Factors associated with birth weight inequalities in Jordan

General Movements Assessment in Infants with High Birth Weight

BACKGROUND

High birth weight (HBW) describes fetal birth weight of more than 4000 g. Infants with HBW have a high risk of developing neurological and developmental problems. Until recently, there were no studies in the literature that investigated the quality of spontaneous movements and the integrity of the developing nervous system in infants with HBW. The aims of this study were (1) to describe age-specific detailed early spontaneous movements in infants with HBW and (2) to compare the detailed early spontaneous movements of infants with HBW and normal birth weight (NBW).

METHODS

Twenty-two infants with HBW (median birth weight = 4190 g) and 22 infants with NBW (median birth weight = 3255 g) were included at 10 to 19 weeks post-term age (median = 13 weeks). All infants were assessed according to General Movement Assessment using three- to five-minute video recordings. Video recordings of each infant were evaluated using Motor Optimality Score for three- to five-month-old infants-Revised score sheet.

RESULTS

Motor Optimality Score-Revised (MOS-R) (P < 0.001), observed postural patterns (P < 0.001), and age-adequate movement repertoire (P = 0.005) were significantly lower in the infants with HBW. Infants with HBW had more aberrant (abnormal or absent) fidgety movements (18%) than those with NBW (0%).

CONCLUSIONS

The results of this study demonstrated that the motor repertoire of infants with HBW tended to decrease more than that of those with NBW. To enable the follow-up of progression as a result of these assessments infants in need should be referred to age-adequate early intervention programs.

Environmental Predictors of Undernutrition Among Under-5 Children at Dabat District Health Facilities, Northwest Ethiopia, 2023

Background

In Ethiopia, undernutrition remains a significant public health concern throughout the year due to persistent household food insecurit. The intensifying conflict in the Dabat district, involving the Ethiopian government and the Tigray Liberation Front, has increased the threat of undernutrition among under-5 children. The cessation of humanitarian aid has worsened food insecurity, increasing the vulnerability of the children in the region. However,there was no data showing the prevalence and environmental pridictors of undernutrition in the Dabat district, northwestern Ethiopia. Therefore, the objective of this study was to determine the prevalence of undernutrition and identify environmental pridictors in this study setting.

Methods

This institutional-based cross-sectional study was conducted from January to March 2023. A total of 400 under-5 children were included in this study using systematic random sampling techniques with a 100% response rate. The study included all under-5 children who visited healthcare facilities during the data collection period. However, it excluded children under-5 who had physical deformities, were critically ill, or had congenital abnormalities or known chronic diseases such as HIV/AIDS, tuberculosis, or chronic heart diseases. Binary logistic regression was used to determine environmental predictors of undernutrition, with statistical significance at a P-value of ⩽.05.

Results

The overall prevalence of undernutrition was found to be 12% (95% CI: 8.72-21.5). Among those affected, 32.8% (95% CI: 21.5-39.8) were stunted, 37.9% (95% CI: 28.8-47.50) were underweight, and 29.3% (95% CI: 21.3-29.7) were wasted. The environmental predictors of undernutrition were latrine use, recent diarrhea episodes, mothers' occupation and place of residence, water treatment before consumption, water sources and storage, water extraction methods, and mothers' handwashing habits.

Conclusions and recommendations

The study found a higher prevalence of undernutrition among under-5 children compared to the 2019 Ethiopia Mini Demographic and Health Survey. This study recommended raising awareness about establishing private toilets, promoting water treatment, proper latrine use, and handwashing practices. Training on personal hygiene and economic support for households should also be provided. Healthcare providers should offer quality health services for under-5 children. Further research is needed to explore specific nutrient deficiencies using laboratory methods.

