European Journal of Cardiovascular Medicine

Birth weight and other anthropometric parameters a long with gestational age are understood to be important factors for survival, future growth and over all development of the child. There is a large body of literature showing that the worldwide problem of low birth weight (LBW), i.e. infants weighing<2500g, is among the strongest determinants of in fan mortality and morbidity. Beside biological factors like gestational age (GA), maternal weight and height, life style factors such as dietary habits, tobacco, and alcohol can influence birth weight. Furthermore there are socio demographic and socio-economic factors that are known to affect birth weight.[1,2]   

Small mother will produce small baby, small female may grow up to become small girl, a women with reduced growth and further exposure to deleterious effects of poverty, malnutrition during infancy and childhood may grow up as small girl with compromised reproductive efficiency . They would thus perpetuate the cycle of producing small babies. LBW rate is directly related to infant mortality rate.

More recently, some studies have found that the perception of stress or anxiety is associated with negative outcomes for mother and offspring, including preeclampsia, preterm birth (PTB), small for gestational age (SGA), congenital heart defects, and impaired cognitive development of the child . Clearly delineating the effects of stress would allow practitioners to focus on specific risk factors and offer reasonable advice and interventions to improve pregnancy and birth outcomes. Additionally, it had been recently reported an association between maternal exposure to severe life events during or in the 6 months before pregnancy and reduced infant birth weight and increased risk of SGA.[3]

These, especially birth weight and gestational age (maturity) are important factors determining survival, future growth and overall development of the child. It was my sincere attempt to study the various determinants of anthropometric measurements of new borns delivered to mothers at Mallareddy Narayana Multispeciality Hospital, tertiary care hospital attached to Mallareddy medical college for women. 

Method Of Collection Of Data

It is a hospital based cross sectional study done by Simple random sampling consisting of newborns and their respective mothers delivered at Mallareddy Narayana multispecialty hospital, tertiary care hospital attached to Mallareddy medical college for women, Suraram during the period of 15 months between December 2020- February 2022. Scientific committee and institutional ethics committee approval was obtained. 200 cases meeting the inclusion criteria were included , randomized and studied. Sample size has been calculated based on the number of deliveries in the last 6 months in the institute.

Inclusion Criteria: 200 live births delivered at Mallareddy Narayana Multispeciality Hospital, Tertiary care Hospital attached to Mallareddy Medical College for Women, Suraram.

Exclusion Criteria: Newborns with major congenital malformation and chromosomal defects. who could not be examined due to medical complications in NICU and whose parents are not willing for this study.

Birth weight was measured by Harson’s electronic weighing machine with accuracy ±5 grams and was recorded within 24 hours after birth. Head circumference, chest circumference, mid arm circumference were measured by non-stretchable measuring tape with accuracy 0.1 cm and length of baby by infantometer with accuracy 0.1 cm. The head circumference was measured after 24 hours after reduction of caput.

The maternal, fetal and other factors, which determine the weight and other parameters of the baby, were collected in a predetermined proforma . Maternal height measured by stature meter. It was done with the help of an attending female nurse in wards. Information collected from available relevant documents such as mother’s card, previous antenatal checkup cards, investigation reports etc. and whenever necessary the information cross checked with nearby family attender.

The Perceived Stress Scale (PSS) was developed by Sheldon Cohen in 1983 and validated in and gender.

Investigation reports which were carried out during antenatal period were collected, like; (1) Hb%, (2) HIV, (3)VDRL, (4) HBsAg and (5) Urine - albumin, sugar, microscopy. These data will be subjected to statistical analysis and the results will be tabulated.

Ballard score will be used to calculate the gestational age New Bellard’ Score (39) Postdelivery methods of determining gestational age in premature infants have been developed and validated. The New Ballard Exam allows for gestational assessment in infants as early as 20 weeks' gestation and utilizes parameters of physical (6 criteria) and neurological (6 criteria) maturity to reach a score that correlates with gestational age.

This is the most commonly used tool for postnatal assessment of gestational age, due to its ease of use and the limited accuracy of other methods of gestational age determination. The New Ballard Exam complements the historical or ultrasonographic estimates.

New Ballard Score is a valid and reliable clinical tool for Gestational age assessment until day 7. It slightly overestimates the Gestational age with increasing post natal age.

