Professional Documents
Culture Documents
The Association between Antenatal Care and Low Birth Weight newborn at
Bhumibol Adulyadej Hospital, Thailand
Teenat Kanjanasingh, MD., Buppa Smanchat, MD., Sinart Prommas, MD.
Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Bangkok, Thailand
Objective : To study the association between antenatal care and low birth weight newborn.
Material and Method : Case control study, There were 2312 pregnant women who delivered at Bhumibol
Adulyadej Hospital during January 1 to July 31, 2011. Study group was 168 pregnant women who delivered
newborn whose body weight less than 2500 grams and control group was 168 pregnant women who
delivered newborn which birth weight 2500 to 4000 grams selected by systematic random sampling. Multifetal
pregnancy, still birth and newborn with severe congenital anomaly incompatible with life were excluded
from this study.
Results : Antenatal care equal or greater than 4 visits was not correlated with low birth weight newborn
(OR 0.92, 95 % CI 0.722.10). Good antenatal care was the protective factor of low birth weight newborn (OR
1.91, 95 % CI 1.053.45). Other protective factors of low birth weight newborn were body weight before
pregnancy greater than 45 kilograms (OR 2.80, 95 % CI 1.29 6.09), total weight gain during pregnancy
equal or greater than 10 kilograms (OR 2.88, 95 % CI 1.28 - 6.48). Risk factor of low birth weight was
obstetric complication (OR 0.09, 95 % CI 0.03-0.23).
Conclusion : Antenatal care equal or greater than 4 visits was not the protective factor for low birth weight
newborn. But good antenatal care was the protective factor of low birth weight newborn.
Keywords : Antenatal care, Low birth weight
Royal Thai Air Force Medical Gazette, Vol. 59 No.2 May - August 2013
Introduction
Low birth weight (LBW) has been defined
by World Health Organization as weight at birth less
than 2,500 grams (g) (5.5 pounds). A babys low
weight at birth is either the result of preterm birth
(before 37 weeks of gestation) or restricted fetal
(intrauterine) growth. Low birth weight is closely
associated with fetal and neonatal mortality and
morbidity, inhibited growth and cognitive
development, and chronic diseases later in life1.
In Thailand, 10th National Economic and
Social Development Plan (2007-2011)2 were aimed to
reduce the LBW incidence to lower than 7 % of all
births. The incidence of LBW in Bhumibol Adulyadej
Statistic Analysis
Data were presented as frequency. The
results were analyzed by univariate analysis followed
Result
Form January 1 to July 31, 2011, there were
2312 deliveries in Bhumibol Adulyadej Hospital.
There were 209 low birth weight deliveries, accounted
for 9.04 %. According to the study criteria, the study
group was 168 low birth weight cases. The control
group was 168 normal birth weight cases.
Table 1 showed the maternal demographic
data in both groups, including age, parity, and
history of abortion, occupation, income and
education. All data of two groups were not different
significantly.
In univariate analysis (table 2), the
significant protective factor of low birth weight were
ANC > 4 visits, good ANC, pre-pregnancy body
weight > 45 kg, total weight gain during
pregnancy > 10 kg. The risk factors of low birth
weight were bad obstetric history and obstetric
complication.
Multivariate analysis (Table 3) demonstrated
that the significant protective factors were good ANC
(OR=1.91, 95 % CI = 1.05-3.45), pre-pregnancy body
weight > 45 kg (OR=2.80 95 % CI = 1.29-6.09), total
weight gain during pregnancy > 10 kg (OR = 2.88,
95 % CI = 1.28-6.48). The risk factor was obstetric
complication (OR = 0.09, 95 % CI = 0.03-0.23).
Low birth weight (n=168) (%) Normal birth weight (n=168) (%) p-value
0.68
32 (19.05)
101 (60.12)
35 (20.83)
27 (16.07)
117 (69.64)
24 (14.29)
0.74
Parity
Nullipara
Parity =1
Parity > 2
88 (52.38)
55 (32.74)
25 (14.88)
81 (48.21)
60 (35.72)
27 (16.07)
Abortion
37 (22.02)
38 (22.62)
Gestational age
GA < 37 wk
GA > 37 wk
94 (55.95)
74 (44.05)
24 (14.28)
144 (85.72)
Occupation
Unemployed
Business
Government
Employed
Student
Income (Baht)
<10000
10,000-20,000
20,001-30,000
>30000
Education
No education
Primary
Secondary
Bachelor
>Bachelor
0.96
0.06
56 (33.33)
13 (7.74)
12 (7.14)
85 (50.60)
2 (1.19)
72 (42.86)
16 (9.52)
4 (2.38)
72 (42.86)
4 (2.38)
0.52
35 (20.83)
92 (54.77)
21 (12.50)
20 (11.90)
46 (27.38)
86 (51.19)
21 (12.50)
15 (8.93)
0.19
6 (3.57)
28 (16.67)
99 (58.93)
29 (17.26)
6 (3.57)
2 (1.19)
32 (19.05)
104 (61.90)
29 (17.26)
1 (0.6)
ANC > 4
Good ANC
Age < 20 year
Pre-pregnancy body weight > 45 kg
Pre-pregnancy body mass index > 20
Height > 145 cm
Total weight gain > 10 kg
Maternal underlying disease
Bad obstetric history*
Obstetric complication**
Smoking
Alcohol drinking
132 (78.57)
62 (36.90)
32 (19.05)
96 (57.14)
85 (50.59)
164 (97.61)
82 (48.80)
11 (6.54)
12 (7.14)
43 (25.59)
6 (3.57)
4 (2.38)
149 (88.69)
86 (51.19)
27 (16.07)
134 (79.76)
97 (57.74)
165 (98.21)
137 (81.54)
9 (5.35)
3 (1.78)
8 (4.76)
3 (1.78)
1 (0.59)
1.66
1.26
1.10
1.78
1.05
4.07
2.40
0.98
0.94
0.78
0.98
0.98
95% CI
1.02-2.70
1.04-1.57
0.84-1.43
1.26-2.52
0.72-1.70
0.46-36.05
1.70-3.40
0.93-1.04
0.90-0.99
0.71-0.85
0.94-1.01
0.95-1.01
* Bad obstetric history included prior preterm birth, prior low birth weight, prior stillbirth, prior fetus with
congenital anomaly, prior early neonatal death
** Obstetric complication included gestation hypertension, preeclampsia, eclampsia, fetal growth
restriction, abnormal amniotic fluid, and placenta previa and placenta abruption
Table 3 Multiple logistic regression analysis
Protective Factors
ANC > 4
Good ANC
Total weight gain > 10 kg during pregnancy
Pre-pregnancy body weight > 45 kg
Bad obstetric history
Obstetric complication
95 % CI
0.92
1.91
2.88
2.80
0.22
0.09
0.72-2.10
1.05-3.45
1.28-6.48
1.29-6.09
0.04-1.00
0.03-0.23
Discussion
The result from the multiple logistic
regression analysis models showed that number
of antenatal care 4 visits or more was not the
significant protective factor of low birth weight
(OR = 0.92, 95 % CI = 0.72-2.10). While in other
studies, number of antenatal care less than 4 time
was the significant risk factor of low birth weight4-7
Despite Tripeds study showed antenatal care less
Conclusion
This case control study showed that at least
4 visits of antenatal care 4 visits was not the
protective factor for low birth weight. Good ANC
in Bhumibol Adulyadej Hospital was the significant
protective factor. Other significant protective factor
was pre-pregnancy body weight > 45 kg and total
weight gain > 10 kg during pregnancy whereas the
significant risk factor was obstetric complication.
Reference
1.