Title
An analysis of intra-uterine growth retardation in rural Malawi
Author
Verhoeff, F.H.
Brabin, B.J.
van Buuren, S.
Chimsuku, L.
Kazembe, P.
Wit, J.M.
Broadhead, R.L.
Publication year
2001
Abstract
Objective: (1) To describe the sex-specific, birth weight distribution by gestational age of babies born in a malaria endemic, rural area with high maternal HIV prevalence; (2) to assess the contribution of maternal health, nutritional status and obstetric history on intra-uterine growth retardation (IUGR) and prematurity. Methods: Information was collected on all women attending antenatal services in two hospitals in Chikwawa District, Malawi, and at delivery if at the hospital facilities. New-borns were weighed and gestational age was assessed through post-natal examination (modified Ballard). Sex-specific growth curves were calculated using the LMS method and compared with international reference curves. Results: A total of 1423 live-born singleton babies were enrolled; 14.9% had a birth weight < 2500 g, 17.3% were premature (< 37 weeks) and 20.3% had IUGR. A fall-off in Malawian growth percentile values occurred between 34 and 37 weeks gestation. Significantly associated with increased IUGR risk were primiparity relative risk (RR) 1.9; 95% CI 1.4-2.6), short maternal stature (RR 1.6; 95% CI 1.0-2.4), anaemia (Hb < 8 g/dl) at first antenatal visit (RR 1.6; 95% CI 1.2-2.2) and malaria at delivery (RR 1.4; 95% CI 1.0-1.9). Prematurity risk was associated with primiparity (RR 1.7; 95% CI 1.3-2.4), number of antenatal visits (RR 2.2; 95% CI 1.6-2.9) and arm circumference < 23 cm (RR 1.9; 95% CI 1.4-2.5). HIV infection was not associated with IUGR or prematurity. Conclusion: The birth-weight-for-gestational-age, sex-specific growth curves should facilitate improved growth monitoring of new-borns in African areas where low birth weight and IUGR are common. The prevention of IUGR requires improved malaria control, possibly until late in pregnancy, and reduction of anaemia. Chemicals/CAS: Antimalarials
Subject
Health
Anaemia
Developing country
Intra-uterine growth
Reference curves
Adult
Africa
Analysis
Anamnesis
Arm
Body height
Calculation
Controlled study
Delivery
Endemic disease
Gender
Gestational age
Growth curve
Hospital
Human immunodeficiency virus
Human immunodeficiency virus infection
Information processing
Intrauterine growth retardation
Low birth weight
Malaria control
Maternal welfare
Monitoring
Mother
Newborn screening
Nutritional status
Parity
Prematurity
Prenatal care
Reference value
Risk assessment
Rural area
Seroprevalence
Anemia, Iron-Deficiency
Antimalarials
Birth Weight
Cross-Sectional Studies
Female
Fetal Growth Retardation
Gestational Age
HIV Infections
Humans
Infant, Newborn
Infant, Premature
Malaria
Malawi
Nutritional Status
Pregnancy
Pregnancy Complications, Infectious
Pregnancy Trimester, Third
Reference Values
Risk Factors
Rural Population
Sex Factors
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DOI
https://doi.org/10.1038/sj.ejcn.1601200
TNO identifier
236206
ISSN
0954-3007
Source
European Journal of Clinical Nutrition, 55 (8), 682-689
Document type
article