Neurological signs are more reliable than physical ones.(40) However some studies says is inaccurate for extremely premature infants and hence refinement of Gestational age assessment scoring systems is needed to optimize clinical benefit.[4]

Chi-square test for discontinuous variables and unpaired t-test for continuous variable at 5% significance (p<0.05) level were used for statistical analysis using software SPSS 22.0 version.

Table-1: Relationship between birth weight, gestational age and other anthropometric parameters

Anthropometric parameters like length, head circumference, chest circumference and mid arm circumference increases proportionately with birth weight and were statistically significant. Duration of gestation will determine the birth weight and other parameters proportionately increase with birth weight. Change in parameters according to statistical analysis were found significant.

Table-2: Distribution of babies on intrauterine growth and gestational age.

In this study, Term-AGA forms the biggest group followed by, Preterm-AGA, Term- SGA, Preterm-SGA, Pre term-LGA. The difference was statistically significant.

Table-3: Distribution of babies according to maternal pregnancy weight gain and birth weight

Mean birth weight is lowest in babies born to mothers who gain less than 5 kg weight during pregnancy, birth weight increases with weight gain during pregnancy and was highly significant. It was highest in those with 6-10 kgs weight gain group. Lowest birth weight recorded was 1.4kg.

Table-4: Distribution of babies according to socioeconomic status and birth weight.

In this study mothers with class I kuppuswamy scale was not recorded. Mean birth weight was lowest in class V socio economic class. Birth weight increases in upper socio economic class was highly significant.

Table-5: Distribution of babies according to maternal literacy level and birth weight.

According to above table mean birth weight was lowest in the mothers with primary education group and highest in mothers having degree. Incidence of low birth weight incidence decreases and mean birth weight increases with higher education level; was statistically highly significant.

Table-6: Distribution of babies according to inter pregnancy interval and birth weight

Above table tabulates distribution of babies according to inter pregnancy interval and birth weight. Mean birth weight was lowest in those with inter pregnancy interval < 1 year. Mean birth weight increases as spacing increases. LBW rate was highest in <1 year spacing and lowest in > 3 year spacing. .

Hence LBW rate decreases and mean birth weight increases as spacing increases and was found significant between < 1 year and > 3 years group.

Table-7: Distribution of babies according to Birth order and birth weight

LBW was highest in birth order I and II. Among 66 babies born with 1st birth order 14(31.8%) babies and with 81 with 2nd order 38(31.8 %) were LBW and as the birth order increases LBW rate decreases.

Table-8: Distribution of babies according to birth weight and multiple gestation

The above table compares birth weight of children in singletons and twins. Mean birth weight of singletons was 2810 gm. compared twins with mean birth weight 2310gm, difference being 500 gm., which was not statistically significant.

Table-9: Distribution of babies according to disorders and birth weight

Lowest Hb% recorded in the study was 4 gm which was statistically significant. Among babies born to 24 anemic mothers 45% were LBW compared to non-anemic (18%).

Maternal PIH was found significantly associated with LBW. But the difference was not statistically significant. The difference was not significant. Mean birth weight for newborn born to mothers with thyroid disorders was 2.78kg vs. 2.81 kg in those born for mothers with no thyroid disorder.

Table-10: Distribution of babies according to Maternal Blood group and Mean birth weight

Above table compares the birth weight of babies against maternal blood group. In this study 5 Rh negative mother were recorded. The difference of Mean birth weight was not significant.

Table-11: Distribution of babies according to maternal stress and mean birth weight

The incidence of LBW was found to be highest(11 out of 16)68% among those with high risk of stress perception, while LBW incidence in moderate risk was 44% and further decreases in mothers with low risk of stress 7%. The difference in mean birth weight among low risk (2.94 kg) and high risk (2.35 kg) group of mothers was found to be and was significant

Table-12: Percentage of newborns in each group

From the above table it is evident that Term AGA constitutes the biggest group. Preterm babies constitute 17.5% and term- SGA account for 14.5% of the cases.

