Demographic surveillance over 12 years helps elicit determinants of low birth weights in India

Birthweights at term have increased globally: insights from a systematic review of 183 million births

OBJECTIVE

This study aimed to assess global trends in mean birthweights at term, as reported in peer-reviewed literature.

DATA SOURCES

We electronically searched PubMed, Embase, and Web of Science up to September 2023, using combinations of the search terms: "birth weight"; "birth-weight"; "birthweight"; "trend". There were no restrictions based on language or geographic area.

STUDY ELIGIBILITY CRITERIA

We included all ecological and observational studies reporting mean birthweight at term as a continuous numerical variable over time.

METHODS

We assessed the quality of included studies using the Dufault and Klar checklist modified by Betran et al. Univariate and multivariate linear models were used to examine the effects of time (years) and geographical origins. Subgroup analyses focused on national data sources and on data collected from 1950 onward.

RESULTS

Among 6447 reviewed articles, 29 met our criteria, reporting mean birthweight data from over 183 million infants worldwide. Most studies were hospital-based (48.3%), 44.8% used national data, and a minority used municipality, community, or regional data (6.9%). Geographically, North America (31.0%) had the highest representation, followed by Asia and Europe (27.6% each), and South America and Oceania (6.9% each). Our univariate linear regression model (Model 1) revealed a significant increase in mean birthweight at term over time (4.74 g/y; 95% confidence interval, 3.95-5.53; P<.001). Model 2, incorporating continental dummy variables into the first model, confirmed this trend (3.85 g/y; 95% confidence interval, 2.96-4.74; P<.001). Model 3, focusing on available national data, did not find a significant relationship. Model 4 narrowed its focus on records from 1950 onward, reporting a robust annual increase of 7.26 g/y (95% confidence interval, 6.19-8.33; P<.001). Model 5, adjusting for the number of participants included in each study, reported a conclusive mean term birthweight increase of 1.46 g/y (95% confidence interval, 0.74-2.18; P<.001).

CONCLUSION

This systematic review of 29 studies shows an increase in term birthweights over time, particularly when considering data since 1950. Limitations include study quality variations, data source diversity, and data sparsity, underscoring the need for future research to use precise gestational age distinctions and predetermined time frames to gain a deeper understanding of this trend and its implications for maternal and child health.

Sociodemographic patterns of preterm birth and low birth weight among pregnant women in rural Mysore district, India: A latent class analysis

Few studies have utilized person-centered approaches to examine co-occurrence of risk factors among pregnant women in low-and middle-income settings. The objective of this study was to utilize latent class analysis (LCA) to identify sociodemographic patterns and assess the association of these patterns on preterm birth (PTB) and/or low birth weight (LBW) in rural Mysore District, India. Secondary data analysis of a prospective cohort study among 1540 pregnant women was conducted. Latent class analysis was performed to identify distinct group memberships based on a chosen set of sociodemographic factors. Binary logistic regression was conducted to estimate the association between latent classes and preterm birth and low birth weight. LCA yielded four latent classes. Women belonging to Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more", had higher odds of preterm birth (adjusted Odds Ratio (aOR): 95% Confidence Intervals (CI): 1.77, 95% CI: 1.05-2.97) compared to women in Class 4 "high SES/later marriage/primigravida/no children". Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight (aOR: 2.52, 95% CI: 1.51-4.22) compared to women in Class 4. Women less than 20 years old were twice as likely to have PTB compared to women aged 25 years and older (aOR: 2.00, 95% CI: 1.08-3.71). Hypertension (>140/>90 mm/Hg) was a significant determinant of PTB (aOR: 2.28, 95% CI: 1.02-5.07). Furthermore, women with a previous LBW infant had higher odds of delivering a subsequent LBW infant (aOR: 2.15, 95% CI: 1.40-3.29). Overall study findings highlighted that woman belonging to low socioeconomic status, and multigravida women had increased odds of preterm birth and low birth weight infants. Targeted government programs are crucial in reducing inequalities in preterm births and low birth weight infants in rural Mysore, India.

Study on low birth weight and its associated factors among newborns delivered in a tertiary care hospital of Banda district, Uttar Pradesh

Background: Low birth weight is associated with higher morbidity and mortality including impaired growth and development, malnutrition etc. Worldwide, one- fifth of newborns delivered are low birth weight. Aims & objectives: To estimate frequency of low birth weight & its associated factors among newborns delivered in a tertiary care hospital. Materials & Methods: A cross sectional analysis of 290 newborns delivered in tertiary care hospital, Banda, Uttar Pradesh during period of 15th February 2021 to 31st December 2021 was done for estimating low birth weight frequency & its associated factors including child characteristics, mother characteristics & father characteristics using data from medical record section of hospital. Frequency, percentages, mean, standard deviation, chi square test & independent t- test was used. P value <0.05 was considered significant. Results: 91 out of 290 newborns delivered were low birth weight (27.9%, 95% CI- 23.1%- 33.4%). The following factors were shown to have a significant association with low birth weight: education of mother (p=0.04), education of father (p=0.03), occupation of father (p=0.02), and duration of pregnancy (p<0.001). Conclusion: This study demonstrated that education of mother, education of father, occupation of father, and duration of pregnancy had significant association with low birth weight frequency that suggests that improving literacy status can help in decreasing burden of low birth weight apart from other factors.

