Fetal Malnutrition and Associated Factors among Term Newborn Babies at Birth in South Gondar Zone Hospitals, Northwest Ethiopia

Background. Undernutrition contributes to almost half of all under-five deaths. Fetal malnutrition (FM) has been implicated in both short- and long-term consequences among fetal, neonatal, and adult life. Currently, Ethiopia lacks information on the prevalence of fetal malnutrition and its associated factors. This study, therefore, is aimed at assessing the prevalence of FM at birth and its associated factors in South Gondar zone hospitals, northwest Ethiopia. Methods. A cross-sectional study was carried out from November 1, 2019, to April 30, 2020, among four hospitals of South Gondar zone. All women with their live newborns who met the eligibility criteria were included. Clinical assessment of nutritional status including other anthropometric measurements was done immediately after delivery. The newborn was declared as fetal malnourished if the clinical assessment of nutritional status cut-off point is less than 25. Data were collected by trained clinical midwives. Besides bivariate regression analysis, a multivariable logistic regression analysis was done to identify associations. Results. A total of 1592 mothers with their live newborns participated in this study. The prevalence of fetal malnutrition was 21.7% (95% CI: 19.7-23.9). Intimate partner violence (AOR: 1.97, 95% CI: 1.52-2.56), placental weight less than 512 grams (AOR: 2.76, 95% CI: 2.13-3.57), and small for gestational age (AOR: 1.96, 95% CI: 1.46-2.62) were significantly associated with fetal malnutrition. Conclusions. The prevalence of fetal malnutrition was a public health problem in this study. Intimate partner violence, placental weight, and small for gestational age were found the most significant variables. To avert fetal malnutrition, positive family relation and additional or balanced nutritional supplementation during pregnancy are critical. We recommend researchers do clinical follow-up research which comprises a detailed investigation of placental, maternal, and fetal factors including genes.

Assessment of Common Maternal Risk Factors in Fetal Malnutrition

Introduction: Nutritional assessment of the newborn gives the reflection of the growth process in the intrauterine period. The Clinical Assessment of Fetal Nutritional Status score (CAN score) method is only the method to assess the fetal malnutrition which includes the clinical observation for the presence of the sign of malnutrition in newborns. Since the fetal growth is related to availability of intrauterine nutrition and placental function, there may be several maternal factors associated with the fetal malnutrition. Objectives: The main objective of the study was to determine the prevalance of Fetal Malnutrition in term newborns and the role of maternal factors in the etiology of fetal malnutrition (FM) in the Neonatal and Maternity Units of B.P Koirala Institute of Health Sciences, Dharan. Methodology: This was a hospital based observational cross sectional study of consecutive, singleton, term live babies delivered between September 2019 to March 2020. Fetal malnutrition was diagnosed using Clinical Assessment of Fetal Nutritional Status score (CAN score) developed by Metcoff. The maternal history was obtained from the mother which included age, parity, socioeconomic class, pre pregnancy weight, number of antenatal care during pregnancy, history of maternal illness and drugs taken during pregnancy. Nutritional status of the mother was determined using weight, height, mid arm circumference (MAC) and the body mass index (BMI). Collected data was entered in Microsoft excel 2010 and converted it into SPSS 23 version software, for statistical analysis. Results: Of the 400 studied newborns, 73 [18%] had FM. The prevalence of teenage pregnancy, primiparity, lower maternal mid arm circumference and vegetarian diets were higher in the mothers of the babies who had suffered fetal malnutrition than the mothers of the babies without FM (p value <0.05).The adverse maternal condition like Pregnancy induced hypertension (PIH), Antepartum hemorrahge (APH), Urinary tract infection (UTI), fever during pregnancy had significant impact in the fetal malnutrition(p value <0.05). Conclusion: Improvement in the socioeconomic condition of women and good antenatal care could reduce most of the maternal factors associated with fetal malnutrition. There should be implementation of more accessible programs which address the issues of the maternal nutrition and the maternal health care in Nepal.

Comparative Assessment of Fetal Malnutrition by Anthropometry and CAN Score with associated maternal factors in Sub-District hospital of Uttarakhand

