Risk factors for small-for-gestational-age and preterm births among 19,269 Tanzanian newborns

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Abstract

Background

Few studies have differentiated risk factors for term-small for gestational age (SGA), preterm-appropriate for gestational age (AGA), and preterm-SGA, despite evidence of varying risk of child mortality and poor developmental outcomes.

Methods

We analyzed birth outcome data from singleton infants, who were enrolled in a large randomized, double-blind, placebo-controlled trial of neonatal vitamin A supplementation conducted in Tanzania. SGA was defined as birth weight <10th percentile for gestation age and sex using INTERGROWTH standards and preterm birth as delivery at <37 complete weeks of gestation. Risk factors for term-SGA, preterm-AGA, and preterm-SGA were examined independently using log-binomial regression.

Results

Among 19,269 singleton Tanzanian newborns included in this analysis, 68.3 % were term-AGA, 15.8 % term-SGA, 15.5 % preterm-AGA, and 0.3 % preterm-SGA. In multivariate analyses, significant risk factors for term-SGA included maternal age <20 years, starting antenatal care (ANC) in the 3 ^rd trimester, short maternal stature, being firstborn, and male sex (all p < 0.05). Independent risk factors for preterm-AGA were maternal age <25 years, short maternal stature, firstborns, and decreased wealth (all p < 0.05). In addition, receiving ANC services in the 1 ^st trimester significantly reduced the risk of preterm-AGA ( p = 0.01). Significant risk factors for preterm-SGA included maternal age >30 years, being firstborn, and short maternal stature which appeared to carry a particularly strong risk (all p < 0.05).

Conclusion

Over 30 % of newborns in this large urban and rural cohort of Tanzanian newborns were born preterm and/or SGA. Interventions to promote early attendance to ANC services, reduce unintended young pregnancies, increased maternal height, and reduce poverty may significantly decrease the burden of SGA and preterm birth in sub-Saharan Africa.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR) – ACTRN12610000636055, registered on 3 ^rd August 2010.

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Most cited references 16

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The associations of birth intervals with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis

Naoko Kozuki, Anne Lee, Mariângela F. Silveira … (2013)

Background Short and long birth intervals have previously been linked to adverse neonatal outcomes. However, much of the existing literature uses cross-sectional studies, from which deriving causal inference is complex. We examine the association between short/long birth intervals and adverse neonatal outcomes by calculating and meta-analyzing associations using original data from cohort studies conducted in low-and middle-income countries (LMIC). Methods We identified five cohort studies. Adjusted odds ratios (aOR) were calculated for each study, with birth interval as the exposure and small-for-gestational-age (SGA) and/or preterm birth, and neonatal and infant mortality as outcomes. The associations were controlled for potential confounders and meta-analyzed. Results Birth interval of shorter than 18 months had statistically significant increased odds of SGA (pooled aOR: 1.51, 95% CI: 1.31-1.75), preterm (pooled aOR: 1.58, 95% CI: 1.19-2.10) and infant mortality (pooled aOR: 1.83, 95% CI: 1.19-2.81) after controlling for potential confounding factors (reference 36-<60 months). It was also significantly associated with term-SGA, preterm-appropriate-for-gestational-age, and preterm-SGA. Birth interval over 60 months had increased risk of SGA (pooled aOR: 1.22, 95% CI: 1.07-1.39) and term-SGA (pooled aOR: 1.14, 95% CI: 1.03-1.27), but was not associated with other outcomes. Conclusions Birth intervals shorter than 18 months are significantly associated with SGA, preterm birth and death in the first year of life. Lack of access to family planning interventions thus contributes to the burden of adverse birth outcomes and infant mortality in LMICs. Programs and policies must assess ways to provide equitable access to reproductive health interventions to mothers before or soon after delivering a child, but also address underlying socioeconomic factors that may modify and worsen the effect of short intervals.

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Advanced maternal age and adverse perinatal outcome: a review of the evidence.