A scoping review of the social determinants of maternal health in the MENA region

One crucial step to improving maternal health outcomes in any region is understanding the social determinants of maternal health, which vary significantly across the world´s geographical areas and within individual countries. The variability in these determinants is manifested in the Middle East and North Africa (MENA) region. Using a scoping review process, we identified articles analyzing social factors influencing maternal health outcomes in the MENA region. A total of 50 articles were included in this review. Several social factors impact independently or in association with maternal health outcomes or utilization of maternal health in the MENA region. These factors include: residing in an area of conflict, residing in a rural region, low accessibility and quality of health care, low level of education, antagonistic relationship with spouse and family-in-law, cultural practices such as female genital mutilation and early marriage, traditional practices, and beliefs, low household wealth, women´s financial security, women's bad childbirth history, and interpersonal violence. Multi-sector collaboration across governmental ministries, non-governmental organizations, local authorities, healthcare delivery programs, and community members is critical to creating long-term solutions in maternal health for MENA nations. Together they must address traditional practices harmful to women, poor accessibility, availability, and affordability of health services. To benefit women, a long-term commitment of organizations at local, national, and international levels to social investments in women´s education, financial status, and cultural norms is recommended for MENA nations.

Cold, dark and malnourished: a cross-sectional analysis of the relationship between energy poverty and household burden of malnutrition in sub-Saharan Africa

OBJECTIVE

Energy poverty contributes to the general well-being of households; however, there is representational paucity on its role in household nutrition across sub-Saharan Africa (SSA). This study examined the influence of different domains of energy poverty and a Multidimensional Energy Poverty Index (MEPI) on household burden of malnutrition in SSA.

SETTING

Secondary data from the most recent Demographic and Health Survey conducted in 18 SSA countries were analysed.

DESIGN

A cross-sectional design was used to examine the relationship between household energy poverty and household burden of malnutrition.

METHODS

Different dimensions of household energy poverty and an MEPI were computed from the sources of energy used for cooking, lighting, entertainment and accessing information by households. Household burden of malnutrition was coded as a binary categorical dependent variable using indicators of undernutrition, overnutrition and anaemia among women of reproductive age (15-49 years) and children under five years in the household.

RESULTS

More than nine in ten households were energy poor in terms of cooking fuel and about three in four were energy poor in terms of lighting. Considering the various domains of energy poverty, lack of electricity for lighting, using biofuels, not owning a refrigerator/freezer, not owning a television/radio and not owning a mobile phone were associated with increased odds of a household experiencing undernutrition. Similarly, deprivation in these domains was associated with a lower likelihood of households experiencing overnutrition, the only exception being using biofuels. Overall, households that were most energy poor on the MEPI were more likely to be undernourished and double and triple burden malnutrition households but less likely to suffer from overnutrition.

CONCLUSION

These results highlight the complex and multifaceted nature of the relationship between energy poverty and household burden of malnutrition and provides guidance for appropriate interventions to address energy poverty and malnutrition in SSA.

Fetal Glucocorticoid Mediates the Association between Prenatal Per- and Polyfluoroalkyl Substance Exposure and Neonatal Growth Index: Evidence from a Birth Cohort Study

Glucocorticoid plays a key role in the growth and organ maturation of fetus. However, the effect of glucocorticoid on the association between per- and polyfluoroalkyl substance (PFAS) exposure and fetal growth is still unknown. We detected cord cortisol (active glucocorticoid in human) and 34 PFAS concentrations in the maternal serum samples, which were collected from 202 mother-fetus pairs in the Maoming Birth Cohort from 2015 to 2018. The mediation effect of cord cortisol on the association between maternal PFAS and the neonatal growth index (NGI) was estimated. We found that higher PFAS concentrations were associated with lower NGI in terms of ponderal index, birth weight (BW), head circumference (HC), and its z-scores (BWZ and HCZ) (P < 0.05). Fetal cortisol could mediate 12.6-27.3% of the associations between PFAS and NGI. Specifically, cord cortisol mediated the association between branched perfluorooctane sulfonate (branched PFOS) and HCZ by 20.4% and between perfluorooctanoate (PFOA) and HCZ by 27.3%. Our findings provide the first epidemiological data evincing that fetal cortisol could mediate the association between prenatal PFAS exposure and fetal growth. Further investigations are recommended to elucidate the interactions among cord cortisol, PFAS, and fetal growth.

