Association of maternal dietary patterns with child birth weight and size in India: Evidence from National Family Health Survey, 2005 to 2016

Background: Maternal dietary diversity during pregnancy is a major determinant of birth weight and birth size of infant. During pregnancy, mother diet is highly dependent on their topographical, cultural, and sociodemographic circumstances. Objective: The objective of the study was to assess the association between the maternal dietary intake with child birth weight and birth size along with the sociodemographic factors in India. Materials and Methods: The data for this study were drawn from the National Family Health Survey (NFHS), 2005 to 2006 and 2015 to 2016 held in India. Inferential statistical analysis Chi-square was built to test was used to examine the association between maternal dietary patterns, and logistic regression model was used to analyze the effect of mother’s dietary patterns on child birth weight and size by controlling the sociodemographic factors. Results: Mother’s daily intake of fish, meat, green leafy vegetables, and fruits was associated with higher birth weight or size and lower risk of intrauterine growth retardation. Women with ?2 dietary diversity categories had significantly higher proportion of low birth weight (LBW) and size of babies comparatively to those in the ?2 dietary diversity categories, there were lesser chance of LBW and small size of babies with women’s dietary diversity 3 (odds ranges from 1.09 to 1.44) or ?4 (odds ranges from 1.15 to 1.59). Furthermore, low birth order, mother’s underweight status, low maternal education, and wealth status significantly have positive association with the poor birth outcomes. Conclusion: The birth weight and size of newborns were found positively associated with the mother’s dietary intake. To meet the aim of maternal dietary diversity and to achieve the double bonus, the government should focus more on supplementation and food security programs during pregnancy that also include nutritional education as well as behavioral and social change interventions strategies.

Birth Size and Maternal, Social, and Environmental Factors in the Province of Jujuy, Argentina

Introduction: birth size is affected by diverse maternal, environmental, social, and economic factors. Aim: analyze the relationships between birth size—shown by the indicators small for gestational age (SGA) and large for gestational age (LGA)—and maternal, social, and environmental factors in the Argentine province of Jujuy, located in the Andean foothills. Methods: data was obtained from 49,185 mother-newborn pairs recorded in the Jujuy Perinatal Information System (SIP) between 2009 and 2014, including the following: newborn and maternal weight, length/height, and body mass index (BMI); gestational age and maternal age; mother’s educational level, nutritional status, marital status and birth interval; planned pregnancy; geographic-linguistic origin of surnames; altitudinal place of birth; and unsatisfied basic needs (UBN). The dataset was split into two groups, SGA and LGA, and compared with adequate for gestational age (AGA). Bivariate analysis (ANOVA) and general lineal modeling (GLM) with multinomial distribution were employed. Results: for SGA newborns, risk factors were altitude (1.43 [1.12–1.82]), preterm birth (5.33 [4.17–6.82]), older maternal age (1.59 [1.24–2.05]), and primiparous mothers (1.88 [1.06–3.34]). For LGA newborns, the risk factors were female sex (2.72 [5.51–2.95]), overweight (1.33 [1.22–2.46]) and obesity (1.85 [1.66–2.07]). Conclusions: the distribution of birth size and the factors related to its variability in Jujuy are found to be strongly conditioned by provincial terrain and the clinal variation due to its Andean location.

Spatial Distribution of Infant Mortality in Ethiopia: Using Demographic Health Survey, the Ethiopia

Background Mortality is one of the demographic variables that affect population trends. Among mortality of children, Infant mortality contributed to more than 75% of all under-five deaths globally. It disproportionately affects those living in the different regions of countries and within the region. Exploring the spatial distribution and identifying associated factors is important to design effective intervention programs to reduce infant mortality. Thus, this study aimed to assess the spatial distribution and associated factors of infant mortality in Ethiopia using the 2016 Ethiopian Demographic and Health Survey (EDHS). Method The Data this study were used Ethiopian Demographic and Health Survey in 2016. A total of 11,023 live births from the EDHS data were included in the analysis. Spatial analysis was done to explore spatial distribution of infant mortality using ArcGIS version 10.4. Results This study revealed that the spatial distribution of infant mortality was non-random in the country with Moran’s index 0.1546 (P-value=0.0185). The Afar and Somali regions of Ethiopia were identified in this study on the hot spot of infant mortality. Conclusions The spatial distribution of infant mortality varies across the country. ANC usage, sex of a child, birth interval, birth size, birth type, birth order, wealth index, residence, region, and the spatial variable (Si) were significant predictors of infant mortality. Therefore, it needs interventions in the hot spot areas. Focusing on maternal health care services, rural residences, multiple births, infants having a smaller birth size, and male infants deserves special attention.

