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Risk factors for small for gestational age births in Ahmedabad, India
D V Mavalankar1, R H Gray, C R Trivedi
1Public Systems Group, Indian Institute of Management, Ahmedabad.
Insights
Poor maternal nutrition is the leading cause of small for gestational age (SGA) births in India, contributing significantly to intra-uterine growth retardation. Improving maternal nutrition and antenatal care can substantially reduce SGA incidence.
Area of Science:
- Public Health
- Maternal and Child Health
- Epidemiology
Background:
- Intra-uterine growth retardation is a significant public health concern in developing nations.
- Low birth weight (LBW) is a key indicator of intra-uterine growth retardation.
- Identifying risk factors is crucial for targeted interventions.
Purpose of the Study:
- To identify and quantify risk factors for small for gestational age (SGA) births in India.
- To estimate the attributable risk of identified factors for SGA.
- To inform public health strategies for preventing SGA.
Main Methods:
- A case-control study involving LBW and control infants.
- Classification of infants as SGA or appropriate for gestational age (AGA) using Indian standards.
- Logistic regression analysis to determine adjusted odds ratios for risk factors.
- Community sample survey to estimate prevalence of risk factors.
Main Results:
- Poor maternal nutritional status (weight < 51 kg) was the primary risk factor for SGA, with a 42% attributable risk.
- Other significant risk factors included anemia, primiparity, poor obstetric history, lack of antenatal care, hypertension, and birth defects.
- These additional factors contributed moderately to the overall attributable risk.
Conclusions:
- Maternal nutrition is the most critical modifiable factor for preventing SGA births in this population.
- Enhancing maternal nutrition and antenatal care services can lead to a substantial reduction in SGA incidence.
- Findings are relevant for public health initiatives in similar developing country contexts.
Abstract:
Intra-uterine growth retardation is an important public health problem in many developing countries. The authors conducted a case-control study of low birth weight (LBW) in three teaching hospitals and a population survey in Ahmedabad city, India during 1987-1988. To identify and quantify risk factors for small for gestational age births, we divided the low birth weight and control infants into small for gestational age (SGA, n = 617) and appropriate for gestational age (AGA, n = 1851) using an Indian birth weight by gestational age standard. Logistic regression was used to estimate adjusted odds ratios for important risk factors. Prevalence of risk factors was estimated from a community sample survey of mothers (n = 1102) who had delivered in the past year. Attributable risks were calculated from odds ratios and prevalence data. The most important risk factors for SGA was poor maternal nutritional status (weight < 51 kg) with an attributable risk of 42 per cent. Other significant risk factors were anaemia, primiparity, poor obstetric history, lack of antenatal care and hypertension during pregnancy, and birth defects, each of which contributed only moderately to the attributable risk. The analysis indicates that improvement of maternal nutrition and antenatal care might prevent a substantial portion of SGA births in this and similar populations.