P-0.001 highly significant. n-31

In our study, 31 out of 200 babies were SGA babies. Malnourished/ disproportionate/ asymmetric IUGR with ponderal index < 2 were 1(3 %) out of 31 and symmetric/ hypoplastic/ proportionate IUGR babies with Ponderal index >2 were 30 (97%). The difference was statistically significant. From the above table it is evident that asymmetric IUGR babies forms the biggest group among IUGR babies.

Table 13: Table showing variation of different mean anthropometric measurements among Symmetric and Asymmetric babies

p- 0.002, highly significant, n-31

All parameters were high in Asymmetric IUGR babies and the difference was statistically significant.

In the present study there were 105 (52.5%) male babies and 95 (47.5%) female babies. Similar observations were made by Samiran Bi Sai[5], Neeraj Agarval[6] and Antoni Swamy.[7] But in statistics of our hospital delivery taken for the study period from Dec 2020 to February 2022 for the period of 15 months, there were more number of male births compared to female births.

In the present study the mean birth weight was 2870 gm in males, 2720 gm in females. There was difference of 150 gm. and the male babies were heavier than females. Similar observations were made by Shajari H, Antoni Swamy, Samiran Bi Sai[6,7,8] and in all the studies male babies were heavier than female babies by 73 to 143 gm. The mean birth weight was higher in the study done by Shajari H[8] and is due to racial and genetic in origin as this study was done in Iran.

the present study 22% of babies were less than 2499 gm. i.e. low birth weight babies. Similar observations were made by Samiran Bi Sai[5] and when compared to the study done by Prasad KN46 and current incidence of LBW in our country is 16.4%, the incidence is high in this study.

Newborns are classified depending Fenton charts into SGA, AGA and LGA babies. In the present study 15% of babies fall into SGA, 84% fall into AGA and 0.5% fall into LGA. These findings were comparable to the study done by Samiran Bi Sai[5] and Lohitha[9] study. In any of the above studies LGA babies constitute 0.5-0.6%.

Incidence of pre-term births in this study was 5%, term births was 94.5% and Post- term births was 0%. In India 10 to 12 percent of babies born preterm as compared to 5 to 7 percent in the West. The mean birth weight of preterm babies in this study was 2778 gm, in term 2811 gm. Hence, birth weight increases as the duration of gestation increases until 42 weeks. Similar observation was made in above mentioned studies, but mean birth weight continue to increase in the study done by Shajari H.[8]

From the observation made in table 4 in results section it is clear that other parameters like length, head circumference, chest circumference and mid arm circumference increase proportionately with birth weight. In this study mean length of LBW babies were 46.8cm, mean head circumference- 33.5 cm, mean chest circumference 30.9 cm and mean mid arm circumference 9.8 cm. Our study showed anthropometric values higher compared to previous studies probably because of more number of term babies included and other confounding factors effecting birth weight. And these values of height, head circumference and chest circumference can be used to identify LBW babies by using measuring tape in field setting.

In the present study among 44% of LBW babies, 16.4% of babies constitute male babies and 28% constitute female babies. LBW incidence is more in female babies in this study which is same from other studies- Samiran Bi Sai[5] , Damini Singh et al[10] showed incidence of LBW is more in female babies. This difference may be due to gender preference.

In the present study of 200 mothers and respective newborns, 50.9% of mothers were below 20 years and 3.6% of mothers were above 30 year. Lowest maternal age recorded was 17 years and highest age recorded was 34 year. Mean age at conception was 21.3 year.

In present study mean birth weight is lowest in mothers less than 20year and similar observations were made in other studies. As the maternal age increases birth weight increases and similar observations were made in other studies.Incidence of LBW was more in mothers below 20 years and after 30 years and it decreases with increase in maternal age from 20 to 30 years. Our study correlates with the study done by Guvande UH et al.17 and Kiran Anand53. High incidence of LBW was observed in all above studies.

Mothers were categorized into different groups depending upon the height. Shortest mother recorded in our study was cm and tall mother recorded was 169-cm. Mean maternal height in the present study was 155.69 cm. Height less than 145 cm is considered as short mother for Indian women. None of the mothers below 150 cm deliver baby with birth weight more than 3500gm in this study. In the present study 2% of mothers were less than 145cm.

The mean birth weight was lowest in maternal age group with >160 cm group and mean birth weight decreases as the maternal height increases. As maternal height increases birth weight increases were observed in the study conducted by Bisai S et al[11].