Compromised maternal nutritional status in early pregnancy and its relation to the birth size in young rural Indian mothers

Background Low birth weight is highly prevalent in rural India. As a chronic undernutrition problem, poor birth outcomes are closely related to various nutritional factors more prominently the poor maternal anthropometry at conception. The purpose of the study was to identify how compromised maternal nutritional status in early pregnancy affects the birth size of rural Indian mothers. Methods It was a prospective observational study on singleton pregnant women (n = 204) from 14 villages in Mulshi Taluka of Pune District, Maharashtra, India. Maternal weight (Wt), height (Ht), body fat percent (BF%), head circumference (HC), and sitting height (SHT) were measured at early pregnancy (< 13 weeks of gestation) and infants’ weight and length were measured within 24 h of birth. Groups means were tested using a ‘t’ test while the trend in means was tested using ANOVA. Results Mothers were young (21.46 ± 2.09 yrs), thin (46.46 ± 6.1 kg), short (153.39 ± 5.79 cm), and poorly nourished (19.74 ± 2.41 kg/m2). Mean birth weight was low (2655 ± 507 g) and prevalence of LBW and stunting at birth was highest among mothers in the lower tertile of each of the anthropometric indicators. In particular, stunting was significantly higher for mothers in lower tertile compared to higher tertile of Wt (44.6 Vs 64.6%) and was also true for HC (43.7 Vs 60.6%). Risk for LBW and stunting at birth was almost similar and was significant (p < 0.01) for mothers in the lower tertile of Wt, Ht, BMI, SHT, HC, and BF% as compared to those in the higher tertile of these measurements. Conclusion All the anthropometric indicators of current undernutrition at first trimester as well as that in utero reflected by smaller HC, impose risk for LBW and stunting at birth especially among young rural mothers.

Community-level impacts of sanitation coverage on maternal and neonatal health: a retrospective cohort of survey data

IntroductionAccess to sanitation facilities (toilets or latrines) greatly improves human health. Low community sanitation coverage may lead to increased exposure to pathogens for households both with and without a sanitation facility.MethodsWe created a retrospective cohort using Demographic and Health Surveys from 1990 through 2018. Using regression with matched women as a random intercept, we assessed the association between community-level sanitation coverage and neonatal mortality (Poisson model, n=1 254 862 live births, 187 datasets), small birth size (logit model, n=1 058 843 live births, 187 datasets) and anaemia (logit model, n=1 304 626 women, 75 datasets).ResultsAmong women with household sanitation, the incidence of neonatal death (incidence rate ratio: 0.85, 95% CI 0.77 to 0.93), the odds of small birth size (OR: 0.81, 95% CI 0.76 to 0.87) and anaemia (OR: 0.82, 95% CI 0.79 to 0.85) were lower for women in communities with 100% sanitation coverage compared with 1%–30% (p≤0.001 for all). There was no difference in neonatal deaths between women in communities with 31%–99% sanitation coverage compared with 1%–30% (p≥0.05). Among women without household sanitation, there were no differences in neonatal mortality by community sanitation (p≥0.05). The odds of small birth size were decreased (OR: 0.91, 95% CI 0.87 to 0.97, p=0.003) for women in communities with 61%–99% sanitation coverage compared with 1%–30%; there was no association with the other community sanitation categories (p≥0.05). The odds of anaemia were increased (OR: 1.08, 95% CI 1.06 to 1.11, p<0.001) for women living in communities with 0% sanitation coverage compared with 1%–30%, but no association with the other community sanitation categories (p≥0.05).ConclusionCommunity sanitation coverage is associated with improved maternal and neonatal outcomes, particularly among women with household sanitation. This suggests that the impact of sanitation coverage on maternal and neonatal health is underestimated unless the community-level effects are considered.

