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A study on maternal factors affecting low birth weight in institutional deliveries

Background: Low birth weight is defined as birth weight below 2500 mg. WHO states prevalence of LBW is 26%. LBW babies are more prone for neonatal morbidity and mortality. 1) To assess various factors like maternal age, height, education, socioeconomic status on the birth weight of the baby. 2) To assess obstetric factors like parity, gestational age, antenatal care, anemia, hypertension on the birth weight of the newborn. Methods: A hospital bound cross sectional study done at the tertiary care centre. Study was done for a period of 2 months from 1st June to 30th July 2019 in Adichunchanagiri Institute of Medical Sciences and Research Hospital a rural medical college in Karnataka. Maternal data were collected and baby weight was recorded soon after birth on weighing scale. Results: There were 65 births during the study period. There were 13 babies weighing less than 2500 gm. Prevalence of LBW was 20%. 43.47% mothers were aged between 18 to 25 years and 7.14% were more than 25 years. 30.4% mother’s height was between 140 to 150 cm and 14.2% were more than 150 cm. Regarding maternal education, 15.3% degree, 24.1% PUC, 15% High school and 33.3% were primary school level. Regarding socioeconomic status 22.2% low, 25% lower middle, 18.7% middle class, 18.7% belonged to upper middle class. Regarding gestational age 50% were <37 weeks, 15.5% between 37-42 weeks, 10% were 42 weeks.73.8% women had normal BP, 21.5% were prehypertensive, 4.6% had PIH. Conclusions: Low birth weight is one of the important factors in infant morbidity and mortality. Maternal health was important factor in delivery of low birth babies. Maternal height, sex of baby, mode of delivery has no role in low birth weight babies.


INTRODUCTION
Low birth weight (LBW) is defined by World Health Organization (WHO) as a birth weight less than 2500 g. 1 LBW can result from premature birth (before 37 weeks of gestation) or intrauterine-growth restriction (IUGR), or a combination of the two. 2 The prevalence of low birth weight in India was found to be 26%. There are numerous factors contributing to LBW, both maternal and foetal. 3 Intrauterine growth and development is one of the most vulnerable process in human lifecycle and its aberration can result in lasting profound influence in later life. 4 babies are 5-6 times more likely to die during perinatal period and 3 times more likely to die during infancy compared to normal birth weight babies. 6 Studies suggest that short maternal stature, very young age, high parity, close birth spacing are associated factors. 7 In developed countries, predominant cause of LBW is preterm birth, whereas in developing countries, Intra uterine growth restriction (IUGR) is predominant cause of LBW. Mothers who had multiple gestations had higher risk of delivering LBW babies. The physical environment, specific and nonspecific infections, also plays an important role in determining the infant's birth weight and future health status. 8 Extent of LBW is one of the key vital statistics used as an indicator of the quality of ANC, medical service, and general health service to mother. 9 For the same gestational age, girls weighing less than boys, first born infants are lighter than subsequent infants, and twins weighing less than singletons.
Mothers in deprived socioeconomic condition frequently have LBW infants. In those setting, the infant's LBW stems primarily from the mother's poor nutrition and health over a long period of time, including during pregnancy, the high prevalence of specific and nonspecific infections, or from pregnancy complications underpinned by poverty. Physically demanding work during pregnancy also contributes to poor foetal growth. 10 Our hospital is attached to rural medical college and few studies reported regarding the birth weight of the baby. Hence the present study was done to know the maternal factors affecting the birth weight.
The objective of the study was to assess the impact of various factors like maternal age, height, education, socioeconomic factors, parity, gestational age, antenatal care, anaemia, blood pressure on the birth weight of newborn. Hence the present study was done to know the maternal factors affecting the low birth weight babies.

METHODS
A cross-sectional hospital-bound study was conducted at a tertiary care centre. Study was done for a period of 2 months from 1 st June to 30 th July 2019. Sample size was total number of births during the study period. Inclusion criteria were all singleton normal babies born to both primiparous and multiparous women. Exclusion criteria were multiple births and babies with congenital anomalies and babies born to gestational diabetes mother. Digital weighing scale was used to weigh the babies.
Data was collected from the case sheet of mother and newborn record as well as by interacting with the mothers. Details of investigation reports during ante natal period such as blood group, Hb% and ultrasound reports were collected. Data was collected in prescribed proforma with following details such as maternal age, height, literacy, socioeconomic status, gestational age, LMP, USG reports, mode of delivery, sex and weight of the baby. Statistical analysis was done using statistical package for social sciences software version 20.

RESULTS
The results of the present study were analysed as follows, total number of births during study period were 65. Number of babies who weighed less than 2500 gm were 13, which included 9 female and 4 male. Prevalence of LBW was 20%. Out of 13 LBW babies 5 were delivered by lower segment caesarean section (LSCS) and 8 were normal deliveries.     Maternal nutrition is one of most important factor in LBW babies. In the present study 9LBW babies were born to mothers Hb% less than 12 and 4 LBW babies were born to mothers Hb% more than 12. According to to Zelalem Abera et al among the 62 LBW babies, 29 were born to mother's Hb% less than 11 gm and 33 babies to more than 11 gm. 1 According to Radha Kumari et al 22.6% of LBW babies were born to mother's Hb% less than 10 gm and 6.6% to more than 10gm. 6 According to Anant Pawar et al 11.1±1-01 Hb% in 60 LBW babies. 3 According to Nirmali Gogoi et al Hb% of mother in cases and controls is same and overall Hb% level in both group is low. 5 In the present study out of 13 LBW babies 9 (13.84%) were born at gestational age between 37 -42 wks and 3 (13.84%) after 42 wks. According to study reported by Meresa Gebremedhin et al 71.4% were born < 37 wks and 11.9% were born ≥ 37 wks. 7

CONCLUSION
In the present study the prevalence of low birth weight babies was 20% and lower than the National average. Most of them belonged to low socioeconomic status. The significant predictors of LBW in our study was maternal education, socioeconomic status and haemoglobin %. Improving the socioeconomic status of the mothers, expansion of utilization of ANC and strengthening the existing maternal services at the basic level of community is required.