Mary Carolan-Olah, Dorota Frankowska (2011)

To examine the evidence in relation to advanced maternal age (35-39 years), physiological risk and adverse perinatal outcome (stillbirth, low birth weight, preterm birth) in high-income countries. This review was conducted against a background of increasing maternal age (>35 years) and concerns for fetal and maternal welfare among this group. Consequent to these concerns, increasing trends of birth intervention such as caesarean section and instrumental birth are seen. Although evidence justifies a high rate of intervention among women aged more than 40 years, the evidence for such intervention in women aged 35-39 years is sketchy and often contradictory. A systematic review was conducted of studies in English, that were published between 2000 and 2010. Studies were included if they had extractable data on maternal age (35-39 years) and perinatal outcomes. Of 102 retrieved publications, nine met these criteria. Evidence from this review suggests that rates of adverse perinatal outcome, such as stillbirth, are linked to maternal age 35-39 years. However, rates of increase are modest until 40 years of age or more. The impact of changing maternal socio demographics appears to be of importance but is not yet well understood. Although risk and rates of adverse perinatal outcome are increased among women aged 35-39 years, midwives and women should also be aware that perinatal outcomes are generally favourable for this group. There is also some suggestion in the literature that social advantage may ameliorate some of the effect of advanced maternal age on perinatal outcome. Further research is required to evaluate the soundness and strength of this association. Copyright © 2010 Elsevier Ltd. All rights reserved.

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Nutrition and maternal mortality in the developing world.

D Rush (2000)

This review relates nutritional status to pregnancy-related death in the developing world, where maternal mortality rates are typically >/=100-fold higher than rates in the industrialized countries. For 3 of the central causes of maternal mortality (ie, induced abortion, puerperal infection, and pregnancy-induced hypertension), knowledge of the contribution of nutrition is too scanty for programmatic application. Hemorrhage (including, for this discussion, anemia) and obstructed labor are different. The risk of death is greatly increased with severe anemia (Hb <70 or 80 g/L); there is little evidence of increased risk associated with mild or moderate anemia. Current programs of universal iron supplementation are unlikely to have much effect on severe anemia. There is an urgent need to reassess how to approach anemia control in pregnant women. Obstructed labor is far more common in short women. Unfortunately, nutritional strategies for increasing adult stature are nearly nonexistent: supplemental feeding appears to have little benefit after 3 y of age and could possibly be harmful at later ages, inducing accelerated growth before puberty, earlier menarche (and possible earlier marriage), and unchanged adult stature. Deprived girls without intervention typically have late menarche, extended periods of growth, and can achieve nearly complete catch-up growth. The need for operative delivery also increases with increased fetal size. Supplementary feeding could therefore increase the risk of obstructed labor. In the absence of accessible obstetric services, primiparous women <1.5 m in height should be excluded from supplementary feeding programs aimed at accelerating fetal growth. The knowledge base to model the risks and benefits of increased fetal size does not exist.

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Author and article information

Contributors

Alfa Muhihi: selukundo@gmail.com

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 17 May 2016

Publication date PMC-release: 17 May 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 110

Affiliations

[ ]Ifakara Health Institute, Kiko Avenue, Mikocheni, Dar es Salaam Tanzania

[ ]Africa Academy for Public Health, CM Plaza Building, Mwai Kibaki Road, Mikocheni, P.O.Box 79810, Dar es Salaam Tanzania

[ ]Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA

[ ]Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA

[ ]Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA

[ ]Department of Medicine, Boston Children’s Hospital, Boston, USA

Article

Publisher ID: 900

DOI: 10.1186/s12884-016-0900-5

PMC ID: 4869183

PubMed ID: 27183837

SO-VID: ff299e81-f91a-4ecc-b5ed-3d61fdecd442

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 24 June 2015

Date accepted : 7 May 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: risk factors,birth weight,term-sga,preterm-aga,preterm-sga,tanzania

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: risk factors, birth weight, term-sga, preterm-aga, preterm-sga, tanzania

Risk factors for small-for-gestational-age and preterm births among 19,269 Tanzanian newborns

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Trial registration

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SDG 3: Good Health and Well-Being

Most cited references 16

The associations of birth intervals with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis

Advanced maternal age and adverse perinatal outcome: a review of the evidence.

Nutrition and maternal mortality in the developing world.

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