Association between inadequate prenatal care and low birth weight of newborns in Peru: Evidence from a peruvian demographic and health survey

Objective

To assess the association between inadequate prenatal care (IPNC) and Low birth weight (LBW) in newborns of singleton gestation mothers in Peru.

Methods

We performed a secondary analysis of data from the 2019 Demographic and Health Survey. We included a total of 10,186 women of reproductive age (15 - 49 years) who had given birth to a singleton child in the last 5 years. The dependent variable was LBW (< 2500 g). The independent variables were IPNC (inadequate: when at least one of the IPNC components was absent [number of PNC visits ≥ 6, first PNC visit during the first trimester, compliance with PNC visit contents, and PNC visits provided by trained health personnel]) and each of its components. We evaluated the association using logistic regression models to estimate crude odds ratios and adjusted odds ratios (aOR) and their respective 95% confidence intervals (95% CI).

Results

We found that approximately six out of 100 live births had LBW and that seven out of 10 women had received IPNC. We observed that receiving IPNC (aOR: 1.39; 95% CI: 1.09 - 1.77) and having less than six prenatal control visits (aOR: 3.20; 95% CI: 2.48 - 4.13) were associated with higher odds of LBW regardless of the mother's age, educational level, occupation, wealth, region, rural origin, ethnicity, sex of the newborns, and place of delivery. While, regarding to the other PNC components, first prenatal control in the first trimester (aOR: 0.99; 95% CI: 0.76 - 1.28) and compliance with prenatal control contents (aOR: 1.07; 95% CI: 0.86 - 1.34), they were associated with lower and higher odds of LBW, respectively, regardless of the same adjustment variables, but it was not statistically significant.

Conclusions

IPNC and having less than six PNC visits were associated with higher odds of LBW. Therefore, it is very important to implement strategies that ensure access to quality prenatal care is necessary to reduce the consequences of LBW.

Examining the experience of childbirth and its predictors among women who have recently given birth

Aims

The aim of this study is to examine the experience of childbirth and its predictors among women who have recently given birth.

Design

This is a cross-sectional study.

Methods

This study was conducted on 225 women at 22 Bahman Hospital in Khaf City, Iran. The samples were selected by the continuous sampling method from August to November 2018. Data were collected by demographic questionnaire, fertility information, pregnancy experience scale, satisfaction from birth environment inventory and the childbirth experience questionnaire.

Results

The mean score of childbirth experience was 55.73. According to the regression model, the husband's education, receiving regular care during pregnancy, the person giving birth, presence of a companion, receiving spinal anaesthesia, perineal conditions, being uplifted and hassled about the pregnancy and satisfaction with the birth environment were the predictors of childbirth experience. The regression model showed 39.8% of the change in outcome variable was predicted by independent variables.

Mother's education level is associated with anthropometric failure among 3- to 12-year-old rural children in Purba Medinipur, West Bengal, India

Maternal education plays a central role in children's health and nutrition. Living conditions and socioeconomic status are linked with mother's education, which in turn determines the health and development of a child. The Composite Index of Anthropometric Failure (CIAF) is a single indicator that reflects overall rate of three conventional indices of undernutrition: underweight, stunting and wasting. The study was undertaken among 621 rural Bengalee children (308 boys and 313 girls) aged 3-12 years from the Purba Medinipur district of West Bengal, India. Height (cm) and weight (kg) were recorded and NCHS standard values used to calculate z-scores (<-2SD). The same data were used to calculate CIAF as an indicator of 'anthropometric failure' (AF) or undernutrition. The prevalence of AF among the children was 59.40%. Chi-squared analysis was employed to evaluate the significance of differences in the prevalence of CIAF between the sexes and the association between nutritional indicators and socioeconomic parameters in the two sexes. Multiple binary logistic regression (MBLR) analyses (including the forward stepwise method) were also performed. Odds ratios with 95% confidence intervals were used to assess the risk of having AF. Results showed that mother's education was significantly associated with undernutrition (AF) controlling for the other factors considered. A very high prevalence of undernutrition is persisting in this region of India despite national nutritional supplementation programmes being operational. More attention to the improvement of living conditions and hygiene, and more particularly the education of women, in this population might be effective in attaining improved child growth and health.

