|Year : 2014 | Volume
| Issue : 1 | Page : 20-24
A study of birth weight of full term neonates and its' determinants
Yugantara R Kadam, Randheer V Dhoble, Alka D Gore
Department of PSM, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra, India
|Date of Web Publication||10-Dec-2013|
Yugantara R Kadam
Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Low birth weight (LBW) is highly prevalent in India and has a multifactorial causation. There is a need to study and identify the modifiable and non-modifiable risk factors determining birth weight. This will help in planning ante natal care more effectively. Materials and Methods : Study-type-cross-sectional study-setting: Hospital based. Study-subject: Mothers and their new borns. Sample size: All the births taken place during the study period. Study period: July 2010-June 2011. Study tools : (0 i) Questionnaire. (ii) pediatric weighing machine. Inclusion criteria : m0 others attending ante natal care (ANC) clinic from 1 st trimester with minimum three antenatal visits, non-anemic at the end of 2 nd trimester, had full-term and singleton delivery. Exclusion criteria : H/O pregnancy induced hypertension (PIH), diabetes mellieutus (DM), tuberculosis (TB), urinary tract infection (UTI), delivered preterm and tobacco chewers or mishri users. Statistical Analysis : Percentages, mean and SD of birth weight, χ2 test, ANOVA, Z-test, and Binary logistic. Results: By using birth weight as a continuous data it was observed that birth-weight was significantly associated with maternal age (F = 3.360, df = 2, P = 0.035), education (F = 4.401, df = 4, P = 0.002) and breakfast (z = 3.970, P = 0.00). Proportion of LBW was 42.4%. For analysis, groups of newborns on the basis of birth weight showed significant association between LBW and maternal education (χ2 = 12.734, df = 4, P = 0.013), breakfast (χ2 = 13.241, df = 1, P = 0.00) and evening snacks (χ2 = 4.275, df = 1, P = 0.013). According to the binary logistic regression, breakfast and education were significant and best predictors for birth weight. Conclusion: Education and breakfast are strong determinants of birth-weight. Less educated women need more intense health education.
Keywords: Birth weight, determinants of birth weight, diet, nutrition
|How to cite this article:|
Kadam YR, Dhoble RV, Gore AD. A study of birth weight of full term neonates and its' determinants. Med J DY Patil Univ 2014;7:20-4
| Introduction|| |
Birth weight reflects gestational conditions and development in the fetal period.
In 1975, the World Health Organization defined low birth weight (LBW) as birth weight less than 2,500 g, and considered it as a consequence of premature interruption of pregnancy and/or intrauterine growth restriction.  Even nowadays, the etiology for LBW is complex, and it has remained as a public health problem in many countries and different regions of the world.  Birth weight is an important indicator of a child's vulnerability to the risk of childhood illness and chances of survival. There is considerable evidence, mostly from developed countries, that intra uterine growth retardation (IUGR) is associated with an increased risk of coronary heart disease, stroke, diabetes, and raised blood pressure.  The rapidly increasing burden of chronic diseases is a key determinant of global public health. Already 79% of deaths attributable to chronic diseases are occurring in developing countries, predominantly in middle aged men.  LBW is highly prevalent in India and has a multifactorial causation. According to Natinal Family Health Survey 3, 22% births were LBW.  In India more than half of LBW babies are born at term.  The birth weights have hardly changed over the years especially in some rural areas. 
This study was planned to identify determinants of birth weight of full-term babies of mothers who had uneventful pregnancy, which will help in planning ante natal care more effectively.
| Materials and Methods|| |
This was a hospital based cross-sectional study. This study included mothers who delivered in the hospital and their newborns. Inclusion criteria for mothers were as follows : mothers who had minimum 3 antenatal visits at Ante Natal Clinic from 1 st trimester, who were non-anemic by the end of 2 nd trimester and had full-term and singleton delivery. Exclusion criteria included a history of pregnancy induced hypertension (PIH), gestational diabetes, tuberculosis, and a history of urinary tract infection during the pregnancy. Mothers who were tobacco chewers or mishri (burnt tobacco used for teeth cleaning) user were also excluded from the study. All the mothers who were eligible and delivered during the study period irrespective of mode of delivery and willing to participate were included in the study. Study period was July 2010-June 2011. Written consent was taken after explaining the study. Study tools were (i) interview schedule and (ii) Digital Pediatric weighing machine. Interview schedule suitable for the study was developed by investigators after thorough review of literature and discussions held with experts. Interview schedule was pretested and appropriate changes were made. All the mothers included in the study were interviewed and birth weight was recorded within 48 h of delivery. Information was collected on socio-demographic factors. For dietary history mother was asked about the frequency of consumption of food in a day. For the same she was asked whether she takes lunch, dinner, breakfast, and evening snacks daily or not. Obstetric history was recorded. Data were analyzed by using the statistical software SPSS statistics 19 trial version. Percentages, mean and SD of birth weight were calculated for given sample. Chi-square test, ANOVA, Z-test and Binary logistic regression analysis was used for inferential analysis.
