Timalsina U, Sharma S, Giri S, Basyal B, Bhandari S, Neupane M Risk factors of Intrauterine growth retardation: A study in a tertiary hospital of Nepal Timalsina U, Sharma S, Giri S, Basyal B, Bhandari S, Neupane M Utsav Timalsina, 4th year Medical Student, Institute of Medicine, Kathmandu, Nepal

Introduction Birth weight is an important determinant of an infant’s survival and future development. Low Birth Weight (LBW), defined as a weight of less than 2500g at birth regardless of gestational age. Globally, LBW contributes to 40-60% of newborn mortality. In Nepal, there is high prevalence (11.9 -32%) of LBW.

Research question What are the major factors associated with low birth weight term babies?  

Conceptual framework Low Birth Weight Maternal related factors Anemia in pregnancy Maternal weight gain during gestation Hard physical work BMI (Height and Weight) Hypertension Smoking and alcoholism Mother related factors Age of mother at child birth Smoking and alcoholism Education of mother Mother’s occupation Earning status Gravida Parity Birth spacing History of abortion ANC status Socio-economic Family type Family size Economic status Caste group Residence Food security Sex determination Sex of the child

Case-control study in Tribhuvan University Hospital, Nepal. Materials and Methods Case-control study in Tribhuvan University Hospital, Nepal. Cases All singleton newborns with birth weight <2500gm 156 Controls Singleton newborns with normal birth weight 312 Preterm babies, new born with congenital diseases and twin delivery were excluded. Powered to detect an odds ratio of 1.8 at two sided significance level of 0.05 and 80%power.

Materials and Methods Mothers were interviewed by medical students with pretested structured questionnaires in Nepali. Informed consent was taken and medical records were observed. Questionnaire were drafted reviewing related articles and standards. Non-stretchable measuring tape and weighing scale were used. Analyses were done using SPSS (version 14) using appropriate tests.

Result Characteristics of the mothers with LBW

Result History of previous premature delivery 8.59 (1.57-46.91) Factors OR (95% CI) P value History of previous premature delivery 8.59 (1.57-46.91) p=0.013 Maternal age less than 22yrs 2.95 (1.76-4.94) p=0.000 Delivery by a caesarean section 11.14 (6.33-19.60) Disadvantaged ethnic group 0.41 (0.20-0.81) p=0.01 Height of mother 1.19 (.49-2.9) p=.069 Very hard physical work 1.53 (.94-2.46) p=.082 Not eating meat, beans, green vegetables regularly 1.08 (.64-1.83) p=.752

Result These factors were not associated with the delivery of LBW babies: History of previous abortions; place of residence rural or urban Education level and occupation of mother or father Cooking food during pregnanacy and type of food consumed during prgnancy Family type and number of family members Number of antenatal check-ups and maternal hemoglobin level (<10 vs >=10gm/dl)

The major factors associated with LBW in term babies are: Conclusion The major factors associated with LBW in term babies are: History of previous premature delivery Delivery by a caesarean section Maternal age less than 22yrs

Discussion The independent risk factors of giving birth to low birth weight babies in Nepal are: Babies born of pregnant mothers of less than 22 years age History of previous premature delivery Delivery by a caesarean section The limitations of study are: sample population may not be the representative of typical community where the LBW is biggest It precludes the home delivered LBW infants Preterm babies and those with congenital anomalies were not considered

Future prospective A large number of infants’ death can be averted by addressing LBW and associated preventable factors. The study will provide further impetus in the attainment of MDG 4(Millennium Development Goal) goal.

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