Volume 2 • Issue 9 • 1000177J Community Med Health EducISSN: 2161-0711 JCMHE, an open access journal

Journal of Community Medicine & Health Education

Agarwal et al., J Community Med Health Educ 2012, 2:9 DOI: 10.4172/2161-0711.1000177

Research Article Open Access

Maternal Risk Factors Associated with Low Birth Weight Neonates in a Tertiary Care Hospital, Northern IndiaGagan Agarwal1*, Sartaj Ahmad2, Kapil Goel3, Vijay Kumar4, Parul Goel5, Meenal Garg6 and Ajay Punj7

1,4,7Department of Pediatrics, Subharti Medical College, Meerut, Uttar Pradesh, India2Department of Medical Sociology, Subharti Medical College, Meerut, Uttar Pradesh, India3Department of Community Medicine, Subharti Medical College, Meerut, Uttar Pradesh, India5Department of Biochemistry, Subharti Medical College, Meerut, Uttar Pradesh, India6OBG AIIMS, New Delhi, India

AbstractLow birth weight is ������by many socio-economic factors like habitat, urban or rural, education, birth

order, substance abuse by mother, religion and caste, age of mother nutritional status of mother, Body Mass Index, Hemoglobin level etc., quality of ante-natal care received (ANC) and spacing of pregnancies. Low birth weight babies pose challenge to the families and communities. They contribute major share in perinatal and neonatal mortality and also towards mental, physical and development challenges in pediatric population.

Objective: To assess the impact of maternal social factors on the birth weight of newborn.

Study setting: This study was conducted in a tertiary care hospital attached to Subharti medical college of Meerut District.

Study design: Hospital based Cross sectional study.

Study population: 325 women delivering live infants in the study setting.

Study period: Six months i.e. from January 2011 to June 2011.

Material and methods: All 325 mothers who delivered live infants in a tertiary care hospital attached to Subharti medical college, Meerut District were interviewed. Data was collected on a structured, pre-designed and pre-tested questionnaire.

Statistical analysis: Data was entered in Microsoft Excel and the results were expressed as proportions.

Results: The overall prevalence of LBW neonates was 32.3%. Majority (71.42%) of mothers was living in rural areas and 52.39% of the mothers belonged to joint families. 52.39% of the mothers were illiterate. Majority of mothers (76.19%) were housewives and their socio-economic status was IVth class (47.61%). The highest prevalence of LBW was found among mothers aged <18 years (42.86%), addicted to tobacco chewing (53.33%) and smoking (33.33%). Among mothers with pre pregnancy weight was less than 40 kg seen in 80.96%. Prevalence was seen (47.61%) of LBW was inversely proportional to the 6.0-8.0 gm Hemoglobin level and Primiparous mothers was found to be (42.86 %) and in parity of >5 (23.80%).

Conclusion: Birth weight remained an important factor affecting the neonatal infant and childhood mortality and morbidity. Low birth weight babies are more likely to have disabilities in four of developmental delay, poor growth and mental disabilities. For reducing the prevalence of low birth weight, public health strategy needs to focus attention on better maternal nutrition and education.

*Corresponding author: Gagan Agarwal, Assistant Professor, Department of Pediatrics, Subharti Medical College, Meerut, Uttar Pradesh, India, E-mail: drgagan15@gmail.com

Received August 01, 2012; Accepted October 26, 2012; Published October 29, 2012

Citation: Gagan A, Sartaj A, Kapil G, Vijay Kumar, Parul G, et al. (2012) Maternal Risk Factors Associated with Low Birth Weight Neonates in a Tertiary Care Hospital, Northern India. J Community Med Health Educ 2:177. doi:10.4172/2161-0711.1000177

Copyright: © 2012 Gagan A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords: Social demographic; Age of mothers; Addiction habits;Hb% level; Birth order; LBW; Neonates

IntroductionLow birth weight (LBW) has been defined by the World Health

Organization (WHO) as weight at birth of less than 2500 g. LBW at birth may be the outcome of either preterm birth (before 37 weeks of gestation) or retarded fetal (intrauterine) growth [1].

In 1976, the 29th World Health Assembly agreed on the following definition; Low birth weight (LBW) is a weight at birth of <2,500 gm (upto and including 2,499 g) irrespective of gestational age [2]. Birth weight is a major determinant of child’s health and nutrition. In India, birth weight has remained low, with the NFHS reported proportion of low birth weight (LBW) babies about 23% for rural and 19% for urban population. The NFHS 3 reports association of low birth weight to place of residence (urban or rural), age of mother, religion and caste, birth order of the baby, education, wealth and use of tobacco [3].