U-Shaped Association between Maternal Hemoglobin and Low Birth Weight in Rural Bangladesh

Low birth weight (LBW) is associated with a higher risk of neonatal mortality and the development of adult-onset chronic disease. Understanding the ongoing contribution of maternal hemoglobin (Hgb) levels to the incidence of LBW in South Asia is crucial to achieve the World Health Assembly global nutrition target of a 30% reduction in LBW by 2025. We enrolled pregnant women from the rural Tangail District of Bangladesh in a Maternal Newborn Health Registry established under The Global Network for Women's and Children's Health Research. We measured the Hgb of pregnant women at enrollment and birth weights of all infants born after 20 weeks gestation. Using logistic regression to adjust for multiple potential confounders, we estimated the association between maternal Hgb and the risk of LBW. We obtained Hgb measurements and birth weights from 1,665 mother-child dyads between July 2019 and April 2020. Using trimester-specific cutoffs for anemia, 48.3% of the women were anemic and the mean (±SD) Hgb level was 10.6 (±1.24) g/dL. We identified a U-shaped relationship where the highest risk of LBW was seen at very low (< 7.0 g/dL, OR = 2.00, 95% CI = 0.43-7.01, P = 0.31) and high (> 13.0 g/dL, OR = 2.17, 95% CI = 1.01-4.38, P = 0.036) Hgb levels. The mechanisms underlying this U-shaped association may include decreased plasma expansion during pregnancy and/or iron dysregulation resulting in placental disease. Further research is needed to explain the observed U-shaped relationship, to guide iron supplementation in pregnancy and to minimize the risk of LBW outcomes.

Low birth weight and birth weight status in Bangladesh: A systematic review and meta-analysis

The prevalence of low birth weight (LBW) is high in Bangladesh, but no study has collated recent estimates of LBW prevalence from throughout the country. The aim of this meta-analysis was to evaluate the prevalence of LBW and birth weight status in Bangladesh. We searched PubMed, Medline, Ovo and Google Scholar to find published articles in national and international journals from 2000–2020 and reviewed for relevance. Meta-analysis and Q test were performed to estimate the prevalence and heterogeneity of LBW from all included articles. Meta-regression was done to quantify associations with sample size and study year. Stratified analysis was conducted and effect size calculated for differences in LBW prevalence by sex, division and urban/rural area. In total 48 studies with 166,520 births were found and included in this meta-analysis. The pooled prevalence of LBW was 29.1% (95% CI, 28.9–29.3%) in overall, 29.9% (29.7–30.2%) in rural and 15.7% (14.9–16.6%) in urban areas. There was no significant difference in average birth weight between boys and girls (SD, 0.71; 95% CI, −0.43–1.83). Prevalence of LBW was higher in north-east Bangladesh compared to other zones (p<0.05). The pooled prevalence of LBW did not change significantly for last two decades. The prevalence of LBW in Bangladesh remains high. Lack of improvement suggests an urgent need for scaled up maternal and prenatal interventions and services known to reduce LBW. Urban/rural and divisional differences in rates suggest areas of greatest need.

Maternal exposure to cooking smoke and risk of low birth weight in India

Over half of the households in India are using unclean cooking fuels (UCF) and exposed to harmful pollutants that has adverse effects on weight of new born baby. Though studies examined the contextual determinants of birth weight, the association of cooking practices and kitchen location with low birth weight (LBW) is limited in India. This paper investigates the comprehensive effects of household air pollution (HAP) on LBW, mean birth weight (MBW) and birth size in India. Data from 93,721 full-term singleton births from the fourth round of National Family Health Survey, conducted during 2015-16 is used in the analyses. Binary logistic and linear regression methods were used to assess the effect of cooking practices on the outcome variables. Children born in households using clean cooking fuels (CCF) (2877 g, 95% CI: 2876-2877) had 80 g higher birth weight compared with UCF (2797 g, 95% CI: 2796-2798). Households using UCF and cooking without separate kitchen (2779 g, 95% CI:2778-2780) had 59 g and 98 g lower MBW as compared to the households using UCF and cooking in separate kitchen (2817 g, 95% CI:2816-2818) and CCF respectively. Significant associations of LBW observed with the place of cooking and cooking practices but no significant association found for cooking fuels. The HAP from poor cooking practices is associated with risks of LBW in India. Transition from unclean to clean fuels, provision of the separate kitchen should be encouraged to reduce the maternal exposure to HAP and improve birth outcomes.

Reducing rates of discharge against medical advice in the neonatal intensive care unit in a tertiary care hospital in South India: a mixed-methods study

OBJECTIVE

To elucidate characteristics among neonates and their mothers who were discharged against medical advice (DAMA), providers' perspectives on DAMA and the effect of an intervention to reduce DAMA in a tertiary care hospital in South India.

METHODS

We conducted a mixed-methods study to identify neonates at risk of DAMA. We reviewed charts of neonates and their mothers who were DAMA and conducted logit regression analysis to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to determine associations with DAMA. We conducted focus group discussions with nurses and doctors. We developed an intervention that included family counselling, supplemental funds for hospital bills and involving family members to reduce DAMA.

RESULTS

Of 10 834 neonates, 179 (1.7%) were DAMA over the study period. Maternal characteristics associated with DAMA included higher previous parity (aOR 1.9, 95% CI 1.1-2.3, P = 0.001). Mothers who received antenatal care had lower odds of DAMA (aOR 0.2, 95% CI 0.1-0.7, P = 0.039). Neonates with lower birth weight (aOR 2.1, 95% CI 1.7-9.4, P = 0.002) and congenital malformations (aOR 3.3, 95% CI 1.1-5.3, P = 0.005) also had higher odds of DAMA. The most commonly cited reasons for DAMA were financial constraints, inadequate counselling and perceived poor prognosis. The average monthly number of neonates who were DAMA decreased from 3.6 (1.6%) to 1.5 (0.6%) after our multi-pronged intervention.

CONCLUSIONS

Neonates with severe illness and poor prognosis had higher odds of DAMA. A multi-pronged intervention demonstrated reductions in the rates of DAMA. This intervention may be trialled in similar settings to reduce DAMA.