Association of Prepregnancy Nutritional Status and Physical Activity Levels with Birth Size Outcomes among West Sumatran Pregnant Women: Results from the Vitamin D Pregnant Mothers Cohort Study in Indonesia

Background: Maternal and neonatal morbidity is still high in developing countries like in Indonesia. There are several factors may affect maternal health during pregnancy such as physical activity level (PAL) and pre-pregnancy nutritional status. Aim: To analyze the association between maternal physical activity status (PAL) and pre-pregnancy body mass index (PP BMI) with birth size outcomes. Methods: A prospective birth cohort study, Vitamin D Pregnant Mothers (VDPM) Study, to 183 healthy singleton pregnant women. Pre-pregnancy body mass index was classified according to WHO guidelines for Asian Population. Women PAL was measured at the first trimester (T1) and third trimester (T3) during pregnancy using the Global Physical Activity Questionnaire (GPAQ). Birth size outcomes were measured immediately after birth such as birth weight, birth length, and head circumference. Results: Pregnant women at T3 had two times lower physical activity than T1 of pregnancy (OR, 2.18; CI, 1.044-4.57; p = 0.045). Maternal PAL at T1 and T3 were mostly in sedentary level (74.3% and 77.1%, respectively). There was no association between PP BMI, PAL, and birth size outcomes (p > 0.05 for all comparisons). However, the physical activity at T1 had a significant association with birth weight outcomes [MD (95%CI): 155.3 (13.8 – 296.8), p = 0.032]. There was a significant interaction between maternal PAL and PP BMI on birth weight (p interaction = 0.011) and head circumference (p interaction = 0.034). Conclusions: Our study reveals that pre-maternal nutritional status and physical activity behavior during the pregnancy associated with the head circumference and birth weight outcomes. Further large studies are needed to confirm our findings.

839A novel approach to investigating poor growth in a longitudinal study of infants in PNG

Background Children in Papua New Guinea (PNG) experience high rates of malnutrition and poor growth - nearly half of children under 5 are stunted and 16% wasted. Methods We investigated predictors of infant growth over the first year of life using longitudinal data from mothers and infants in PNG. Between 2015 and 2018, 699 pregnant women were enrolled. At delivery, one, 6- and 12-months post-partum blood samples and anthropometric measurements were taken from mothers and infants. Using structural equation modelling with full information maximum likelihood, multivariate latent growth curve (LGC) modelling for infant weight and length (i.e. simultaneous estimation) was undertaken, and maternal factors that influenced growth investigated. Results A quadratic function for growth (weight and height) was estimated. Boys were larger at birth (49cm, 3.2kg vs. 48cm, 3.0kg; Wald χ2(2) =15.3, p&lt;0.001) and gained more weight and length monthly (Wald χ2(4) =68.4, p&lt;0.001). Maternal height, MUAC and number of antenatal healthcare visits were associated with birth weight and length, but not growth. Maternal nutrition and infections, breastfeeding and complementary feeding were not associated with birth size or growth. Conclusions Maternal height and MUAC and antenatal healthcare were associated with birth size and no maternal factors were associated with growth. Prenatal interventions to improve postnatal infant growth may be challenging in this environment Key messages Compared to conventional LGC analysis, multivariate LGC modelling using SEM provides less biased estimates of infant growth and factors associated with growth, particularly in the presence of missing data and infant-specific weight and height heterogeneity.

1498Community-level risk factors for birth size of child in selected developing countries (1992-2018): multilevel analysis

Background We aimed to identify emerging community-level risk factors for birth size in the last two decades in developing countries, particularly in Bangladesh, India, Indonesia, and Nigeria, having the highest burden of low birth weight (LBW) births globally. Methods We used data from multiple rounds of the Demographic and Health Surveys (DHS) conducted throughout the last two decades in the selected countries. We applied multilevel binary logistic regression models and estimated the intra-correlation coefficient (ICC) and median odds ratio (MOR) with a 95% confidence interval (CI) to analyze community-level variation in the birth size of child. Results The odds of having a smaller than average size birth increased by 1.28 times (95% CI: 1.11-1.79) in Bangladesh (2014), 3.03 times (95% CI: 2.90-3.18) in India (2015-16), 1.40 times (95% CI: 1.28-1.58) in Indonesia (2017) and 2.32 times (95% CI: 2.15-2.53) in Nigeria (2018) when women moved from low-risk to high-risk communities. The children residing in communities with a higher level of female illiteracy, higher level of inadequate antenatal care visits (ANC), higher use of unimproved toilet facilities were more likely to born with smaller than average birth size during 1992-2018. Conclusions The study confirms a significant community-level variation in smaller than average birth size among all analysed countries. Community with higher levels of female illiteracy, inadequate ANC visits, use of unimproved toilet facilities emerged as significant risk factors throughout the last two decades. Key messages The community-level risk factors have an independent association with the birth size of child regardless of individual-level characteristics of women and children.