LBW is associated with multiple problems such as fetal and

neonatal mortality or morbidity. Compromised growth and cognitive development, with increased risk of cardiovascular and metabolic disorders in adult life, has also been reported [4].

The importance of reducing the incidence of low birth weight is most obvious for the first year of life: low birth weight is the single most important factor affecting infant morbidity and mortality. However,

Volume 2 • Issue 9 • 1000177J Community Med Health EducISSN: 2161-0711 JCMHE, an open access journal

Citation: Gagan A, Sartaj A, Kapil G, Vijay Kumar, Parul G, et al. (2012) Maternal Risk Factors Associated with Low Birth Weight Neonates in a Tertiary Care Hospital, Northern India. J Community Med Health Educ 2:177. doi:10.4172/2161-0711.1000177

Page 2 of 4

there is growing evidence that the adverse consequences of low birth weight continue throughout the life cycle [5].

As children, low birth weight infants are more likely to have disabilities, hospitalizations, brain damage, and poorer language development, be placed in special education classes, and display more intellectual impairments [6]. Later in life, they are at increased risk for health problems such as adult chronic conditions, ischemic heart disease, and higher levels of fasting serum insulin, as well as at greater risk of being in the lower socioeconomic classes [7].

“Birth weight” is the first weight of the fetus or infant obtained after birth and should be measured during the first hour after birth, before the appreciable postnatal loss of weight occurs [8]. Also, the large proportion of home births creates huge gaps in birth weight information. The widespread problem is a reflection of the lower socio-economic status of rural and sub urban women affecting their nutritional status [9].

Material and MethodsThis cross sectional study was conducted in a tertiary care hospital

which is attached to Subharti medical college of Meerut District. 325 mothers who delivered live infants in a tertiary care hospital were interviewed. The purpose of study was to know the prevalence of LBW babies as well as the effect of biosocial profile of mothers. The period of study was six month (i.e. from Jan 2011 to June 2011). Data was collected on a structured and pre-tested questionnaire. Social characteristics, maternal age, addiction habits, hemoglobin (Hb%) levels, Parity, LBW neonate discussed. Data was entered in Microsoft Excel programme and using calculation in percentage.

ResultsTable 1 suggested that among 325 women studied, a total of 105

mothers had given birth to low birth weight neonates (<2500 g). In this study overall prevalence of LBW neonates was found to be 32.30%. Among the mothers who had newborn babies with LBW, higher prevalence of LBW neonates were found among mothers who were living in rural areas (71.42%) compared to urban areas (28.58%). It was observed that LBW neonates were higher in mothers (52.39%) who belonged to joint families. 52.39% of the mothers were illiterate.

Majority of mothers (76.19%) were housewives and it was observed that maximum association was found between LBW neonates and socio-economic status in IVth class 47.61%.

Table 2 shows the prevalence of LBW among mothers aged <18 years (42.86%) and those >35 years (33.33 %). High prevalence was seen in those who were addicted to tobacco chewing (53.33%) and smoking (33.33%). Maximum prevalence was observed among mothers with pre pregnancy weight of less than 40 kg seen in 80.96%. Prevalence of 47.61% of LBW was inversely proportion al to the 6.0-08.0 g Hemoglobin level. The prevalence among Primiprous mothers was found to be (42.86%) and it fell up to parity 4 and showed a rose in parity of >5 (23.80%).

Discussion In this study it has been observed that the overall prevalence of

LBW neonates was found to be 32.30%. The proportion of low birth weight babies in a Kerala study (1997) was found to be 18% [10].

In this study prevalence of low birth weight babies among mothers who were living in rural areas was 71.42% and in urban areas was

Mothers who delivered birth a baby Number Percentage Normal > 2500Gm 220 67.70 LBW <2500Gm 105 32.30

Place of ResidenceRural 75 71.42Urban 20 28.58ReligionHindu 46 43.80Muslim 52 49.53Others 07 06.67Education of MothersIlliterate 55 52.39Up to Primary 27 23.80Up to High School 15 14.29Intermediate and above 10 09.52Types of FamilyNuclear 50 47.61Joint 55 52.39Occupation of MothersHousewife 80 76.29Farming Services 20 19.04Others 05 04.76Socio-economic StatusI 00 00.00II 10 09.52III 15 14.28IV 50 47.62V 30 28.58

Table 1: Socio- demographic Characteristics of the mothers (N=325).

