Indian Journal of Community Medlclne Vol XXV, No 4,Oct -Dee ,200O

MATERNAL HEALTH AND LOW BIRTH WEIGHT AMONG INSTITUTIONAL DELIVERIES

Mohammad Zafar Idris, Anuradha Gupta, Uday Mohan,
Anand Kumar Srivastava, Vinita Das*
Upgraded Deptt of Community Me&me,
*Deptt of Obstetrics and Gynaecology,
Kmg George’s Medical College, Lucknow
Abstract:
Research question Whether Incidence of low bxth weight has declmed, dunng last two decades?
GbJecttve To study the mcldence of low birth weight and its association wtth maternal health correlates
Study design Cross-sectional study
PredIctor variables Maternal diseases, nutntlon, physical work, past obstetric comphcatlons, comphcations of pregnancy and utllizatioh
ot ANC services
Outcome vanable Birth weight of newborn
Setting Queen Mary Hospttal, K G Medical College, Lucknow
Pamclpants 889 mothers along with their 901 newborns
Statlstlcal analysis Incidence rate, Z score, Population attnbutable nsk
Results Overall incidence of low birth weight was 32 2% and mean birth weight 2669 7gmsk447 S D Hugh tncidence of LBW was found
to be slgmflcantly associated wtth maternal comphcatlons of current pregnancy, past obstetric history, maternal diseases, ANC status,
dietary intake and nature of work dunng pregnancy

Key words: Maternal health, Low birth weight, Antenatal care, Dietary intake.

Introduction: newborns delivered at Queen Mary Hospital durmg study

Low birth weight 1s a major cause of infant mortality
and IS considered as a sensitive index of natlon’s health and
development A low birth weight infant IS also at increased
risk of being impaired physically o r mtellectually The
frequency of infants weighing2500 gms or less at birth has
for d long served as one of the important indicators of
quality of reproductive performance
The incidence of LBW continues to be high m India,
particularly in Hmdl speaking states, despite adoption of
Health Pohcy m 1983 for bringing it down to below 10
percent by the year 2000 under Health for All by Year 2000
Studies conducted tn the past have shown high
prevalence of low birth weight m Lucknow During past
two decades, several intervention programmes mcludmg
CSSM and RCH, have been launched all over the state to
improve the health status of mothers and children It was m
this context, the present study was designed to find out the
current status of incidence of LBW and associated maternal
health factors m mstltutlonallydelivered newborns
Material and Methods:
period An appropriate sample of 934 mothers was to be
drawn by systematic random sample method by mcludmg
all the mothers dehvenng on alternate days during the
months of August to April Mothers were mtervlewed next
day of delivery and the available health records were
reviewed
A pre-tested schedule was used to record the
mformatron regarding ldentlficatlon of mothers, their
relevant blo-social variables, past obstetrical history,
complications of pregnancy, illness during pregnancy,
utilization of antenatal care, history of dietary intake and
nature of physical activity during pregnancy, along with the
birth weight and sex of new born The mformatlon, thus
collected, was analyzed and tested for statistical
significance Odds ratlo and population attributable risk
were calculated by consldenng the mothers having low
birth weight delivery as cases and normal dehverles as
control group
Observations:

The present study was conducted at Queen Mary A total of 889 (95 1% of estimated) mothers along
Hospital, attached to department of Obstetrics and with their 901 newborn mcludmg 30(3 3%) stlllborns, were
Gynaecology of K G Medical College, Lucknow The included m the present study 12( 1 34%) mothers had twin
study population comprised of mothers along with deliveries

156
 lndran Journal of Community Medicine Vol. XXV, No.4. Oct.-Dec., 2000

Incidence of low birth weight:

Table I: Birth weight in relation to sex of newborn.
Birth werght Male Female Total
(Grams) No.(%) No.(%) No.(%)
<lOOO O(O) l(O.2) l(O.1)
1001-1500 6(1.3) z,~ >* 5(1.2) ll(1.2)
1501-2000 T 22(4.6) 25(5.9) 47(5.2)
2001-2500 “-: 1 113(23.6) 118(27.6) 231(25.6)
2501-3000 . -8 / f 234(49.3) 198(46.3) 432(47.9)
3001-3500 87(18.3) 73(17.1) 160(17.7)
3501 + 12(2.5) 7(1.6) 19(2.1)
Total 474(52.6) 427(47.4) 901(100)
Mean birth weight 2691.7gms + 444 S.D. 2645.6gms k 45 1 S.D. 2669.7gms f 447 S.D.

