A hospital based study on the prevalence of low birth weight in newborn babies and its relation to maternal health factors

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Int J Res Med. 2014; 3(1);4-8 e ISSN:2320-2742 p ISSN: 2320-2734

A hospital based study on the prevalence of low birth weight in newborn babies

and its relation to maternal health factors

Krupal Joshi

1*

, Kishor M. Sochaliya

2

, Atul V. Shrivastav

3

, Divyesh M. Gohel

4

,

Shyamal K. Purani

5

, Girija P. Kartha

5

1_Resident,2_{Assistant Professor}5_{Professor, Department of PSM, C.U. Shah Medical College Surendranagar, Gujarat} 3_{Assistatn Professor, Department of Pathology, C.U. Shah Medical College Surendranagar, Gujarat}

4_{Resident, Department of Paediatrics, C.U. Shah Medical College Surendranagar, Gujarat}

INTRODUCTION

Intrauterine growth and development is one of the most vulnerable processes in the human life cycle and its aberrations can result in profound and lasting influence in later life. In the context of developing countries, intrauterine growth has been invariably assessed by birth weight1. The birth weight of an infant is the single most significant determinant of its chances of survival, healthy growth and development2. Low birth weight is one of the most serious challenges in maternal and child health in both developed and developing countries. Its public health significance may be ascribed to numerous factors – its high incidence, its association with mental retardation and a high risk of perinatal and infant mortality, human wastage and suffering, the very high cost of special careand intensive care unit

and its association with socioeconomic

underdevelopment2. Low birth weight is considered as a sensitive index of Nation’s health and development4. The NFHS 3 reports association of LBW to place of residence (urban or rural), age of

*Corresponding Author

Dr. Krupal J. Joshi

87, “Aashutosh”, Sanjivani Society, Ratanpur Surendranagar-363020

Email:

dr_krupal@yahoo.co.in

mother, religion and caste, birth order of the baby, education, wealth and use of tobacco5. The incidence of LBW babies (< 2500 gm) continues to be high in India at about 30% in contrast to 5-7% in developed countries6. Preterm babies account for only 10% LBW babies, the rest being term intrauterine growth retarded (IUGR) infants7. With this background, the present study was conducted with following objectives.

Objectives: The objectives of the study were; 1. To estimate the prevalence of low birth weight

among new born babies.

2. To identify various maternal factors associated with low birth weight of newborns.

MATERIALS AND METHODS

The present hospital based cross-sectional study was conducted in a tertiary care teaching hospital C. U. Shah Hospital, Surendranagar, Gujarat. The period of study was 3 month (i.e. from September 2012 to November 2012). The study population comprised of mothers along with newborns delivered at C. U. Shah Hospital during the study period. Of the total 116 deliveries occurred during this 3 months, mothers of 109 new born babies were interviewed and examined using a predesigned and pretested questionnaires. The remaining 7 mothers

ORIGINAL ARTICLE

ABSTRACT

BACKGROUND: Low birth weight (LBW) is defined as birth weight of < 2.5 kg. Birth weight is a reliable index

of intra uterine growth retardation and a major factor determining child survival, future physical growth and mental development. A multifactorial inter-relationship exists between the environment in which pregnant mothers live and the growth of the fetus. Objective: To estimate the prevalence of LBW among new born babies and to study the association of LBW with maternal risk factors. MATERIALS AND METHODS: A total of 109 live new born babies delivered at Ob. & Gy. Department of C U Shah Hospital were reviewed from September to November 2012. The data was collected with the help of interview technique using predesigned and pretested questionnaires followed by thorough clinical examination and anthropometric measurements of mothers. RESULTS: The mean birth weight of newborns was 2.76 kg with a range of 2.20 to 3.32 kg. The prevalence of LBW was 55.96%. The factors which were significant for LBW were poor socio-economic status, antenatal care, gestational age, parity, inter-pregnancy interval and past H/o of maternal illness. CONCLUSION: LBW was found to be present in 61 (55.96%) newborns. The factors that found significantly associated with LBW were gestational age at delivery, number of antenatal visits, past history of maternal illness, birth interval, type of work, iron and folic acid supplementation, sex of new born, residency, socio-economic class and parity.

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were excluded due to immediate transfer, non response, non co-operation for examination and

incomplete information. The World Health

Organization (WHO) definition of LBW was used, i.e., birth weight less than 2500g3. The birth weight of new born was recorded within 1 hour of delivery. Modified Prasad’s classification was used to grade the socio-economic status of the respondents. Study variables included were birth weight and sex of baby, maternal socio-demographic profile, mother’s anthropometric & reproductive profile like height and weight, parity, inter-pregnancy interval, gestational age, number of ANC visits, iron and folic acid supplementation, hemoglobin status and past history of maternal illness. The information thus collected was analysed using SPSS windows. Simple proportions and chi-square were used to analyse the data.