Association of birth weight with maternal age Number Percentage

< 18 years 45 42.8618-25 years 15 14.2925-30 years 10 09.5235+ 35 33.33Birth weight in relation to maternal addiction habitsNo addiction 90 85.72If Yes,. Types of addiction Tobacco Chewing 08 53.33Bidi Smoking 05 33.33Others 02 13.34Birth weight in relation to maternal body weight< 40 Kg 85 80.96> 40Kg 20 19.04Birth weight in relation to maternal Hb Level<6.5 gm 10 09.526.5-8.gm 50 47.618.0-11.gm 28 26.67>11.0 17 16.20Birth weight in relation to ParityPrimi Para 45 42.86Second Para 05 04.77Third Para 15 14.29Fourth Para 15 14.29> Fifth Para 25 23.80

Table 2: Distribution of the Material risk factors associated with LBW in Neonates.

Volume 2 • Issue 9 • 1000177J Community Med Health EducISSN: 2161-0711 JCMHE, an open access journal

Citation: Gagan A, Sartaj A, Kapil G, Vijay Kumar, Parul G, et al. (2012) Maternal Risk Factors Associated with Low Birth Weight Neonates in a Tertiary Care Hospital, Northern India. J Community Med Health Educ 2:177. doi:10.4172/2161-0711.1000177

Page 3 of 4

28.58%. Another study from urban population of Bhilai reports LBW proportion of 23% which is rather high for urban population [11].

Majority (76.19%) of the mothers was housewives and it was observed that maximum association was found between LBW neonates and socio-economic status in IVth class 47.61%. It is higher among mothers who were belonged to joint families 52.39%.

Findings of study by Paul [12] revealed that over 70 % of perinatal deaths, 90% neo-natal deaths and 50% infant deaths occur among LBW babies. Another study suggested that causation of LBW are low pre-pregnancy weight (<45 kg), malnutrition, severe anemia, heavy physical work during pregnancy, hypertension, malaria, toxemia, smoking, low socio-economic status, maternal age (<18 yrs and >35 yrs), primiparity, short inter pregnancy period, low educational status etc [12]. Padda et al. also found various impact of biosocial characteristics of the mother on birth weight of the newborn [13]. Deshmukh et al. found that various maternal factors significantly associated with LBW among women [14]. A study conducted by Nagargoje et al. suggested that mother’s education, occupation , socio-economic status, physical activity during pregnancy, sleep and rest duration, age at marriage, tobacco consumption, time of registration of pregnancy, number of ANC visits, tetanus toxoid immunization, days of iron, folic acid and calcium supplements all were found to be significantly associated with LBW [15].

In this study maximum prevalence of LBW (52.39%) was found among of the illiterate mothers. A study conducted by Joshi et al. revealed that prevalence of LBW 45.5% was found among of the illiterate mothers. Educational status plays a role in improved social status and living of standard [16].

The prevalence of LBW among mothers aged <18 years 42.86% and those >35 years 33.33%. A LBW prevalence of 39.1% was found in urban areas of Delhi, the maternal age was identified as a significant determinant [17].

In this study prevalence was seen in those who were addicted to tobacco chewing 53.33% and smoking 33.33%. A study revealed by Rubin et al. that LBW higher in women who were tobacco chewers [18].

Maternal smoking during pregnancy was closely associated with LBW, and preterm birth [19]. A study conducted by Low in 1981 observed that incidence of LBW found among smokers than non smokers [20]. Weight of the mother plays an important role in determining the birth weight of neonate. Maximum prevalence was observed among mothers with pre pregnancy weight of less than 40 kg seen in 80.96%. This study has been strongly supported by the findings of Dhall and Bagga [21].

Maternal hemoglobin is an indirect indicator of overall maternal nutrition and therefore, low maternal hemoglobin can identify undernourished mothers whose fetus may suffer ill effects of malnutrition. In this study Prevalence 47.61% of LBW was inversely proportional to the 6.0-8.0 g hemoglobin level. Prevalence of LBW is inversely proportional to the hemoglobin level. A study conducted by Mavalankar et al. suggested that among the 924 of 1024 mothers screened for hemoglobin (Hb) level, it was more than 10.9 mg in 35.28% only. Thus, two-thirds of the mothers in this study were anemic. Anemia in the mother is a risk factor for LBW [22].

The prevalence among Primiparous mothers was found to be 42.86% and it fell up to parity 4 and rose in parity of >5 in 23.80%. Similar finding to our study for association of parity with birth weight have been reported by Kour et al. (2000) [23].

ConclusionBirth weight remained an important factor affecting the neonatal

and infant mortality and morbidity. Low birth weight babies are more likely to have disabilities in form of developmental delay, poor growth and mental disabilities. For reducing the prevalence of low birth weight, public health strategy needs to focus attention on better maternal nutrition and education.