Overall mean birth weight was found to be 2669.7
gms. f 447 S.D. 32.2% newborns were weighing 2500
grams or less. Among low birth weight babies, only 1(0.3%)
was weighing less than 1000 grams while majority (79.6%)
were in the weight group of 2001-2500 grams. Amongst
normal birth weight babies, majority (70.7%) were in the
weight group of 2501-3000 grams and only 3.1% were
weighing more than 3500 grams. The difference between
male and female infants was not significant.

Maternal Health and LBW:

Table II: Maternal health parameters and low birth weight.
Health parameters No. of Low birth weight Odds ratio p value/PAR’
deliveries No.(%)
Past adverse outcomes 259(28.7%) llkq44.4) 2.13 PC.01
Abortron/miscarriage 26(31.7) 1.23 NS
Still brrth 8 14(66.6) 5.23 PC.01
Neonatal death 44 23(52.3) 2.92 PC.01
Prevrous LBW delivery ’ 67 32(47.7) 2.44 p-z.01
Previous LSCS 32 13(40.6) 1.82 NS
Others / t 13 7(53.8) 2.67 PC.01
Normal 642(71.3%) 175(27.2) 1.00 15.5%’
Maternal illness 109(12.1%) sO(45.8) l.% p<.o5
Acute Infectron 12(66.6) 4.60 PC.01
Chronrc mfections 2 3(42.8) 1.72 p<.o1
Severe anaemia 46 21(45.6) 1.93 PC.01
Cardiovascular disorders 08 3(37.5)
Diabetes mellitus 15 5(33.3) A:$ K
Others 15 6(40.0) 1.53 PC.05
None 792(87.9%) 240(30.3) 1.00 17 3%’
Complications of pregnancy 78(8.8%) 47(60.2) 3.61 pi.01
Pre-eclampsra/eclampsra 31 24(77.4) 8.18 p<.oo1
Antepartum haemorrhage . 15 g(60.0) p<.o1
Rh incompatibility 13 6(46.1) z NS
Hydramnios 7 3(42.8) 1:79 NS
Malpresentations & others 5(41.6) 1.70 NS
None 823(::.4%) 243(29.5) 1.00 8.3%’
Utilisation of antenatal care .
Adequate (23) \i’*, : 528(58.6) 98(18.5) 1.00 42.5%’
Inadequate (l-2) 261(28.9) 129(49.4) 4.28 p-z.01
Nil (0) 112(12.4) 63(56.2) 5.64 pq.01
Total 901 290(32.2)
*Population attributable risk
. ,.= -

Maternal health and low birth weight 157 ldris Mi! et al

 lndlan Journal of Community Medlclne Vol XXV, No 4, Oet -Dee ,200O

I. Past obstetric history and LB W: 3. Complications of pregnancy and LB W:

A total of 259 mothers (28 75%) had previous adverse
obstetric history and 44 40% of them had LBW dehverles
The difference between normal hlstory and history of still
birth, neonatal death, previous LBW delivery was found to
be statlstlcally slgmftcant (z=3 94, p< 01, z=3 54, p< 01,
z=3 4, p< 01 respectively)
2. Significant maternal illness during pregnancy and
LBW: .
A total of 109 mothers (12 1%) had significant illness
during their pregnancy and 45 8% of them delivered LBW
babies Highest mcldence (66 6%) of LBW was observed
among mothers who had stgmficant acute infection,
followed by 45 6%. 42 8% and 37 5% among severely
anaemic, with chronic mfectlons and cardiovascular
disorders respectively and was lowest (33 3%) m dlabetlc
mothers The difference between mothers with and wlthout
Illness was statlstlcally significant, (z=2 06, p< 05) The
difference between mfectlous and non-mfectlous diseases
was also found to be statIstIcally slgmflcant (z=3 16,
PC 01)
8 6 percent mothers had some comphcatlons of
pregnancy and the Incidence of LBW amongst them was
60 26% Toxaemia of pregnancy was associated with
highest (77 42%) rncldence of low birth weight followed by
haemorrhage (60 0%). Rh mcompatlbthty ( 4 6 15%),
Hydrammos (42 86%) and malpresentatlons and others
(41.6%) The difference between normal and comphcated
cases was found to be statlstlcally slgmftcant (z=5 55,
P< 05)
4. Utilization of antenatal care and LB W:
Highest incidence of low birth weight (56 25%) was
observed m the mother who did not recetve any antenatal
care, followed by 49 43% m those taking inadequate care
and the difference between the two groups was not found to
be slgnlficantThe lowest incidence (18 56%) was observed
among those avalhng adequate care and the difference
between them and those availing Irregular or no care was
found to be statlstlcally highlysignificant(z=9 01, pc 001)

