Analysis of the maternal factors associated with VLBW babies

Introduction: VLBW is associated with increased mortality and morbidity. In country like India where poverty, illiteracy & low socio-economic factors play a major role, incidence of VLBW & its complications can be reduced by targeting on the socio-demographic, obstetric factors, maternal nutrition & health education. Methodology: This is a Prospective study in a single centre over a period of 1 year. All newborns admitted to the neonatal unit during the study period with birth weight < 1500 gram were included and Still births & babies with major congenital malformations were excluded. An equal number of newborns with birth weight > 2500 gram were selected by simple randomized technique on same day of the selection of study group & were used as a control population to study maternal factors. Maternal factors analyzed in the study include Age of mother, Parity, Birth interval, Height, Weight, Mid arm circumference, Literacy level, Per capita income per month, Family structure, Mother's occupation, Antenatal care, Bad obstetric history, Maternal disease during the antenatal period Neonatal details of birth weight, gestational age, sex of the baby was collected. Results: Higher incidence of VLBW babies were noted among young mothers, primiparity, when birth interval was < 2 years, maternal weight < 40kg and with MAC < 20 cm. Incidence of VLBW was more in mothers who were illiterate and with bad obstetric history. Conclusion: A well-nourished multiparous mother between 20-30 years with birth interval of > 2years with good literacy & without any BOH has the best chance of producing a good weight baby.


Introduction
Birthweight is a universal undisputed predictor of healthy childhood. Perinatal and infant mortality rates are greater among low birth weight infants and they have increased morbidity and long term developmental problems. Incidence of low birth weight reflects the socio-economic-development and mother's nutritional status. In India about 30% of babies born are of low birth weight out of which nearly 10% are preterm [1]. High incidence of neonatal morbidity and mortality is due to neglect of nutrition, health and education of female children and poor status and empowerment of women in society. Early teenage marriages, frequent pregnancies, maternal malnutrition, fewer antenatal consultations, bad obstetric history, medical diseases complicating pregnancy and But only very few studies has been dealt with very low birth weight and maternal factors.

Aim & Objective:
Toanalyzethe maternal factors associated with VLBW babies. Birth weight assessment: The newborns were weighed naked during the first hour of life before significant postnatal weight loss occurred using an electronic weighing machine. Gestational age assessment: Gestational age was assessed by Ballard's scoring.

Material and Methods
Maternal assessment: By questioning the mother, details of Age, Parity, time interval since previous delivery were collected.
Data of weight during first trimester, Height were obtained from case sheets. Mid arm circumference was measured using a non-stretchable tape. Based on level of literary, mothers were grouped into 3 categories-Illiterate, primary & middle school, high school & above.
Depending on per capita income,they were divided into 3 groups-incomeless than 500 rupees, between 500-999 rupees, more than 1000 rupees. Family structure was classified as nuclear & joint family.
Based on mother's occupation status they were grouped into 3 categories-House wife; light work (those mothers who work < 8 hour duration in a shady environment., e.g., Semi profession, clerical jobs, women workingin shops & stalls); Heavy work (those mothers who work > 8 hours duration especially under sun., eg., Unskilled, semiskilled & skilled laborers).
Based on antenatal care they were divided into 3 groups-No Antenatal visits,less than 5 visits, more than 5 visits. Maternal diseases during antenatal period were enquired into &crosschecked with case sheet records.
Interventions: Newborn care as per standard unit protocol.
Data Analysis: Data collected were enrolled in excel sheets & Statistical analysis was done using Pearson Chi -squared test. Test was considered significant if p value was less than 0.05.
Frequency of VLBW babies was more among women aged <20 years than mothers aged > 20 years which was statistically significant. Incidence of VLBW was more among primi mothers when compared with others which was statistically significant. Mothers with birth interval < 2 years were found to have more VLBW babies than mothers with birth interval > 2 years.
There was no correlation found between mother's height & VLBW delivery. It was noted that lower the mother's weight higher the incidence of babies with VLBW which was statistically significant.
Pediatric Review: International Journal of Pediatric Research Aailable online at: www.pediatricreview.in 592|P a g e In mothers with mid arm circumference </ = 20 cm, the incidence ofVLBWwas higher. The incidence decreases with an increase in MAC which was statistically significant. There was a significant relation between educational status of mother & baby's birth weight. As the literacy rate of mother increases birth weight alsoincreased. There was a clearcut relation between per capita income & incidence of VLBW babies which was statistically significant. As per capita income decreases, incidence ofVLBW increased. There was no relation found between family structure & incidence of VLBW. There was no correlation between mother's occupation & VLBW. Therewas no correlation between number of antenatal visits & VLBW.
Pediatric Review: International Journal of Pediatric Research Aailable online at: www.pediatricreview.in 593|P a g e Primary cause of very low birth weight is premature birth [1]. Otherfactors contributing to the risk of very low birth weight include i) Race -African -American babies are twice as likely to have very low birth weight than caucasian babies [2], ii) Age -teenage mother have higher risk ofhaving a baby with very low birth weight [3].
iii) Multiple birth -Multiple birth babies are at increased risk of very low birth weight. About 10% of twins and one third of triplets have very low birth weight [1] iv) Mother's health -women who are exposed to drugs, alcohol and cigarettes duringpregnancy are more likely to have low or very low birth weight babies [4].
Mother's oflower socio-economic status [5] are also more likely to have poor pregnancy nutrition [6]. inadequate prenatal care, and pregnancy complications -all factors that cancontribute to very low birth weight. v) Illiteracy [7]. Hard labour, poor family atmosphere [8] decreased birth interval [9] previous history of bad obstetric history [10] and poor prepregnancy nutrition [11] also contributes to very low birth weight.
Unlike previous belief of birth weight determined entirely by genetic and ethnic factors, studies have shown the influence of factors like mother's inadequate nutrition [6] chronic diseases, hard physical work [4], poor socio-economic conditions, obstetric factors and anthropometric factors [12]. Sampath Kumar et al., found that maternal age, parity, gravida, maternal height and maternal weight were associated with LBW [13]. Dhar GM et al., observed that factors contributing to low birthweight (LBW) include poverty, ignorance, inability to use health care services Early marriages, Poor maternal nutrition, heavy manual labour and smoking [14]. Malik S et al., found, a strong association between birth weight and maternal height, weight, age, ANC visits and risk status of pregnancy [15]. Nair NS etalnoted that primis, elderly mothers and mothers who had not received good quality antenatal care had risk of having low birth weight babies [16].

Conclusion
Birth weight of an infant is determined by a multitude of biological & socio-economic factors. Some of them are determined even before conception. A well-nourished multiparous mother between 20-30 years with birth interval of > 2years with good literacy & without any BOH has the best chance of producing a good weight baby. To achieve above goal, concentration should bediverted on female literacy, care of girl child & adolescent nutrition, Health education, genetic counselling, improving standard of living, easy availability of health care & early detection with prompt treatment of obstetrical factors.
Funding: Nil, Conflict of interest: None initiated, Perission from IRB: Yes