Neonatal anthropometry: the thin-fat Indian baby. The Pune Maternal Nutrition Study.

OBJECTIVE: To examine body size and fat measurements of babies born in rural India and compare them with white Caucasian babies born in an industrialised country. DESIGN: Community-based observational study in rural India, and comparison with data from an earlier study in the UK, measured using similar methods. SUBJECTS: A total of 631 term babies born in six rural villages, near the city of Pune, Maharashtra, India, and 338 term babies born in the Princess Anne Hospital, Southampton, UK. MEASUREMENTS: Maternal weight and height, and neonatal weight, length, head, mid-upper-arm and abdominal circumferences, subscapular and triceps skinfold thicknesses, and placental weight. RESULTS: The Indian mothers were younger, lighter, shorter and had a lower mean body mass index (BMI) (mean age, weight, height and BMI: 21.4 y, 44.6 kg, 1.52 m, and 18.2 kg/m(2)) than Southampton mothers (26.8 y, 63.6 kg, 1.63 m and 23.4 kg/m(2)). They gave birth to lighter babies (mean birthweight: 2.7 kg compared with 3.5 kg). Compared to Southampton babies, the Indian babies were small in all body measurements, the smallest being abdominal circumference (s.d. score: -2.38; 95% CI: -2.48 to -2.29) and mid-arm circumference (s.d. score: -1.82; 95% CI: -1.89 to -1.75), while the most preserved measurement was the subscapular skinfold thickness (s.d. score: -0.53; 95% CI: -0.61 to -0.46). Skinfolds were relatively preserved in the lightest babies (below the 10th percentile of birthweight) in both populations. CONCLUSIONS: Small Indian babies have small abdominal viscera and low muscle mass, but preserve body fat during their intrauterine development. This body composition may persist postnatally and predispose to an insulin-resistant state.

Unsafe motherhood: the determinants of maternal mortality.

PIP: Maternal mortality is a three-step process (pregnancy, pregnancy-related complications, and death). Close birth spacing, early pregnancy, unwanted pregnancy, and access to family planning are determinants of maternal mortality. World Fertility Survey figures show that 35% of maternal deaths in Asia could be prevented if all women who did not want children had access to contraceptives. The status of women affects health during pregnancy. Many years of physical neglect and inequitable distribution of food, health care, and other resources effect stunting, an inadequately formed pelvis, low pre-pregnancy weight, anemia, and chronic illnesses such as malaria. Conditions such as aseptic abortion can be prevented. Clean delivery practices, proper management of the third stage of labor, and tetanus immunization are other preventive measures. Many complications are difficult to prevent and to predict; some studies have estimated that up to 50% of maternal deaths were to "low risk" women. The timing of detection of complication and the effectiveness and speed of treatment impact on survival. Intervention means preventing delays in seeking care, delays in reaching an appropriate facility (substantial numbers of deaths occur en route), and delays in receiving treatment, even after reaching the appropriate facility. The timing between the occurrence of the emergency and death involves sociocultural, logistic, and health services factors. When safe motherhood efforts become part of child survival efforts, maternal health will improve.^ieng

Determinants of low birth weight: a community based prospective cohort study.

The study aimed at identifying and quantifying determinants of low birth weight (LBW) by following a community based prospective cohort of pregnant women in 45 villages in Pune district. In the 1922 live births born to mothers without a chronic illness, in whom birth weight was available within 24 hours, the cumulative incidence of LBW (< 2500 g) was 29%. The unadjusted relative risks for LBW were significantly higher for lower socio-economic status (RR = 1.71), maternal age less than 20 years (RR = 1.27), primiparity (RR = 1.32), last pregnancy interval less than 6 months (RR = 1.48), non-pregnant weight less than 40 kg (RR = 1.3), height below 145 cm (RR = 1.51), hemoglobin less than 9 g/dl (RR = 1.53) and third trimester bleeding (RR = 1.87). Multivariate logistic regression analysis showed that the adjusted odds ratio for LBW decreased with increasing gestational duration, non-pregnant weight, parity and rising education level of the mother. Socio-economic status, non-pregnant weight, maternal height, and severe anemia in pregnancy had substantial attributable risk per cent for LBW (41.4%, 22.9%, 29.5% and 34.5%, respectively). The findings suggest that selectively targetted interventions such as improving maternal education and nutrition, specifically anemia, wider availability of contraception to delay the first pregnancy and to increase pregnancy intervals may help in identifying and ensuring adequate care for those women at greatest risk of LBW.

PIP: In India, medical social workers followed a cohort of 1922 pregnant women in 45 contiguous villages in Pune District at monthly intervals so researchers could identify and quantify risk factors of low birth weight (LBW: 2500 g). 29% of the infants were LBW infants. LBW infants were significantly more likely to be born to mothers of very low socioeconomic status (unadjusted relative risk [RR] = 1.71), aged less than 20 (RR = 1.27), pregnant for the first time (RR = 1.32), whose last pregnancy interval was shorter than 6 months (RR = 1.48), whose nonpregnant weight was less than 40 kg (RR = 1.3), whose height was less than 145 cm (RR = 1.51), whose hemoglobin was less than 9 g/dl (RR = 1.53), who bled during the third trimester (RR = 1.87), and who delivered the infant prematurely (i.e., 32 weeks) (RR = 3.84). Mothers with 8-10 years of formal schooling were less likely to have an LBW infant than illiterate mothers (RR = 0.78). Boys were less likely to be LBW infants than girls (RR = 0.78). The multivariate logistic regression analysis revealed that the adjusted odds ratio for LBW fell as gestational age (0.207), nonpregnant weight (0.711), parity (0.835), and maternal educational status (0.869) increased. The attributable risk percentages for risk factors were 73.9% for premature birth, 46.6% for third trimester bleeding, 41.4% for very low socioeconomic status, 34.5% for hemoglobin less than 9 g/dl, 32.5% for last pregnancy interval shorter than 6 months, 29.5% for height less than 145 cm, 24.4% for primiparity, 22.9% for nonpregnant weight less than 40 kg, 21.3% for adolescent mother, and 21.5% (preventive fraction) for high maternal educational status. These findings suggest that health professionals should target limited resources to improving maternal education and nutrition status (i.e., reducing anemia), to providing wider availability of contraception to delay age at first pregnancy and to increase intervals between births, and to making sure that mothers at greatest risk of delivering a LBW infant receive appropriate care.

Foot tape measure for identification of low birth weight newborns.

The majority of births in rural India take place at home, Logistic constraints make early and reliable identification of low birth weight babies difficult. Using neonatal foot length as a proxy measure for birth weight, we devised a tri colored foot tape intended for use at home by the neonatal caretaker or birth attendant. The tape was field tested in a rural community in the Pune district. Results showed a sensitivity of 68.2% and a predictive value of 45.5% for identifying low birth weight. For very low birth weights (< 1500 g) the sensitivity was 100%, specificity 95.2% and the positive predictive value 60%. Interobserver reliability comparing a trained medical social worker and the household member was high (kappa score of 0.82). If implemented on a larger scale this simple, low cost technology has the potential to significantly enhance the yield of identification of low birth weight babies born at home.