Nutritional parameters and LB W:

Table III: Dietary intake, physical activity and LBW.
Nutritional parameters Dehverles Low birth weight Relative risk p value/PAR*
No (%) No % incidence

Additional dietary intake

None 278(30 8) 104(37 4) 21 pc 001
Inadequate 459(50 9) 157(34 2) 19 p<OOl
Adequate 164(18 2) 29(17 6) 10 45 3%*
Physical activity during pregnacy
Sedentary 296(32 9)‘ 79(26 6) 13 p<Ol
Mild/normal 281(31.2) 57(20 3 ) 10 3 6 9%*
Moderate + 324(35 9) 154(47 5) 23 p< 001
Total 901 290(32 2)

*Population attributable nsk.

1. AaMtional dietary intake during pregnancy and LB W:
The mctdence of LBW was maximum (37 4%)
amorig those taking no addItiona diet, followed by 34 2%
among those taking inadequate addItiona diet, whde it was
lowest (17.6%) among mothers taking adequate additIona
diet during pregnancy The difference between mothers
taking adequate additional diet and those taking either
Inadequate or no addlttonal diet was statlstlcally highly
significant (z=4 3 1, p< 001).

Maternal health and low birth weight 158 ldns MZ et al


2. Physrcal actwrty during pregnancy and LB W:
The mcldence of LBW was highest (47 5%) amongst
mothers engaged m moderate to heavy actlvlty, followed by
those In sedentary actlvlty (26 6%) and was lowest amongst
those havmg normal or mild actlvlty durmg their
pregnancy The difference between moderate to hard
workmg mothers and either those engaged m sedentary or
mild work was statIstIcally highly slgmflcant (z=7 01,
p<OOlandz=535,pcOOl)
Discuscion:
The lncldence of LBW, was found to be high (32 2%)
Overall, mean birth weight was 2669gms +447 S D The
mcldence of LBW has shown a very dlsturblng Increase
durmg last twenty years when it was reported to be only
18 2% with mean birth weight of 2876 6 gms by Azam et
al (1980)’ and 23 1% by Krlshnan et al (I 988)2 from the .
same lnstltutlon Slmllarly, high lncldence has also been
reported by UNICEF-ICMR ( 1987)3 from slums and rural
areas and Parmar et al (1987)“ However, Lompalatlvely
lower rates have been observed by Lawolyn et al (1994)’
from Ibddan, Nlgerla and Malvanker et al (1992)h from
Ahmedabad city Past hlstory of obstetric comphcatlons
was found to be associated with Increased mcldence of
LBW dcllverles These results are slmllar to those made by
Malvanker et al (1992), who reported that poor obstetric
hlstory was an Independent risk factor for both term and
preterm LBW Infants while Soltam et al (1991)’ observed
that abnormal birth during previous pregnancy along with
other factors were associated with LBW dehverles m
subsequent pregnancies Past hlstory of adverse outcome
was also found to be slgmflcantlyassociated with adverse
outcome m the present pregnancy Bukketla et al (1993)“,
Luke et al (1993)” and Rame et al (1994)“’ have reported
slmllar fmdmgs, slgmfylng that women with previous
hlstory of comphcatlons and adverse outcome were more
hkely to have LBW dehverles In subsequent pregnancies
The relatlonshlp between maternal diseases and !ow birth
weight IS a controversial SubJect Maternal diseases, both
mfectlous and chrome diseases, m the present study, were
found to be slgmflcantly associated with mcreasmg
mcldence of LBW Severe anaemla (Hb<7gm%) was found
to be slgmflcantlyassociated with LBW The role of severe
anaemla m pre-maturity and low birth weight IS well
estabhshed’
Maternal health and low birth weight
lndlan Journal of Community Medlclne Vol XXV, No 4,Oct -Dee ,200O
Mothers takmg adequate addItIona diets were havmg
slgmflcantly lower mcldence of LBW m comparison to
those either taking Inadequate or no addItIonal diet durmg
their current pregnancy These fmdmgs are slmrlar to
Raman et al (1981)” and Bhatla et al (1983)“, both
observed tha\ the intrauterine growth improved
slgmfrcantly with mcreasmg mtake of calories m rural and
urban pregnant women Toxaemla of pregnancy was found
to be associated with the maxlmum (77 4%) mcldcnce of
low birth weight and Its asboclatlon with low birth wclght
was highly significant Deorarl et al ( 1985)” and Lm Rx
( 1993)14, observed that eclampsla and pre-eclampsla were
the maJor risk factors associated with LBW Modcratc to
heavy physlcal actlvlty durmg pregnancy was slgmficantly
associated with low birth weight m the present stud) These
results conform to fmdmg of UNICEF-ICMR (1987)’ and
Pomerance et al (1974)15 Different authors have given
different explanations, Pomerance et al (1974)” and Naeye
( 1981)‘h have observed that hard work m standlng posItIon
and hot chmate, reduces the placental blood flow A
slgmficantly higher mcldence of low birth weight was
found among those mothers who received Inadequate or no
care at al!, compared to those recelvmg adequate antenatal
care These fmdmgs are slmllar to those made by Soltam et
al ( I99 I)’ and Ferraz et al ( 1990)”
Thus, the results of the present study reveal that the
mcldence of low birth weight IS still high m the area and
achievement of goal of less than 10 percent, set under the
HFA by 2000 AD IS still a distant dream The control of
dssoclated risk f a c t o r s , particularly, addItIonal dietary
intake (PAR=45 3%) and optlmal utlhzatlon of antenatal
care (PAR=42 5%) durmg pregnancy, need to be addressed
on prlorlty basis to achieve the target of 10% mcldcnce of
low birth weight
References:
1 Azam MA Study of birth weight of children with
special reference to maternal serum protelnb Thesis
SubmItted t o Lucknow Umverslty, Lucknow f o r
Award of MD m Social and Preventive Medlcmc
(1980)
2 Krlshnan V, Idrls MZ, Srlvastava VK, Bhushan V et
al High risk scormg and pregnancy outcome m
mstltutlonal dehverles Indian J Commumty
Medicine, (1988) October, Vol XIII, No 4, 176 9
159 ldns MZ et al
 lndlan Journal of Community Medicme Vol XXV, No 4. Ott -Dee , 2000