In this study contribution of maternal height to low birth weight, more or less remains nil. BMI of normal women should be between 20-24. Cut off point of >25 and >30 are considered as overweight and obesity. Weight gain in women with normal BMI is 11 to 16 kg. An obese women should not gain more than 7 kg, where as an underweight (BMI <19kg) may be allowed to gain up to 18 kg. Maternal nutrition and weight gain during pregnancy is directly related to birth weight. However it may not be the specific indicator as there are other factors for low birth weight. The total weight gain during the course of singleton pregnancy for healthy women averages 11 kg. Rate of weight gain is 1 kg in 1st trimester and 5 kg in 2nd and 3rd trimesters. Fifty percent of weight gain is maternal and 50% is fetal contribution.

In the present study, average weight gain was 8.4 kg. Maximum mean birth weight noted in 6- 10 kg weight gain group and lowest mean birth weight noted in <5 kg weight gain group. Hence mean birth weight increases with increase in maternal weight gain during pregnancy.

In the present study 54.5% of mothers in <5 kg weight gain group delivered LBW babies and LBW rate decreases as the pregnancy weight gain increases. Similar observation was made in the study done by Kiran Anand et al.[12]

Among 200 mothers in the present study no mother in Class I socio economic status recorded. Contribution of each class was, Class I- nil, class II-28%, class III- 51.5%(highest), class IV- 18 and class V-2%. Mean birth weight was high in upper socio economic status and lowest in class V. Similar observations were made in the studies conducted by. LBW rate

In the present study among 44% of LBW babies, 16.4% of babies constitute male babies and 28% constitute female babies. LBW incidence is more in female babies in this study which is same from other studies- Samiran Bi Sai[5] , Damini Singh et al[10] showed incidence of LBW is more in female babies. This difference may be due to gender preference.

In the present study of 200 mothers and respective newborns, 50.9% of mothers were below 20 years and 3.6% of mothers were above 30 year. Lowest maternal age recorded was 17 years and highest age recorded was 34 year. Mean age at conception was 21.3 year.

In present study, mean birth weight is lowest in mothers less than 20year and similar observations were made in other studies. As the maternal age increases birth weight increases and similar observations were made in other studies.

Incidence of LBW was more in mothers below 20 years and after 30 years and it decreases with increase in maternal age from 20 to 30 years. Our study correlates with the study done by Guvande UH et al.17 and Kiran Anand53. High incidence of LBW was observed in all above studies.

Mothers were categorized into different groups depending upon the height. Shortest mother recorded in our study was cm and tall mother recorded was 169-cm. Mean maternal height in the present study was 155.69 cm. Height less than 145 cm is considered as short mother for Indian women. None of the mothers below 150 cm deliver baby with birth weight more than 3500gm in this study. In the present study 2% of mothers were less than 145cm.

The mean birth weight was lowest in maternal age group with >160 cm group and mean birth weight decreases as the maternal height increases. As maternal height increases birth weight increases were observed in the study conducted by Bisai S et al[11].

In this study contribution of maternal height to low birth weight, more or less remains nil. BMI of normal women should be between 20-24. Cut off point of >25 and >30 are considered as overweight and obesity. Weight gain in women with normal BMI is 11 to 16 kg. An obese women should not gain more than 7 kg, where as an underweight (BMI <19kg) may be allowed to gain up to 18 kg. Maternal nutrition and weight gain during pregnancy is directly related to birth weight. However, it may not be the specific indicator as there are other factors for low birth weight. The total weight gain during the course of singleton pregnancy for healthy women averages 11 kg. Rate of weight gain is 1 kg in 1st trimester and 5 kg in 2nd and 3rd trimesters. Fifty percent of weight gain is maternal and 50% is fetal contribution.

In the present study, average weight gain was 8.4 kg. Maximum mean birth weight noted in 6- 10 kg weight gain group and lowest mean birth weight noted in <5 kg weight gain group. Hence mean birth weight increases with increase in maternal weight gain during pregnancy.

