Soheila Khazaee, Bahare Ghiasi, Fariba Mahmoodzade.
Ilam University, Iran.
ADDRESS FOR CORRESPONDENCE
Soheila Khazaee, Iran-Tehran-3rahe Taleghani-kocheye Taherian-Mojtamae maskoni sabz-vahede 35. | | Abstract | Low birth weight (LBW) is one of the main causes of mortality in children less than one year old especially neonates. This research is for investigation of low birth weight rate and identify risk factors such as maternal age, way of delivery and number of pregnancies. Study was designed as a case-control. Of 3073 neonates at birth in 2005, 183 neonates had LBW. Of these 130 LBW were chosen as case group and 260 normal weight neonates (birth weight more than 2500 grams) were chosen as control group. Incidence of LBW in this study was 5.9 percent. In case group, there were 56.2% male and 43.8% female and in control group 56.9% male and 43.1% female. Sex of neonates with weight at birth didn't have significant relationship (p=0.8). In case group, 50.8% were born of normal vaginal delivery and 49.2% by caesarean section. In control group, results were: 62.3% normal vaginal delivery and 37.7% cesarean section. There was insignificant relationship between way of delivery and weight of birth. (p=0.8). In case group, 1.6 times increased incidence of caesarean section was seen (OR = 1.6). The greatest cause of cesarean in case group was multiple pregnancy (47.5%) and in control group was previous cesarean (33.6%). In 83.1% of case group, and 98.1% of control case group fetal presentation was cephalic, and 16.9% of case group and 1.9% of control group fetal presentation were noncephalic. There was significant relationship between fetal presentation and weight of birth (P=0.000). In case group, 10.3 times increase in non-cephalic presentation was seen (OR = 10.3). 73.8% of case group were pre-term and 26.3% were small for gestational age and term. Gestational age less than 37 week increased probability of LBW by 46.1 times (OR =46.1). Mean weight in case group was 1900 ± 611 grams and in control group was 3317 ± 472 grams. In case group, 5% of neonates were extremely low birth weight (ELBW), 16% very low birth weight (VLBW) and 79% were moderately low birth weight.
| | | | Keywords | | Neonate, Low birth weight, pregnancy, delivery | | | | Introduction | Perinatal period is the period from 20th gestational age to 28th days after birth and associated with highest mortality. (1) The greatest risk of mortality is in 24 hours after birth. In premature babies, mortality is 40 times more and in LBW is 200 times more than neonates with normal weight. In 1997 in USA, VLBW ratio was 1.4%. VLBW neonates are responsible for more than 50% of neonatal death and 50% of neonatal mortality with 20% survival in babies less than 600 grams and 85-90 % survival in babies between 1250-1500 grams. Perinatal care increases LBW survival. Compared with term neonates, VLBW neonates have more hospitalizations at one year of age due to complications of prematurity, infections, neurologic complications and sociopsychotic disturbances. (2)
The main cause of LBW in USA is prematurity but in developing countries is intrauterine growth retardation (IUGR). The very low birth weight infants are premature and occasionally IUGR. 99% of birth occurs in hospital but only 82% of pregnant women take prenatal care in the first trimester. Suitable prenatal care decreases LBW incidence. Causes of insufficient prenatal care are poor financial sources, inadequate education about significance of prenatal care and inappropriate programs. Because LBW is the main factor for mortality of neonates, recognition of risk factors helps to prevent and reduce mortality and morbidity in neonates. Thus, we investigated LBW incidence in ILAM city and determined risk factors associated with it.
