBW) term births, and delivery mode were tabulated. Healthcare costs per cohort, extrapolated costs assuming 100 patients per cohort, and incremental costs per infant delivered were calculated. The highest prematurity and cesarean section rates were recorded after double embryo transfers (DET), while the lowest rates were found in single embryo transfers (SET). Premature singleton deliveries increased directly with number of transferred embryos [6.3% (SET), 9.1% (DET) and 10.0% for ≥3 embryos transferred]. This trend was also noted for rate of cesarean delivery [26.7% (SET), 36.6% (DET), and 47.1% for ≥3 embryos transferred]. The proportion of LBW infants among deliveries after DET and for ≥3 embryos transferred was 3.9 and 9.1%, respectively. Extrapolated costs per cohort were US$718,616, US$1,713,470 and US$1,227,396 for SET, DET, and ≥3 embryos transferred, respectively. Attempting to improve IVF pregnancy rates by permitting multiple embryo transfers results in sharply increased rates of multiple gestation and preterm delivery. This practice yields a greater frequency of adverse perinatal outcomes and substantially increased healthcare spending. Better efforts to encourage SET are necessary to normalize healthcare expenditures considering the frequency of very high cost sequela associated with IVF where multiple embryo transfers occur.

A Study on the Risk Profile of Postnatal Women with Low Birth Weight Babies

A descriptive retrospective cross -sectional study using existing data from a one-year birth registers of 6928 postnatal women was done at District McGann hospital, Shimoga, India. The objective was to study the risk profile of the mothers who delivered low birth weight (LBW) babies and their contribution to the problem. Mothers without formal education were 4 times more likely to give birth to LBW neonates than those who had attained higher education. There was a linear decrease in low birth weights of newborns as fraternal educational level increased. There was no statistically significant difference among parents' occupations regarding LBW of their newborns. Unmarried mothers were more likely to give birth to LBW babies as compared to their married counterparts and the difference was statistically significant. Hypertension, pre-eclampsia and eclampsia disease complex had the highest prevalence and population attributable risk of low birth weight. Other complications and diseases which contributed to high prevalence of LBW included anaemia, thromboembolic diseases, tuberculosis, malaria and other infections. Prevalence of LBW was high in women with premature rupture of membrane, placenta praevia and abruption of placenta. LBW was strongly associated with gestational age below 37 weeks and also with malnutrition. There was a statistical significant difference between the proportions of LBW infants from mothers who did not receive antenatal care and those who attended for the services. There is need of increasing promotion of reproductive health services in relation to safe motherhood at community level in order to reduce risk factors of LBW.

Low birth weight of newborns: Magnitude of the problem seen in a 100 bed hospital of a rural area in Vellore district, Tamil Nadu (India)

Sir, Low birth weight (LBW) has been defined by the World Health Organization (WHO) as weight at birth of less than 2500 g.(1) LBW at birth may be the outcome of either preterm birth (before 37 weeks of gestation) or retarded fetal (intrauterine) growth.(1) LBW is associated with multiple problems such as fetal and neonatal mortality or morbidity. Compromised growth and cognitive development, with increased risk of cardiovascular and metabolic disorders in adult life, has also been reported.(2) The estimated proportion of LBW infants in India is 7.8%.(1) Accurate and reliable data on LBW incidence in India is still limited especially from rural areas of Tamil Nadu. We undertook a retrospective analysis of LBW data available at the Sri Narayani Hospital and Research Centre, a 100 bed hospital situated outside Vellore city limits. The women who attended the ante-natal clinic or came for delivery were from the rural and peri-urban population of Vellore district of Tamil Nadu, India. We also investigated the association between LBW, random blood glucose level (RBS), hemoglobin (Hb) levels, maternal age and complications during delivery of the patients. Generally, information from rural areas of India is sparse in published literature. Information on all pregnant women who came for pre-natal check-ups and who delivered a child at the obstetrics and gynecology facility in the hospital during the period January 2005 to October 2008 were included in the analysis. Relevant information was acquired from the medical charts. Hemoglobin level was estimated by the cyanmethemoglobin method. The weights of the newborns were recorded using an appropriate balance (Phoenix Co, India). All babies were weighed within one hour of birth by a trained nursing personnel. The blood glucose levels were measured by GOD-POD method in a fully automated biochemistry analyzer (Dade Behring, Germany). Statistical analysis was done by comparison of proportions using the Chi-square test in the Epi Info ver.6.03 programme. Among 1024 subjects studied, a total of 121 (11.81%) newborn babies were less than 2,500 g. There were 304 mothers from peri-urban areas and 720 mothers from rural areas. Among the mothers who had newborn babies with LBW, 36 (11.84%) belonged to peri-urban population and 85 (11.08%) belonged to rural population. There was no statistically significant difference. The widespread problem is a reflection of the lower socio-economic status of rural and peri-urban women affecting their nutritional status. Similar findings have been reported from some parts of India.(3) An LBW prevalence of 39.1% was found in urban areas of Delhi, the maternal age was identified as a significant determinant.(4) In our study, no difference was found in maternal age distribution of rural or peri-urban communities. The range of age of mothers who delivered normal weight babies was 17–32, median-20, and for those who delivered LBW babies was 21–30, median-22. No obvious difference in maternal age was found. In our series, we did not find any newborn in the category of extremely low birth weight infants, as defined in the literature.(2) Data on LBW related features are shown in the Table 1. In the present study, among the 924 of 1024 mothers screened for hemoglobin (Hb) level, it was more than 10.9 mg% in 35.28% only. Thus, two-thirds of the mothers in this study were anemic. Anemia in the mother is a risk factor for LBW.(5) The random blood sugar level among rural people ranged from 2.7 to 10.6 mmol/l with a median of 5.13 and among the urban people it ranged from 2.7 to 12.7 mmol/l and median was 5.05. Four women alone were identified as potentially having gestational diabetes but no further investigations were done. Among rural women 264 mothers had LSCS, seven mothers had intra-uterine death (IUD), there were two pre-term deliveries, nine of them delivered babies weighing more than 4.0 kgs and 85 mothers delivered babies weighing less than 2.5 kgs. Whereas, in urban mothers, 131 had LSCS, two had IUD and no preterm births, 36 mothers delivered babies less than 2.5 kgs. This indicates the poor nutritional status in rural and urban areas of India as a risk factor for the low birth weight incidence. Table 1 Characteristics of mother and LBW babies stratified as rural vs. peri-urban origin Birthweight remains an important factor affecting infant andchild mortality. Babies of low birth weight are also prone to perinatal morbidity. The results of this study suggest that for reducing the problem of LBW in rural India, the public health strategy needs to focus attention on better maternal nutrition and education. Indian intervention programs encourage wider birth interval, avoidance of teenage marriages and early pregnancies. The public health measures have been most effective only in the state of Kerala; other parts of the country have to play catch-up.