In the present study 54.5% of mothers in <5 kg weight gain group delivered LBW babies and LBW rate decreases as the pregnancy weight gain increases. Similar observation was made in the study done by Kiran Anand et al.[12]

Among 200 mothers in the present study no mother in Class I socio economic status recorded. Contribution of each class was, Class I- nil, class II-28%, class III- 51.5%(highest), class IV- 18 and class V-2%. Mean birth weight was high in upper socio economic status and lowest in class V. Similar observations were made in the studies conducted by. LBW rate. 

In the present study mean birth weight in anaemia group was 2818 gm. and non- anaemia group was 2710 gm. with 108 gm. higher mean birth weight. Similar finding observed in the study conducted by Vural T et al[16] with higher mean birth weight of 184 gm. in no-anemia group. Incidence of LBW was high in anemic group compared to non-anemic group and similar trend observed in the studies done by Sachdeva P et al.[15] So maternal anemia significantly correlated with birth weight and incidence of LBW in the present study.

There were 5(2.5%) babies with maternal diabetes mellitus in this study. 1 LBW baby noted in this diabetic group compared to 22% LBW babies in non-diabetic group. Mean birth weight was 3081 gm. in diabetic group compared to 2798 gm. in non- diabetic group, higher by 283 gm. Similar trend was observed in the studies done by Vedavathi.et al.[17] Kevin Johns et al[18]

Very few studies have been done on Maternal stress effecting Neonatal outcome-It was found that the mean birth weight along with other anthropometric measurements decrease with increasing level of maternal stress and the difference was found to be highly significant. However the difference between mean birth weight in low risk group to the average mean birth weight was not significant which was similar to study done by Deborah.[19]

In the present study mean ponderal index of term babies was 2.72 gm. /cc when compared to < 2.25 in the study done by Basnet[20] in asymmetric IUGR babies it was 1.9 and is comparable with the study done by Basnet [20].

In our study, 31 out of 200 babies were SGA babies. Malnourished/ disprortionate /asymmetric IUGR with ponderal index <2 were 1 (3 %) out of 31 and Symmetric / Hypoplastic / proportionate IUGR babies with Ponderal index >2 were 30 (97 %) out of 31. It is clear that symmetric IUGR babies forms biggest group among total IUGR babies.

From the above table it was evident that birth weight was more in symmetric IUGR babies by 100 gm. Other than birth weight, all parameters are high in Asymmetric. IUGR babies in previous study in contrast to present study. Difference between HC and CC was 3.2 cm in asymmetric IUGR babies compared to 2.5 cm in Symmetric IUGR babies.

Current national LBW rate is 16.4%. In the present study LBW rate was 22%. Regarding IUGR babies, much work can be done to reduce the rate. Contribution of IUGR to LBW incidence is only 1/3rd in west and in developing countries like India, its contribution is 2/3rd. Measures taken to improve mean birth weight in the population will reduce LBW by decreasing IUGR rate.

In this study, it was found that 13.5% of mothers were below 20 years (teenage pregnancy and LBW rate was high and mean birth weight was low. Best age for conception is 20 to 30 years of age. So by discouraging teenage pregnancies, proper spacing (2y), and LBW rate can be reduced.

By improving maternal literacy and socio economic status of the family, good housing, proper sanitary and portable drinking water facility, LBW rate can be reduced. In the present study, 1% of mothers were illiterate. Mean birth weight in primi was less and LBW rate was high.

In the present study, 12% of mothers were anemic! Mean maternal hemoglobin was 11.0%. Maternal anemia strongly influences mean birth weight and LBW rate. In the present study according to documents available like ANC card, mother’s card, etc., mother receiving minimum 4 ANC visits was 99%, and still 12% of mothers were anemic. This indicates antenatal care provided by us is only quantitative and not qualitative. By improving food intake, improving socio economic condition, literacy, qualitative antenatal care by health staff, early referral of risky cases, provision of Iron and folic acid supplementation, parenteral iron therapy and blood transfusion whenever essential can reduce the incidence of anemia and there by reduction in LBW.

By discouraging teen age conception and consanguineous marriages, improving maternal literacy, socio-economic status of the family, pre-pregnancy weight and pregnancy weight gain, proper spacing, good nutrition, iron-folic acid supplementation, early and 100% registration, early referral and proper management of high risk cases in specialized center, qualitative antenatal care, proper emotional support, LBW can be reduced and mean birth weight and overall outcome of the baby can be improved.

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