RESULTS

Table 1: Distribution of new borns according to birth weight (n = 109)

Birth weight(kg) No. of newborns Percentage Mean Weight SD < 2.5 kg 61 55.96 1.9 kg ± 0.34

2.5-3.5 kg 46 42.20 2.8 kg ± 0.21

≥ 3.5 kg 2 01.84 3.6 kg ± 0.14

Total 109 100 2.76 kg ± 0.56

Table 2: Relationship between LBW and maternal socio-demographic factors (n = 109)

Material SD factors No. of new Born Normal Babies LBW X2 P Valu e No. %

Maternal age

< 20 13 6 7 53.84

0.057 0.999

21-25 53 23 30 56.60

26-30 32 14 18 56.25

31-35 10 5 5 50.00

> 35 1 0 1 100.0 Type of Residence

Urban 29 20 9 31.03

9.964 0.001

Rural 80 28 52 65.00 Maternal Education

Illiterate 60 21 39 65.00

5.823 0.054

Primary 44 23 21 47.73

Secondary 5 4 1 20.00 Maternal Occupation

Farmer 27 9 18 66.67

10.12 0.017

Housewife 50 30 20 40.00

Laborer 30 8 22 73.33

Home

business 2 1 1 50.00

Socio Economical status

Class 1 0 0 0 00.00

12.77 0.005

Class 2 1 1 0 00.00

Class 3 21 16 5 23.81

Class 4 59 22 37 62.71

Class 5 28 9 19 67.86

Table 3: Relationship between LBW and maternal constitutional and antenatal factors (n = 109)

Material Factor No. of new Born Nor mal Babi es LBW BABIES

X2 P

Value No. %

Maternal Height

< 140 cm 2 1 1 50.00

0.029 0.864

> 140 cm 107 47 60 56.07 Maternal weight

< 40 kg 19 6 13 68.42

1.44 0.22

> 40 kg 90 42 48 53.33 Sex of new born babies

Male 59 32 27 45.76

5.431 0.019

Female 50 16 34 68.00 Frequency of ANC check up

< 3 visit 56 21 35 62.50

21.62 0.00002

≥ 3 visit 34 25 9 26.47

No visit 19 2 17 89.47 ANC Conducted by

Doctor 39 27 12 30.78

17.77 0.0001

Nurse 51 18 33 64.71

Other 19 3 16 84.21 Iron folic acid given

Yes 90 45 45 50.00

7.45 0.006

No 19 3 16 84.21

Anemia (Haemoglobin level)

≥ 10 gm/L 8 4 4 50.00 3.38

0.18

7-10 gm/L 65 24 41 63.08

< 7 gm/L 0 0 0 00.00

No record 36 20 16 44.44

No 103 47 56 54.37

Table 4: Relationship between LBW and maternal reproductive factors (n=109)