Factors associated with low birth weight at term: a population-based linkage study of the 100 million Brazilian cohort

BACKGROUND

Factors associated with low birth weight at term (TLBW), a proxy for intrauterine growth restriction (IUGR), are not well-elucidated in socioeconomically vulnerable populations. This study aimed to identify the factors associated with TLBW in impoverished Brazilian women.

METHODS

Records in the 100 Million Brazilian Cohort database were linked to those in the National System of Information on Live Births (SINASC) to obtain obstetric, maternal, birth and socioeconomic data between 2001 and 2015. Multivariate logistic regression was performed to investigate associations between variables of exposure and TLBW.

RESULTS

Of 8,768,930 term live births analyzed, 3.7% presented TLBW. The highest odds of TLBW were associated with female newborns (OR: 1.49; 95% CI: 1.47-1.50), whose mothers were black (OR: 1.20; 95% CI: 1.18-1.22), had a low educational level (OR: 1.57; 95% CI: 1.53-1.62), were aged ≥35 years (OR: 1.44; 95% CI: 1.43-1.46), had a low number of prenatal care visits (OR: 2.48; 95% CI: 2.42-2.54) and were primiparous (OR: 1.62; 95% CI: 1.60-1.64). Lower odds of TLBW were found among infants whose mothers lived in the North, Northeast and Center-West regions of Brazil compared to those in the South.

CONCLUSION

Multiple aspects were associated with TLBW, highlighting the need to comprehensively examine the mechanisms underlying these factors, especially in more vulnerable Brazilian populations, in order to contribute to the elaboration of health policies and promote better conditions of life for poor and extremely poor mothers and children.

Association between parity and macrosomia in Shaanxi Province of Northwest China

OBJECTIVE

To explore the relationship between parity and macrosomia and provide the necessary reference for the maternal and children health service.

METHOD

A cross-sectional epidemiological survey with the purpose to assess the birth outcomes was conducted in Shaanxi province, China.

RESULTS

The incidence of macrosomia in multiparas was higher than that in primiparas. Univariate analysis showed that maternal age < 25 years, peasant/housework, living in rural areas and female infants were the protective factors of macrosomia. The possibility of having a macrosomic infant also increased with gestational age, maternal education level, household wealth index, living in Central Shaanxi and gestational diabetes. The generalized linear mixed models represented the association between parity and macrosomia. After adjusting for statistically significant factors in univariate analysis from model 1 to model 3, the risk of being born macrosomia was 1.26 times higher for a multipara compared to that for a primipara.

CONCLUSIONS

Present study indicated parity of two children was associated with increased risk for macrosomic births compared with parity of one child. Compared to primiparas, multiparas should far strengthen the pre-pregnancy education and the guidance during pregnancy to control pre-pregnancy body mass index and pregnancy weight, and keep the appropriate exercise and balanced diet.

Are perfluorooctane sulfonate alternatives safer? New insights from a birth cohort study

BACKGROUND

Experimental studies show that chlorinated polyfluorinated ether sulfonic acids (Cl-PFESA 6:2 and 8:2), one of perfluoroalkyl substances (PFAS) used as perfluorooctane sulfonate (PFOS) alternatives, are reproductive toxicants in vivo and in vitro. However, the associations between gestational exposure to Cl-PFESAs and birth outcomes are unknown.

OBJECTIVES

We investigated associations between 6:2 Cl-PFESA and 8:2 Cl-PFESA in maternal serum and birth outcomes.