Introduction: Fetal malnutrition is an important contributor to perinatal mortality and morbidity.This study was aimed to assess the nutritional status of the newborn at birth using ClinicalAssessment of Nutrition (CAN score) and compare it with other conventional anthropometric indices.In addition to studying maternal variables associated with fetal malnutrition. Material andMethods: This prospective study was conducted at Sub-District hospital, Uttarakhand for a 3-monthduration from June 2020 to August 2020. Total 765 term, singleton newborn without majorcongenital malformation or comorbidities were included in the study. Anthropometric indices andCAN score were assessed and compared. Results: The incidence of fetal malnutrition was 17.39%using the CAN score. Fetal malnutrition was detected in 133(17.3%), 65(8.5%), 141(18.4%),91(11.8%), 85(11.1%) of newborn using CAN score, PI, Gestational age, BMI, and MAC/HCrespectively. Out of clinically malnourished babies identified by CAN score, PI, gestational age, BMIand MAC/HC identified 49.23% (32), 76.6% (108), 56.04%(51), 49.41%(42) as fetal malnutrition.BMI has the highest sensitivity and diagnostic accuracy for detecting fetal malnutrition. Maternalvariables associated with FM include early maternal age during conception 81.4% (623),primigravida 33.1% (112), anemia (21%), irregular antenatal checkups (40%) and concurrentillnesses (PIH, urinary tract infection, heart disease, renal disease, vascular disease) (50.9%).Conclusion: CAN score is a simple, handy and cost-effective tool to identify FM. Using BMI with CANscore can serve for screening FM. Among maternal variables, primigravida (33.1), anemia (21.5%),irregular antenatal checkup (40.25%), Concurrent medical illnesses (50.96%) is strongly associatedwith FM. Maternal age is not statistically significant.

Birth weight and body fat mass in adults assessed by bioimpedance in the ELSA-Brasil study

Intrauterine life is a critical period for the development of body fat and metabolic risk. This study investigated associations between birth weight and total and truncal body fat in adults. To do so, we analyzed data on 10,011 adults participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who self-reported birth weight as < 2.5kg, 2.5-4.0kg, or > 4.0kg at baseline (2008-2010) and underwent bioimpedance in the next follow-up visit (2012-2014). Greater mean total and truncal fat mass were seen in those with high birth weight compared with adequate birth weight (p < 0.001) in both sexes (total fat: 25.2 vs. 23.1kg in men and 31.4 vs. 27.7kg in women, and truncal fat: 13.5 vs. 12.4kg in men and 15.9 vs. 14.2kg in women). U-shaped patterns were observed in restricted cubic-spline analyses in the subset of 5,212 individuals reporting exact birth weights, although statistically significant only for those with high birth weight. In the whole sample, in comparing high to adequate birth weight, the latter predicted having a large (> 85 percentile) total and truncal fat mass, respectively: OR = 1.76, 95%CI: 1.37-2.25 (men) and OR = 1.86, 95%CI: 1.42-2.44 (women); OR = 1.68, 95% CI: 1.31-2.16 (men) and OR = 1.73, 95%CI: 1.31-2.28 (women). However, low birth weight predicted having a large (> 85 percentile) % truncal fat only in women (OR = 1.40, 95%CI: 1.03-1.91). In conclusion, in these men and women born in a period in which fetal malnutrition was prevalent, birth weight showed complex, frequently non-linear associations with adult body fat, highlighting the need for interventions to prevent low and high birth weight during pregnancy.

Detection of fetal malnutrition and its associated maternal factors in a rural setting

Background: The objectives of study were to analyse and compare the methods for detection of fetal malnutrition and to study the maternal factors associated with fetal malnutrition in babies born in rural hospitals.Methods: Periodic prospective cross-sectional case-control questionnaire-based study. Nursing home and Hospital based in rural population from January 2017-March 2018. There were 350 term newborns born in Shrinivasa Nursing Home, and Crawford General Hospital, Sakleshpur, were selected consecutively. Inclusion criteria: live, singleton term neonates. Exclusion criteria: Preterms, post-terms, those with congenital malformation, multiple gestations, cephalhematoma, subgaleal bleed. Anthropometry, fetal malnutrition assessed using clinical assessment of nutrition (CAN) score, Ponderal and Kanawati indices between 24–48 hours of birth. Newborns with fetal malnutrition (cases), and well-nourished babies (controls) assessed for maternal risk factors using standardised questionnaire from mothers.Results: CAN score identified 185 (52.9%) as malnourished and 165 (47.1%) as normal; Ponderal index classified 170(48.6%) as malnourished and 180 (51.4%) normal. Kanawati index grouped 151 (43.1%) as malnourished. Maternal factors: age (91.7% among <20 yr mothers-malnourished, 25% among >35 yrs), socioeconomic status (status 3, 4 had 57.2%, 66.7% malnourishment), improper antenatal care(80.7% irregulars; 38.5% among regulars), primiparity (60%;against 38.3% among multipara), pre-eclampsia (78.7%; 41.3% in normotensives), anemia (55.4%), weight gain (83.2% in <10 kg; 33.33% in >10 kg), stature (73.5% in <145 cm; 39.7% in >145 cm), medical illness (55.81%).Conclusions: CAN score is simple, systematic, clinical method of identifying malnutrition; statistically superior as screening tool. Maternal factors: improper antenatal checkups, primiparity, pre-eclampsia, medical illness, inadequate weight gain, short stature had significant association with fetal malnutrition. Maternal age, socioeconomic status, anemia not statistically significant.