Material Factor No. of new Born Normal Babies LBW Babies

X2 P

Value No. %

Parity

Nullipara 35 15 20 57.14

17.45 0.0015

1 29 21 8 27.59

2 21 7 14 66.67

3 17 5 12 70.59

Inter Pregnancy interval

1-2 yr 27 7 20 74.07

9.285 0.025

2-3 yr 19 12 7 36.84

≥ 3 yr 10 7 3 30.00

NAD(Primi) 53 22 31 58.49 Gestational age

Pre term 46 0 46 100.0 62.62

6 0.00

Term 63 48 15 23.81

Post term 0 0 0 00.00 Past H/O Maternal illness during pregnancy

Yes 32 8 24 75.00

6.661 0.009

No 77 40 37 48.05

Type of delivary

Normal 83 36 47 56.62

0.109 0.946

Forceps 0 0 0 00.00

Ventuse 6 3 3 50.00

LSCS 20 9 11 55.00 Complication during and after delivary

Yes 6 1 5 83.33

1.93 0.16

No 103 47 56 54.37

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LBW with the different socio-demographic factors of the mother. The factors which were found to be significantly associated with the low birth weight of the newborns were type of residence, type of work and socio-economic status. However, age of the mother at the time of conception and maternal education were found insignificant in the present study. The birth weight is found to be lowest in the babies of mothers in the age group of 21-30 years. Higher prevalence of LBW neonates were found among mothers who were living in rural areas (65%) compared to urban area (31.03%). The birth weight of newborn babies was also influenced by educational status of mothers, as 65 % of illiterate mothers delivered their babies with LBW. Majority of the mothers having LBW babies involved in the hard work like labor (73.33%) and farming (66.67%). And it was observed that maximum mothers born LBW babies were belongs to socio-economic class IV and V (62.71% and 67.86% respectively). Table 3 depicts that the LBW rate was high among mothers with height >140 cm (56.07%) & body weight <40 kg (68.42%). Out of all the registered mothers’ outcome was better in mothers who were going for ANC check up 3 or more times compared to no or less than 3 visits. Similarly, the birth weight of babies seems to be influenced significantly by the person who conducts ANC. As LBW rate was higher among mothers whose antenatal checkup was conducted by nurse or other staff compared to doctor. The prevalence of LBW was also higher among mothers who did not consume IFA tablets during pregnancy (84.21%) compared to those who consumed IFA tablets (50%). Maximum numbers of LBW babies were born to mothers’ with hemoglobin level 7-10 gm/L (63.08%) followed by more than 10 gm/L (50%). The data of table 4 reveal that the rate of LBW babies were high among the mothers with parity three (70.59%) and it decreases with the decrease of parity. The association of parity and LBW babies was also found statistically significant. More number of LBW babies (74.07%) were born to mothers whose inter pregnancy interval was 1-2 year compared to 2-3 year (36.84%) and more than 3 years (30%). Maximum numbers of LBW babies (100%) were born pre-term, which is also statistically significant. Similarly mothers with history of any of the maternal illness during pregnancy delivered more number of LBW babies (75%) compared to no such history. Majority (56.62%) of LBW babies were delivered normally followed by LSCS (55%) and ventuse (50%). Table 5 shows the bivariate analysis of maternal constitutional and reproductive factors among the study subjects.

Table 5: Bivariate analysis of maternal risk factors of low birth weight (n = 109)

Factor MEAN ±SD

95% Confidence

Interval

Level of significa nce Maternal age 25 ± 4.13 (19 - 39) NS

ANC frequency 1.58 ± 1.108 (0 - 3) HS

Inter pregnancy

interval 1.193 ± 1.36 (0 - 5) S Maternal height 150 ± 4.03 (140 - 160) NS

Maternal weight 45.58 ± 7.39 (36 - 71) NS

Anaemia 6.90 ± 3.85 (0 - 12) NS

*HS – Highly significant, S – Significant, NS – Non significant

DISCUSSION

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also reported by AR Mahmood et al18. The prevalence of LBW was observed maximum among the mothers weighted less than 40 kg (68.42%). And the data has also been supported by the findings of Dhall and Bagga19. LBW was strongly associated with inadequate or no antenatal care, which was supported by PS Thomre et al14. Deshmukh et al17 documented that mothers who were anemic were more prone to have LBW and our findings are in conformity with their observations. Parity of mother is usually associated with birth weight. However, after attaining a maximum weight at fourth or fifth parity a decrease in birth weight with subsequent parity has been seen20, 21. In this work, higher weighted babies are observed in first parity, after which the birth weight is declining with subsequent parity. Present study also revealed that the percentage of low birth weight decreases with increasing inter pregnancy interval. Similar finding were also observed by Ghosh et al (1969)22, Das et al (1977)23 and Deswal BS et al (1999) 24 in their study. In this work strong positive association of gestational age of baby to birth weight is observed. Prevalence of LBW baby is very high in preterm baby than its counterpart. This finding is also corresponds to finding of other workers11, 25. The relationship between maternal diseases and low birth weight is a controversial subject. Maternal diseases, both infectious and chronic diseases, in the present study, were found to be significantly associated with higher proportion of LBW (p=0.009).

CONCLUSION

Birth weight remains an important factor affecting infant and child morbidity and mortality. Babies of low birth weight are also more prone to perinatal morbidities. As there are several factors interacting in this phenomenon, so it is not feasible to single out any particular factor affecting low birth weight. From the present study, it was revealed that the maternal factors like rural locality, laborious work, low economic class, inadequate/no utilization of

antenatal services, inadequate IFA tablets

consumption, multiparity, short inter pregnancy interval, pre-term delivery and past history of maternal illness are found to be significantly associated with LBW.

Recommendation:

The results of the present

study suggest that for reducing the burden of

LBW, it is the need to strengthen the existing

maternal services at the basic level of

community i.e., at door steps of the

beneficiaries if possible. The factors that should

be more focused are maternal literacy and

nutrition status, socio-economic development,

teenage pregnancy, awareness regarding birth

spacing and increasing the use of health care

services during pregnancy.

Limitation:

1. The result of the study cannot be generalized because the present study was a hospital based

study. Other governmental and

non-governmental health sectors were not involved. 2. Precise information regarding weight gain of the

women during pregnancy could not be obtained as majority women are illiterate coming from rural area and not aware about the significance of weight records.

Acknowledgement:

We acknowledge the cooperation extended by Department of Obstetrics and Gynecology and Management of C. U. Shah Medical College and Hospital, Surendranagar.

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