METHODS

We measured four PFAS, including 6:2 Cl-PFESA, 8:2 Cl-PFESA, PFOS, and perfluorooctanoic acid (PFOA) in third-trimester maternal serum collected from 372 mother-child dyads participating in the Guangzhou Birth Cohort Study. Characteristics of mothers and infants were gathered from medical records and by interviewer-administered questionnaires.

RESULTS

PFOS was the most abundant PFAS in maternal serum (median: 7.15 ng/mL), followed by 6:2 Cl-PFESA (median: 2.41 ng/mL). Greater maternal serum levels of all PFAS alternatives were significantly associated with lower birth weight, adjusted for confounding variables. For example, each ln-ng/mL greater concentration of 6:2 Cl-PFESA and 8:2 Cl-PFESA was associated with a 54.44 g [95% confidence interval (CI): -95.66, -13.22] and 21.15 g (95% CI: -41.44, -0.86) lower birth weight, respectively. Greater continuous maternal serum 6:2 Cl-PFESA (OR: 2.67, 95% CI: 1.73, 4.15) and PFOS (OR: 2.03, 95% CI: 1.24, 3.32) were also associated with higher risks for preterm birth, adjusted for confounders, with a possible threshold effect at the highest quartile of 6:2 Cl-PFESA.

CONCLUSIONS

For the first time, we report associations between maternal serum 6:2 Cl-PFESA and 8:2 Cl-PFESA concentrations and adverse birth outcomes. Our findings suggest that PFOS alternatives may be reproductive toxicants in human populations and should be considered with caution before widespread use. Given the preliminary nature of our results, additional epidemiological and toxicological investigations are needed to more definitively assess the risks.

Sociocultural factors associated with the development of postnatal anxiety symptoms

Background

Postnatal anxiety is relatively common when transitioning to parenthood; however, there are relatively few studies assessing postnatal anxiety in Middle Eastern women.

Aim

To identify the prevalence of postnatal anxiety among Jordanian women and associated sociocultural factors.

Method

A descriptive cross-sectional design was used with 324 women. Participants completed the Depression, Anxiety, and Stress Scale (DASS) and Maternity Social Support Scale at 6-8 weeks postpartum in addition to a sociodemographic data form.

Findings

Some 45.4% of women scored above ‘mild’ on the DASS scale. Postnatal anxiety was significantly associated with low levels of support, giving birth to a female baby, financial difficulties, and having four or more children. Findings revealed a high level of postnatal anxiety among Jordanian women.

Conclusion

There is a need for routine assessment, ongoing support, counselling and emotional care, which are important to enhance maternal satisfaction and psychological wellbeing.

Association of low birth weight with thinness and severe obesity in children aged 3-12 years: a large-scale population-based cross-sectional study in Shanghai, China

OBJECTIVES

Low birth weight (BW) is a general symbol of inadequate intrauterine conditions that elicit abnormal fetal growth and development. The aim of current study is to investigate the relationship between low BW and thinness or severe obesity during maturation.

DESIGN

A large-scale cross-sectional population-based survey.

SETTING

134 kindergartens and 70 elementary schools.

PARTICIPANTS

70 284 Chinese children aged 3-12 years.

OUTCOME MEASURES

International Obesity Task Force body mass index (BMI) cut-offs were used to define grade 1, grade 2 and grade 3 thinness, overweight, obesity and severe obesity. Multinomial logistic regression was used to estimate the association between BW and BMI category.

RESULTS

A total of 70 284 children participated in the survey. The percentage of grade 1 thinness and severe obesity in children with low BW is significantly higher than that in children with normal BW (p<0.05). Low BW was associated with an increased risk of grade 1 thinness (OR 1.56, 95% CI 1.38 to 1.75), grade 2 thinness (OR 1.34, 95% CI 1.10 to 1.64), grade 3 thinness (OR 1.99, 95% CI 1.63 to 2.42) and severe obesity (OR 1.27, 95% CI 1.03 to 1.55) but was not associated with obesity (OR 0.85, 95% CI 0.67 to 1.06).

CONCLUSION

There is a positive association between low BW and thinness or severe obesity risk.