A Comparative Evaluation of Multiple Micronutrient and Iron–Folic Acid Supplementation during Pregnancy in Pakistan: Impact on Pregnancy Outcomes

Maternal micronutrient deficiencies are widespread in Pakistan and are potentially associated with maternal undernutrition and intrauterine growth retardation. Intervention strategies largely consist of administration of iron-folic acid supplements during pregnancy. We evaluated the acceptability of multiple micronutrient supplementation and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh through a cluster-randomized design. We randomly assigned 2378 pregnant women to receive either iron-folic acid or multiple micronutrient supplements. The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers. The women in both groups consumed about 75% of the supplements provided, and few reported adverse effects such as vomiting, abdominal pain, etc. There was a small (70 g) but significant increase in birthweight among infants of mothers receiving multiple micronutrients as compared with infants of mothers receiving iron-folic acid supplements (2.95 +/- 0.6 vs. 2.88 +/- 0.5 kg, p = .01). This translated into a 10% reduction (p < 0.17) in the proportion of low-birthweight infants among infants of mothers receiving multiple micronutrients. Although stillbirth rates were comparable in the two groups, the early neonatal mortality rate in the group receiving multiple micronutrients was higher, although not significantly, than that in the group receiving iron-folic acid (43.2 vs. 23.5 deaths per 1000 live births; RR = 1.64; 95% CI, 0.94 to 2.87). Comparable reductions in anemia (hemoglobin < 11 g/dL) were observed, although the proportion with low iron stores (assessed by serum ferritin) was lower in the iron-folic acid group in the postnatal period. Although the proportion of women with subclinical vitamin A deficiency after supplementation did not differ between the two groups, the iron-folic acid group had a higher proportion with lower serum zinc levels in the immediate postpartum period. These data suggest that multiple micronutrient supplements are well tolerated during pregnancy, but the effect on birthweight is modest. The observed effect on early neonatal mortality suggests the need for further studies and careful assessment of the intervention in health system settings.

Women’s health—what’s new worldwide

Women’s health—what’s new worldwide

Kleinräumige Analyse der Säuglingssterblichkeit in Bielefeld unter besonderer Berücksichtigung des Migrationshintergrundes, 2000–2006

From 2002 to 2005 the infant mortality rate in the city of Bielefeld has been higher than that of the state of North Rhine Westphalia, in which Bielefeld is located. The 3-year average in Bielefeld was 7.3 vs. 4.7 per 1 000 live births in the period 2002-2004. The aim of our study was to examine the causes of the elevated infant mortality in Bielefeld. We conducted a small area analysis and an analysis of the migration status of parents and children in the context of infant mortality. We collected data from death certificates stored at the health office of Bielefeld and coded the cause of death according to ICD-10. We extracted nationality and country of birth from the local population registry. The most frequent causes of death were perinatal factors, malformations and sudden infant death syndrome. Three city districts with a high proportion of population groups with specific sociological risks had an elevated infant mortality. Among infants of migrants, malformations were a more common cause of death (40% of all deaths) than among those without migration background. Perinatal causes were less common among infants with a migration background than without one (42% vs. 54%. of deaths). The authors question whether or not a cause-effect relationship exists here. The infant mortality rate and the proportion of low birth-weight infants are associated with the social status. Thus, infant mortality is not distributed evenly within a city, either in geographic or in sociological terms. Conversely, statistics about infant mortality define focal points which can be identified and improved. Analysis according to migration background and socio-spatial structures can help to assess health care provided and to initiate targeted interventions, e.g., via local health conferences.