Approval from Institutional Ethical Committee was taken before data collection.
| Results|| |
Total 649 mothers and their newborns were included in the study. Range of birth weight was 1.20-4.10 kg and mean was 2.671 ± 0.495 kg. There was only single newborn having birth weight 4 kg and/or above. Out of 649 newborns, 275 (42.4%. 95% confidence interval [CI] = 38.52, 46.28) were having LBW.
Mean birth weight of male babies was 2.698 ± 0.510 kg and 2.639 ± 0.477 kg of female babies. Females were lighter by 59 g and difference was not significant (z = 1.496, P = 0.135). Analysis according to the birth weight groups (LBW and normal) shows LBW proportion was high in females (46.2%), but not significant [Table 1].
Maternal age was in the range of 18 years to 39 years with mean and SD of 23.87 ± 3.34 years. Maximum women i.e., 510 (78.58%) belonged to age group of 20-30 years age. Highest mean birth weight (2.850 ± 0.509 kg) was observed in 30-40 years age group. It was 2.706 ± 0.434 kg in under 20 women and lowest, 2.650 ± 0.504 kg in 20-30 years of age group. Therefore, children born to elderly mothers were significantly heavier by 200 g (F = 3.360, df = 2, P = 0.035). However, in analysis according to birth weight groups finding was different. Percentage of LBW was high in middle age group (20-30 years) and lowest in elderly mothers but there is not any significant association between age groups of mothers and birth weight of newborns [Table 1].
Parity wise mean birth weight was high in second para (2.709 ± 0.516 kg) and low in multipara (2.630 ± 0.564 kg). In primi, it was 2.654 ± 0.476 kg. Proportion of LBW was high in multipara and lowest in second para, but parity and LBW are not associated [Table 1].
Education wise minimum birth weight (2.250 ± 0.793 kg) was found in non-literate mothers while maximum (2.854 ± 0.455 kg) in postgraduate mothers. Mean birth weight of 2.518 ± 0.454 kg, 2.680 ± 0.500 kg and 2.727 ± 0.485 kg was observed in women with education up to 4 th standard, 5 th standard to 12 standard and up to graduation respectively. There is linear increasing trend in education and birth weight. Observed difference is significant (F = 4.401, df = 4, P = 0.002). Proportion of LBW was highest in non-literate and lowest in postgraduate mothers. In graduate and postgraduate mothers LBW proportion was lower than the average proportion observed in this study and higher in women with education up to 12 th standard. Birth weight is dependent on education (c2 = 12.734, df = 4, P = 0.013) [Table 2].
Occupation wise 95.53% of mothers were housewives. Highest mean birth weight was seen in mothers who were in service (2.747 ± 0.521 kg) and lowest in farmer mothers (2.333 ± 0.603 kg). However, the difference was not significant (P = 0.611). Mothers in service were either school teacher or in clerical jobs. Proportion of LBW was high in farmers and low in housewives. Hence, there was no association between occupation of mothers and LBW [Table 2].
There were only 26 (4%) mothers out of 649 who were not taking breakfast. All the non-literate and postgraduate women were taking breakfast. There were 5.3% women having primary education, 3.1% women having high-school or higher-secondary and 6.6% having graduation were not taking breakfast. Breakfast consumption was independent of education. Mean birth weight was high in mothers who had breakfast regularly (2.686 ± 0.496 kg) than those who do not (2.296 ± 0.333 kg). Babies born to mothers not having breakfast were lighter by 389 g than their counterpart. This difference was statistically significant (z = 3.970, P = 0.00). There is association between breakfast and birth weight (c2 = 13.241, df = 1, P = 0.00) [Table 3]. Similarly, percentage of LBW was high (76.9%) in mothers not having breakfast.
Out of 649 mothers 390 (60.09%) were not taking evening snacks. Mean birth weight of babies born to mothers' not consuming evening snacks was 2.644 ± 0.502 kg and it was 2.711 ± 0.485 kg if mother was consuming evening snacks. It means babies born to mothers not having evening snacks were lighter by 67 g. However, this difference was not significant (z = 1.691, P = 0.091). Percentage of LBW babies was significantly more common in mothers not having evening snacks (c2 = 4.275, df = 1, P = 0.043) [Table 3].
Combined effect of breakfast and evening snacks, having it or not is presented in [Table 4]. Mean birth weight was high when mother had both breakfast and evening snacks and low when she did not have both. Birth weight is better in mother if she had breakfast but not evening snacks than mothers who had evening snacks but not breakfast [Table 4].
Birth weight group wise analysis shows proportion of LBW is lowest if mother had both breakfast and evening snacks and it is highest if she skips both. High degree significant association was found between birth weight and consumption of evening snacks or breakfast.(c2 = 17.482, P = 0.001) [Table 5].