3 UNICEF-ICMR report UNICEF proJect - 1984
Extracted from future 1986, 17 53-7, Indian J
Paedlatncs, 1987, 801- 18
4 Parmar VR, Bahl L, Sood KK, Randhawa I
Anthropometrlc measurement and prevalence of low
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6 Malvanker DV, Gray RH, Trlvedl CR Risk factors
f o r p r e - t e r m a n d t e r m l o w birth weight m
Ahmedabad, India Int J Epldemlol 1992, 21(2)
263-72
7 Soltam MS, Guedtche MN, Bachlr A, Ghanem H et
al Factors associated with low birth weight in
Tumslan Sahel Arch Fr Pedtatr 199 I, 46(6) 405-6
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et al Pregnancy risk tactors for small for gebtatlonal
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ALta Obstet Gynaec Scan 1993,74(4) 273-9
9 Lube B , Wllhams C , M m o q u e J , Keith L The
changmg pattern of Infant mortality m the USA, The
lole o f p r e n a t a l f a c t o r s a n d their obstetrIca
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11 Raman L Anaemla m pregnancy - Post Graduate
Obstetric & Gynaecology, Madras, Orient Longman
Pubhshers 1981,20 393-69
12 Bhatla BG, BanerJee M, Agrawal DK, Agrawal KN
Foetal growth-relatlonshtp with maternal dietary
intakes Ind J Pedlatr 1983, 50 113-20
13 Deoran AK, Paul VK, Smgh M Permatal outcome m
hypertensive diseases of pregnancy Indian Pedlatr
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14 Lm Rx Maternal medical and obstetric comphcatlons
are maJor risk factors for low birth weight Chang Hua
Fu Chan Ko Tsa Chma 1993, 28( 1) 24-6
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pregnancy - Its outcome on pregnancy outcome Am
J Obstet Gynaecol 1974, 179 867-76
16 N a e y e R L Nutntlonal/non-nutrltlonal mteractlon
that affect the pregnancy outcome Am J Chn Nutr
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17 Ferraz EM, Ggray RH, Cunha TM Determmant of
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101-8

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Maternal health and low birth weight ldrls MZ et al