Low birth weight in Jordan: a hospital-based study

Background: Low birth weight (LBW) is one of the leading causes of neonatal and infant morbidity and mortality.Objective: To determine the prevalence and possible risk factors associated with LBW in four regional hospitals in Jordan.Methods: This retrospective study analyzed the medical records of all singleton live births for the period 2011-2015.Results: A total of 22,789 singleton live births were included for this study. Of these, 4133 (18%) had a LBW. Rates of LBW increased over the 5 years study period. Factors associated with LBW were preterm birth, pregnancy complications or comorbidities, older maternal age (≥35 years), first-born infants, and having a female baby.Conclusion: Midwives' assessment and health education messages to mothers included awareness of risk factors associated with LBW of neonates in Jordan. Effective public health interventions need to highlight the importance of a healthy diet and valuing female off-spring.

Association of maternal serum 25-hydroxyvitamin D concentrations in second and third trimester with risk of macrosomia

Whether the maternal vitamin D deficiency is associated with infant birth weight is still an argument. Here, we performed a nested case-control study (545 women who subsequently delivered infant with macrosomia and 1090 controls) to evaluate the association of the maternal serum 25-hydroxyvitamin D [25(OH)D] concentrations with risk of macrosomia. We measured the serum 25(OH)D concentrations by enzyme immunoassays. Logistic regression analysis, receiver-operator characteristic curve analysis and graphical nomogram were used for the statistical analyses. Among women who delivered infant with macrosomia, 71.2% of the women had serum 25(OH)D concentrations <50.0 nmol/L compared with 61.1% of the control women (P < 0.001). For women with concentrations <50.0 nmol/L, they had a 33% increased risk of macrosomia compared with women whose 25(OH)D ranged from 50.0 to 74.9 nmol/L. The risk of macrosomia was significantly increased with the decreasing concentrations of serum 25(OH)D in a dose-dependent manner (P for trend = 0.001). We also observed a threshold for 25(OH)D of 50.0 nmol/L for delivering infant with macrosomia and a predictive accuracy of the 25(OH)D concentrations included panel, with an area under the ROC curve of 0.712 for delivering infant with macrosomia. In conclusion, maternal serum 25(OH)D <50.0 nmol/L is associated with delivering a macrosomic infant, and vitamin D deficiency should be monitored in pregnant women.

Study on the influence of pregnancy-induced hypertension on neonatal birth weight

To explore the effect of pregnancy-induced hypertension (PIH) on neonatal birth weight and provide the necessary reference value for the maternal and children health service. A cross-sectional study was carried out in Shaanxi Province of China in 2013. And a total of 28 045 singleton live infants and their mothers were recruited using a stratified, multistage, probability-proportional-to-size sampling method. Among the 28 045 women of childbearing age surveyed, multiple linear regression and quantile regression analysis all showed that the birth weight of newborns whose mothers had suffered from PIH during pregnancy was significantly lower than those whose mothers had not suffered from PIH during pregnancy from very low to higher birth weight percentiles (q=0-0.85), an average decrease of 137.45 g (β=-137.45, t=-5.77 and p<0.001). When birth weight was at q=0.90-1.00 percentiles, there was no birth weight difference between two groups. The present cross-sectional study indicated that PIH had an effect of on neonatal birth weight. When pregnant women with PIH are identified then the healthcare professional initiates a closer supervision of their pregnancy in order to ameliorate the status of BP and provide a good intrauterine environment for the fetus. In addition, the gynecologists should admonish the pregnant women that their health is related to the health of their fetus, then gravidas may be more engaged to alert their physician and accept early or preventative interventions. And the healthcare professional should ask and be alert to the issues of hypertension during pregnancy.