| | | | Methods & Materials | | This investigation is a case control study. 3073 live birth neonates were born in Ilam city in one year (2005) of which 2129 were normal vaginal delivery and 944 were born of caesarean delivery. The number of neonates with birth weight less than 2500grams were 183. We selected 130 of LBW neonates as case group and 260 normal birth weight neonates for control group by simple chance sampling. Data was collected by a questionnaire. For qualitative factors such as age and sex, median index was used. For quantitative factors, abundance distribution table was used. For hypothesis test, X test, Z test and T test were used and estimation of relative risk was done using Odds ratio. | | | | Results | Incidence of LBW in Ilam in 2005 was 5.9%. Factors such as sex, gestational age and presentation at time of delivery and correlation with LBW is depicted in Table 1. There was increase in LBW by 46.1 times in neonates with gestational age less than 37weeks (OR = 46.1). Non-cephalic presentation at delivery time was 10.3 times more in case group (OR = 10.3). Median weight of babies in case group was 1900+ 611grams and 3317+ 472 grams in control group. Case group consists of 6 (5%) ELBW neonates (weight less than 1000gr), 21 (16%) VLBW neonates (weight between 1000 - 1500grams), 103 (79%) moderately LBW neonates (weight = 1500 - 2500 grams). 62 mothers in case group and 98 mothers in control group delivered by caesarean section. Cause of C-section in case group was multiple pregnancies in 47.5% whereas in control group 33.3% was previous C-section. Average age of mothers in case group was 24.26 + 5.20 years and in control group was 26.77 + 5.99 years. In only 4.6% of LBW neonates, mother's age was less than 18 years. Incidence of LBW delivery increases 4.1 times in mother's less than 18 years of age. (Z = 2.42 > 1.96) (OR = 4.1). Mothers with age greater than 35years have essentially normal weight neonates. (Z = 0.81 > 1.96).
Table 1: Factors associated with LBW
| Factors associated |
Case group |
Control group |
P value |
Sex
Male
Female
|
73 (56.2%)
57 (43.8%)
|
112 (43.1%)
148 (56.9%)
|
0.88510 |
Gestational age
> 42 weeks
37- 42 weeks
<37 weeks
|
0
34 (26.2%)
96 (73.8%)
|
4 (1.5%)
241 (92.7%)
15 (5.8%)
|
0.000 |
Fetal presentation
Cephalic
Non- cephalic
|
108 (83.1%)
22 (16.9%)
|
255 (98.1%)
5 (1.9%)
|
0.000 |
| | | | Discussion | | One of the most important index in neonatal health is weight at birth. Deviation of birth weight from standard weight especially LBW increases probability of mortality and morbidity. Inspite of LBW neonates being only 7.5% of total neonates, mortality rate due to that is 2/3rd of total neonatal mortality rate. This study in Ilam city during one year (2005) found LBW incidence to be 5.9%. Studies showed that LBW incidence in Babol city was 7.4%, Gorgan 6.3%, Hamadan 10.6%, Tabriz 9.8%, Bushehr 9.6%, Varamin 8%, Ahvaz 7.3%, Tehran 7.3% and 5.6% in two studies, Yassog 5.3% and Shiraz 4.1%, England 7%, Kenia 15%, Turkey 10%, Kuala Lumpur 13.5%. In this study, gender of the child had no difference in LBW as also seen in study in Gorgan (3) whereas Gashtasbi et al found a relation between LBW with sex (P = 0.046) and incidence was five times in female neonates. In our study in Ilam, LBW babies had 1.6 times higher chance of being born of caesarean section as similarly seen by Mohammadian et al (5). Non-cephalic presentation had 10.3 chances of LBW babies and preterm delivery is more related to LBW which is similar to a study by Shahnaz et al (6). Mothers less than 18 years had a higher chance of LBW babies as was seen by Golalipur et al (7). Thus importance of prevention and health care can reduce incidence of LBW. Further investigation about role of nutrient deficiency such as Iron, Zn, and folic Acid during pregnancy in later researches are recommended. | | | | Compliance with Ethical Standards | | Funding None | | | | Conflict of Interest None | | |
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| Cite this article as: | | Khazaee S, Ghiasi B, Mahmoodzade F. Investigation of Low Birth Weight Incidence and Its Risk Factors in Ilam-Iran (2005-2006). Pediatr Oncall J. 2007;4: 23-24. |
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