Reference ID: 2015-01033

Title: Maternal obstetric factors associated with low birth weight and neonatal outcome.

Introduction

Low birth weight is a major cause of infant mortality and is a major sensitive
indicator of the nations health and development. It also indirectly reflects the social,
demographic and health status of the women.

The World Health Organization1 defines low birth weight (LBW) as a weight at
birth less than 2500 gm (upto and including 2.499g) irrespective of gestational age.

More than 20 million infants worldwide representing15.5% of all births are born
with low birth weights (LBW). The global prevalence of LBW is 17%, with the highest
prevalence in South Asia. In fact, more than half the LBW babies are born in South Asia.
The incidence of LBW continues to be high in India. It is estimated to be as high as
33%2. The etiology of LBW is multifactorial. The two major causes are pre-term birth
before 37 weeks of gestation and of restricted fetal growth. Major determinants of LBW
are socio demographic factors3, 4 such as poor maternal nutritional status at conception,
low gestational weight gain, short maternal status, low BMI, inadequate ante natal care,
lack of education, and gender discrimination. Obstetrics causes, such as bleeding in the
first and second trimester, pre-eclampsia, malpresentation are also associated with low
birth weight. Consequences of LBW2 include short-term morbidity like hypothermia,
hypoglycemia and polycythemia. LBW is also closely associated with neo-natal mortality
and morbidity, inhibited growth and cognitive development and chronic diseases in later
life such as diabetes, hypertension, and cardio vascular disease.

Many studies have accounted for the risk factors of LBW, as well as for neo natal
outcomes. The short-term outcomes of antepartum labor and post partum care of LBW
infants have not been well documented. The present study will be conducted in order to
determine delivery influences and perinatal outcomes of LBW neonates.
Objectives

1. To study socio demographic and obstetric factors associated with low birth weight
infants
2. To study outcome of low birth weight babies

Methodology

Study design

Retrospective case control study

Study setting

This study will be conducted in obstetric and neonatal unit of a tertiary referral
hospital between May 2015 to June 2015.

Cases

Women giving live birth to infant with birth weight less than 2500gms will be
enrolled as cases.

Controls

Women giving live births to infants with birth weight equal or more than to
2500gms will be enrolled as controls.
Sample size was calculated with

Prevelence of LBW as 30.3%5

Alpha = 0.05
Effect size d = 0.80
Sample size (case)= 70
Sample size (control)= 70
Power of test =0.95

During the study period of 2 months 70 consecutive women giving birth to LBW
babies and 70 controls will be enrolled in a ratio of 1:1.

Data Collection

Approval will be taken from Institutional Ethical Committee before the initiation
of the study.

Babies born during the study period will be weighed on an electronic weighing
machine within 1 hour of birth. Women will be interviewed after taking written consent
and the case records will be studied with complete confidentiality.

Socio-demographic characteristics of women including age, residence, marital

status, occupation, working hour will be obtained. Socio-economic status will be assessed
by family income and classified by Modified Kuppuswamy scale6.

Womens occupation and total number of working hours during every trimester of
pregnancy will be noted.

Personal habits of tobacco chewing, smoking (active/passive), and alcohol

consumption will be assessed. Nutritional intake will be calculated by daily intake of
calories for seven days and type of diet (vegetarian or non-vegetarian). BMI will be
calculated on the basis of weight (kgs) and height (cms). Weight gain during pregnancy
will be assessed from antenatal records whenever available6.
 Obstetric factors such as gestational age will be calculated from last menstrual
period and also from ultra sonography record in the first trimester whenever available.

Antenatal care will be assessed by her antenatal visit record and classified
according to WHO classification7. Obstetric history of women including parity, before
history of abortion, stillbirth or pre-term birth and interpregnancy interval will be noted.

History of bleeding per vaginum during first or second trimester will be noted.
Hospital records will be studied for presence of pregnancy complication such as anemia,
fever and other medical disorders. Presence of pre-eclampsia and eclampsia, diabetes,
premature rupture of membranes and third trimester bleeding will be noted.

Labour details, mode of delivery, APGAR at birth and 5 minutes need for
antibiotics and admission to NICU will be noted. Neonatal mortality within 7 days and
cause of death of the baby will be studied.

Implications

The study will help to detect antenatal and interpartum factors associated with
LBW babies and their influence on neonatal outcome. The management of modifiable
factors may help reduce the incidence of low birth weight babies and its associated
morbidities and mortalities.
References

1. Low birth weight, country, regional and global estimates, WHO UNICEF, 2000
2. H.P.S Sachdev INT. J Diab dev. Asia, Countries 2001; vol. 21
3. Michel D. kogan social causes for low birth weight. Journal of royal society of
medicine vol. 88, Nov. 1995; 88:611:615
4. T.R. Radhakrishnan, K.R. Thankappan, R.S. Vassan, socioeconomic and
demographic factors associated with birth weight. A community based study in
Kerala, Indian Paediatrics 2000; 37:872-876
5. J.S. Deshmukh, D.D. Motghare, S.P. Zodpey and S.K. Wadhva, Low birth weight
and associated maternal factors in Urban area. Indian Paediatrics January 1998;
vol. 35
6. John Park Evrette Text book or preventive and social medicine 2013, 22nd
edition
7. WHO Antenatal care classification None- nil, poor 1-3, fair 3-5 adequate >=5