Association between maternal interpregnancy interval after live birth or pregnancy termination and birth weight: a quantile regression analysis

We used quantile regression (QR) to assess if the length of the interpregnancy interval (IPI) after live birth and pregnancy termination is associated with weight in subsequent birth. The analysis included 9663 and 3400 women with IPI after live birth and pregnancy termination, respectively. For the women after live birth, an IPI < 12 months had negative effects at the 5th and 10th quantiles of the birth weight (BW) distribution. When the BW was beyond the 90th quantile, the BWs of newborns whose mothers with longer IPI (36-59 months) were higher than the reference group (18~23 months). For women after pregnancy termination in the 10^th quantile, it was observed that those pregnant women with IPIs between 36 and 47 months had a negative effect (150 g) on BW compared with the reference group. This finding revealed that mothers with IPI < 12 months resulted in a decrease of 85 g at 75th quantile. The impact of IPI > 119 months in the upper quantile (95^th) had an increase of 330 g in BW. Our results demonstrated that both short (<12 months) and long (>36 months) IPIs are independently associated with higher risks of low birth weight (LBW) and macrosomia.

The role of mother's education in the nutritional status of children in Serbia

OBJECTIVE

The present study aimed to identify the role of mother's education in the nutritional status of children aged 2-5 years in Serbia.

DESIGN

Nationally representative population-based study. Age- and gender-specific BMI percentiles of children were analysed. In accordance with the WHO growth reference, children with BMI less than the 5th percentile were considered undernourished. Logistic regression was used to calculate the association between mother's education and other socio-economic determinants as possible confounders.

SETTING

UNICEF's fourth Multiple Indicator Cluster Survey, conducted in both Roma and non-Roma settlements in Serbia.

SUBJECTS

Children (n 2603) aged 2-5 years (mean age 3·05 years).

RESULTS

Less than 5 % of children aged 2-5 years were undernourished. There were significantly more undernourished children among the Roma population, in the capital of Serbia and among those whose mothers were less educated. There were statistically significant differences according to mother's education in all socio-economic characteristics (ethnicity, area, region of living and wealth index). Mother's level of education proved to be the most important factor for child's nutritional status; place of living (region) was also associated.

CONCLUSIONS

Mother's education is the most significant predictor of children's undernutrition. It confirms that investment in females' education will bring benefits and progress not only for women and their children, but also for society as a whole.

Changes in Socioeconomic Inequality of Low Birth Weight and Macrosomia in Shaanxi Province of Northwest China, 2010-2013: A Cross-sectional Study

Socioeconomic disparities in birth weights (BWs) are associated with lifelong differences in health and productivity. Understanding socioeconomic disparities in BW is presently of concern to develop public health interventions that promote a good start in life in Northwest China. In the study, our objective is to investigate the socioeconomic disparities in low and high BW from 2010 to 2013 in this region.Those single live births were recruited using a stratified multistage sampling method in Shaanxi province from August to December 2013. Data were collected with a structured questionnaire and a review of birth certificates. Socioeconomic status (SES) was stratified based on the calculated household wealth index. Prevalence differences (PDs) and concentration indices (CIs) were used to depict the SES inequality of low BW (LBW) and macrosomia.Information for 28722 single live births born were obtained in Shaanxi province. From 2010 to 2013, the overall rates of LBW decreased, and the difference in LBW across differing SES groups decreased by 0.7% (boys, 0.4%; girls, 0.8%). From 2010 to 2013, the overall rates of macrosomia increased by 14.3% (boys, 17.5%; girls, 7.8%), whereas the PDs in macrosomia across various SES groups remained unchanged. From 2010 to 2013, concentration indices for SES inequalities in LBW and macrosomia confirmed the results shown by differences in prevalence. Compared with mothers of high SES, those in low SES group were significantly older, less educated, engaged in farming with less availabile healthcare, and engaged in unhealthy lifestyles (eg, exposure to secondhand smoke) during pregnancy, regardless of the baby's sex.From 2010 to 2013, in Shaanxi province, the negative association between socioeconomic status and LBW weakened. Rates of macrosomia were higher in those of high SES, but the SES disparities varied insignificantly over the same time. Our findings may provide valuable insights to direct healthcare policies for pregnant women to reduce inequalities in health, quality of life, and productivity for their children as they age into adulthood.