For reducing the prevalence of low birth weight, public health strategy needs to focus attention on better maternal nutrition and education. Interventional programs should be encouraged not only in health sectors but in all those sectors concerned with social development and social welfare programmes. Women should be educated and encouraged for regular ANC checkups, which augments the detection of these risk factors at the earliest to improve the weight of a newborn. Good nutrition during pregnancy would result in increased birth weight.

Acknowledgments

We are thankful to our staff Mr. Praveen Kumar and Mr. Hirdesh Tyagi for their cooperation in this study.

References

1. �����������������������������

2. World Health Organization (1992) International Statistical ��������of diseases and related health problems. Geneva.

3. http://hetv.org/india/nfhs/nfhs3/NFHS-3-Chapter-09-Child-Health.pdf

4. Walden RV, Taylor SC, Hansen NI, Poole WK, Stoll BJ, et al. (2007) Major congenital anomalies place extremely low birth weight infants at higher risk for poor growth and developmental outcomes. Pediatrics 120: e1512-1519.

5. Kogan MD (1995) Social causes of low birth weight. J R Soc Med 88: 611-615.

6. Valdez R, Athens MA, Thompson GH, Bradshaw BS, Stern MP (1994) Birthweight and adult health outcomes in a biethnic population in the USA. Diabetologia 37: 624-631.

7. Ben-Shlomo Y, Smith GD (1991) Deprivation in infancy or in adult life: which is more important for mortality risk? Lancet 337: 530-534.

8. Valero De Bernabé J, Soriano T, Albaladejo R, Juarranz M, Calle ME, et al. (2004) Risk factors for low birth weight: a review. Eur J Obstet Gynecol Reprod Biol 116: 3-15.

9. Hirve SS, Ganatra BR (1994) Determinants of low birth weight: a community based prospective cohort study. Indian Pediatr 31: 1221-1225.

10. Radhakrishnan T, Thankappan RS, Sarma PS (2000) Socioeconomic and demographic factors associated with birth weight: a community based study in Kerala. Indian Pediatrics 37: 872-876.

11. Misra M, Mishra S, Sharadamma (1995) Epidemiology of low birth weight in an industrial area in India. J Trop Pediatr 41: 374-376.

12. Paul VK (2007) Textbook of preventive and social medicine.

13. Padda P, Surekha K, Srivastava AK (2011) Impact of biosocial characteristics of the mother on birth weight of the newborn. Indian Journal of Community Health 23:2.

14. Deshmukh JS, Motghare DD, Zodpey SP, Wadhva SK (1998) Low birth weight and associated maternal factors in an urban area. Indian Pediatr 35: 33-36.

15. Nargagoje MM, Chaudhary SS, Deshmukh JS, Gupta SC, Misra SK (2011) A case control study for risk factors for Low birth Weight in nagpur city of Maharashtra. Indian Journal of Community Health 23.

16. Joshi HS, Subha SH, Dabral SB et al. Factors associated with LBW in new borns. IJCM 2005;30(4):142-3.

17. Chhabra P, Sharma AK, Grover VL, Aggarwal OP (2004) Prevalence of low birth weight and its determinants in an urban resettlement area of Delhi. Asia Pac J Public Health 16: 95-98.

Volume 2 • Issue 9 • 1000177J Community Med Health EducISSN: 2161-0711 JCMHE, an open access journal

Citation: Gagan A, Sartaj A, Kapil G, Vijay Kumar, Parul G, et al. (2012) Maternal Risk Factors Associated with Low Birth Weight Neonates in a Tertiary Care Hospital, Northern India. J Community Med Health Educ 2:177. doi:10.4172/2161-0711.1000177

Page 4 of 4

18. Rubin DH, Krasilnikoff PA, Leventhal JM, Weile B, Berget A (1986) Effect of passive smoking on birth-weight. Lancet 2: 415-417.

19. Chiolero A, Bovet P, Paccaud F (2005) Association between maternal smoking and low birth weight in Switzerland: the EDEN study. Swiss Med Wkly 135: 525-530.

20. Low JA (1981) Maternal smoking in human reproduction. Can J Public Health 72: 390-393.

21. Dhall K, Bagga R (1995) Maternal determinants of birth weight of north Indian babies. Indian J Pediatr 62: 333-344.

22. Mavalankar DV, Gray RH, Trivedi CR, Parikh VC (1994) Risk factors for small for gestational age births in Ahmedabad, India. J Trop Pediatr 40: 285-290.

23. Kour D, Kour AP, Rashmi (2002) Changing trends in birth eight. J of Obs and Gynae of India 2002 52: 32-6.