ABSTRACT
This paper explores the relationships between maternal weight, height and poor pregnancy outcome using a data set from a case-control study of low birth weight (LBW) and perinatal mortality in Ahmedabad, India. Maternal height and weights were compared between mothers of 611 perinatal deaths, 644 preterm-LBW, and 1465 normal birth weight controls as well as 617 small-for-gestational age (SGA) and 1851 appropriate-for-gestational-age (AGA) births. Weight and height were much lower in this population compared to western standards. Low weight and height were associated with increased risk of perinatal death, prematurity and SGA. After adjusting for confounders, maternal weight remained significantly associated with poor pregnancy outcomes, whereas height was only weakly associated. Attributable risk estimates show that low weight is a much more important contributor to poor outcome than low height. Improvement in maternal nutritional status could lead to substantial improvement in birth outcome in this population.
PIP: In India, researchers analyzed three sets of case control comparisons (611 perinatal deaths vs. 1465 controls, 644 preterm low birth weight [LBW] cases vs. 1465 controls, and 617 small-for-gestational-age [SGA] cases vs. 1851 controls) to investigate the association between maternal weight, height, and weight-height indices and pregnancy outcome. They hoped to identify which maternal anthropometric measure could best predict poor perinatal health. All cases and controls were born at three teaching hospitals in Ahmedabad during 1987-1988. More than 66% of control mothers and around 75% of case mothers weighed less than 50 kg, indicating considerable maternal undernutrition. Low maternal weight was associated with all three poor perinatal outcomes (p 0.01) (adjusted odds ratio [AOR] for perinatal death = 1.6 for 46-50 kg, 1.7 for 41-45 kg, and 2.9 for 40 kg or less; AOR for preterm/LBW = 1.7, 2.5, and 4.9, respectively; AOR for SGA = 1.7, 1.7, and 2.4, respectively). The association between shortness (155 cm) and all three perinatal outcomes was only significant at 150-154 cm for perinatal death (AOR = 1.4), at 150-154 cm and 145-149 cm for preterm/LBW (AOR = 1.3 and 1.5, respectively), and at less than 145 cm and 150-154 cm (AOR = 1.5 and 1.3, respectively) (p 0.01). This association was less than that between maternal weight and perinatal outcomes. The weight-height ratio index and weight-height product index were significantly associated with all three perinatal outcomes (AOR = 1.6-4.9 and 1.4-5.2, respectively; p 0.01). Maternal weight had higher attributable risks than maternal height for perinatal death (37.1% vs. 18.1%), for preterm/LBW (55.6% vs. 18.4%), and for SGA (39.8% vs. 16.4%). Low height was probably mediated through low weight and other factors. These findings show that low weight contributes much more than low height to poor perinatal outcome. Improvement of maternal nutrition, through the Integrated Child Development Services, for example, would likely improve perinatal outcomes.