For multivariate analysis binary logistic regression analysis was carried out by using Wald's backward method to find out strength of association between determinants analyzed in this study and birth weight. Odds ratio (OR) for education was 12.425 (CI 1.202-1.906) and it was statistically significant. Followed by not having breakfast was the strongest predictor of birth weight (OR = 11.182, CI = 0.080-0.517). Binary logistic regression analysis shows education and not having breakfast as strong predictor of birth weight [Table 6].
| Discussion|| |
In India LBW is still high. LBW babies are not only at high-risk of morbidities and mortality, but also their development is affected. IUGR is associated with an increased risk of coronary heart disease, stroke, diabetes, and raised blood pressure in the adulthood. It has been theorized that inadequate growth during the prenatal period may have profound long term effect. This is known as the "fetal origins hypothesis". The evidence suggests that nutrient inadequacies in the womb may cause permanent changes in the structure and/or function of organs and tissues, predisposing individuals to certain chronic diseases later in life.  Therefore, it is very important to take care of risk factors for IUGR during ante natal care (ANC) to have normal birth weight babies.
Inclusion and exclusion criteria for selection of study subjects had taken care of confounders. Mothers with UTI, tobacco users, PIH etc., were excluded from the study. This was an attempt to remove known predictors and keep the focus on other less known predictors.
In this study, proportion of LBW was 42.4%, which is very high in spite of mothers having uneventful pregnancy and regular ante natal care.
There are some studies which found that sex of new born, parity and occupation as a risk factors for LBW. ,,,, However, in this study, statistically significant association was not found for above mentioned risk factors. Similar findings are mentioned by another study for parity, sex of new born. 
Anemia is one of the important determinant of birth weight. ,, However, in this study mothers who were non-anemic by the end of 2 nd trimester were only included in the study.
Young or high maternal age is associated with LBW. , In this study, maternal age was significantly associated with the mean birth weight, but not with birth weight group wise analysis. None of the mother was below 18 years of age. Proportion of LBW was high among women between age group of 20 years and 30 years. It indicates some other factors may be playing a role, which needs further exploration.
Education was significantly associated with birth weight. Similar findings are noted by other studies. ,,,
Maternal nutrition is one of the important determinant of birth weight. ,,,,, Extra nutrition is needed during the pregnancy. Pregnant mother needs an additional energy intake to meet increased metabolic workload and to spare protein for tissue building. Maintaining blood glucose level in the mother is vital because glucose is the fetus's preferred fuel and because the fetus's blood glucose level is always lower than the mothers. That is why intake should be distributed throughout the day.  In this study, all the women were taking lunch and dinner regularly. However, there was difference in consumption pattern of breakfast and evening snacks. Some of them were not taking breakfast and/or evening snacks. Birth weight was significantly better in mothers who had breakfast or evening snacks and it was best when mother had both breakfast and evening snacks. It means instead of advising mother to just increase the diet it would be better to advise her to have breakfast and evening snacks both regularly along with lunch and dinner. This advice is simple to understand and also to follow. In spite of having breakfast and/or evening snacks birth weight had not improved dramatically. In binary logistic regression analysis education is strong predictor of birth weight followed by the non-consumption of breakfast. That means effect of non-consumption of breakfast was stronger than the effect of having breakfast. This finding suggests that quality as well as quantity of food items included in their diet is also important. May be there were some other factors, which had played key role in determining birth weight. As significant linear trend was observed in education and birth weight might suggests that educated mother take better care of themselves, understand, and follow advice effectively and are able to take nutritious food. It has been stated by Susser that effects of maternal nutrition are conditional on baseline nutrition, timings, and content of diets possibly also on infant sex and energy expenditure.  Further, she also mentions that high protein concentrations have produced adverse effects. Diet effects on birth weight apparently bypass maternal weight change and hence, to enhance birth weight, maternal diet appears to deserve more attention than does weight gain.  Another study mentions that high maternal milk consumption and high intake of green leafy vegetables and fruits are associated with reduced risk of small for gestational age babies. Low caloric intake in the third trimester was significantly associated with LBW.  However, in this study history of food items was not included. Education and breakfast consumption was independent of each other. All the non-literate and postgraduate women were taking breakfast. All these findings highlight the importance of quality and quantity of nutrition and it's even distribution throughout the day and need for nutrition education. ,, Especially, non-literate and less educated mothers who are at high-risk of having LBW should be considered as a target group for nutrition education. Some more factors other than those studied in this study may be playing important role in determining the birth weight. To identify them further exploration is needed.
| Conclusion|| |
Breakfast was the strong modifiable determinant of birth weight. Recommending strongly "have breakfast" can take care of extra nutritional requirements. Less educated women need more intense health education. There is also need of nutrition education. To find out role of other factors needs further investigations.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]