Top

Published in:

Open Access 01-12-2009 | Research article

Perinatal outcomes in a South Asian setting with high rates of low birth weight

Authors: Kuryan George, Jasmin Prasad, Daisy Singh, Shanthidani Minz, David S Albert, Jayaprakash Muliyil, K S Joseph, Jyothi Jayaraman, Michael S Kramer

Published in: BMC Pregnancy and Childbirth | Issue 1/2009

Abstract

Background

It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference.

Methods

Population-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA) live births were identified using both a recent Canadian and an older Indian fetal growth standard.

Results

The low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and < 1% in Nova Scotia when the Indian standard was used. In Kaniyambadi, low birth weight, preterm birth and perinatal mortality rates did not decrease between 1990 and 2005. SGA rates in Kaniyambadi declined significantly when SGA was based on the Indian standard but not when it was based on the Canadian standard. Maternal mortality rates fell by 85% (95% confidence interval 57% to 95%) in Kaniyambadi between 1986–90 and 2001–05. Perinatal mortality rates were 11.7 and 2.6 per 1,000 total births and cesarean delivery rates were 6.0% and 20.9% among live births ≥ 2,500 g in Kaniyambadi and Nova Scotia, respectively.

Conclusion

High rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories.

Available only for authorised users

The State of the World's Children 2007. 2006, The United Nations Children's Fund (UNICEF), New York

Moss W, Darmstadt GL, Marsh DR, Black RE, Santosham M: Research priorities for the reduction of perinatal and neonatal morbidity and mortality in developing country communities. J Perinatol. 2002, 22: 484-95. 10.1038/sj.jp.7210743.CrossRefPubMed

Duley L, Hofmeyr J, Carroli G, Lumbiganon P, Abalos E: Perinatal research in developing countries – is it possible?. Semin Fetal Neonatal Med. 2006, 11: 89-96. 10.1016/j.siny.2005.11.006.CrossRefPubMed

Villar J, Belizan JM: The relative contribution of prematurity and fetal growth retardation to low birth weight in developing and developed societies. Am J Obstet Gynecol. 1982, 143: 793-98.CrossRefPubMed

de Onis M, Blossner M, Villar J: Levels and patterns of intrauterine growth restriction in developing countries. Eur J Clin Nutr. 1998, 52 Suppl 1: S5-S15.PubMed

Antonisamy B, Sivaram M, Richard J, Rao PS: Trends in intra-uterine growth of single live births in southern India. J Trop Pediatr. 1996, 42: 339-41. 10.1093/tropej/42.6.339.CrossRefPubMed

Steer P: The epidemiology of preterm labour. BJOG. 2005, 112 (Suppl 1): 1-3.PubMed

Kramer MS: Birthweight and infant mortality: perceptions and pitfalls. Paediatr Perinat Epidemiol. 1990, 4: 381-90. 10.1111/j.1365-3016.1990.tb00661.x.CrossRefPubMed

Murray CJL, Lopez AD: The global burden of disease: a comprehensive assessment of mortality and disability from diseases. Injuries and Risk Factors in 1990 and Projected to 2000. Edited by: Murray CJL, Lopez AD. 1996, Cambridge, MA:Harvard University Press

10.

Child Health and Development: Health of theNewborn. Forty-Fifth World Health Assembly. Twelfth plenary meeting, 13. 1992, May ; WHA45.22

11.

World Summit for Children: World Declaration on the Survival, Protection and Development of Children and Plan of Action for Implementing the World Declaration on the Survival, Protection and Development of Children in the 1990s.

12.

Kramer MS, Barros FC, Demissie K, Liu S, Kiely J, Joseph KS: Does reducing infant mortality depend on preventing low birthweight? An analysis of temporal trends in the Americas. Paediatr Perinat Epidemiol. 2005, 19: 445-51. 10.1111/j.1365-3016.2005.00681.x.CrossRefPubMed

13.

Barros FC, Victora CG, Barros AJ, Santos IS, Albernaz E, Matijasevich A, Domingues MR, Sclowitz IK, Hallal PC, Silveira MF, Vaughan JP: The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1993, and 2004. Lancet. 1982, 365: 847-54. 10.1016/S0140-6736(05)71042-4.CrossRef

14.

Gonzalez R, Merialdi M, Lincetto O, Lauer J, Becerra C, Castro R, García P, Saugstad OD, Villar J: Reduction in neonatal mortality in Chile between 1990 and 2000. Pediatrics. 2006, 117: e949-54. 10.1542/peds.2005-2354.CrossRefPubMed

15.

Patterson J: There rest thy feet: The CHAD Experience. 1990, Vellore: Community Health Department, Christian Medical College

16.

Patterson J: Signs of the times. 2005, Vellore: Community Health Department, Christian Medical College

17.

Joseph A, Joseph KS, Kamaraj K: Use of computers in primary health care. International Journal of Health Sciences. 1991, 2: 93-101.

18.

Joseph A, Abraham S, Bhattacharji S, Muliyil J, John KR, Ethirajan N, George K, Joseph KS: Improving immunization coverage. World Health Forum. 1988, 9: 336-40.PubMed

19.

George K, Joseph A, Muliyil J, Abraham S, Bhattacharji S, John KR: Measles vaccination before nine months. Trop Med Int Health. 1998, 3: 751-6. 10.1046/j.1365-3156.1998.00295.x.CrossRefPubMed

20.

Prasad JH, Abraham S, Kurz KM, George V, Lalitha MK, John R, Jayapaul MN, Shetty N, Joseph A: Reproductive tract infections among young married women in Tamil Nadu, India. International Family Planning Perspectives. 2005, 31: 73-82. 10.1363/3107305.CrossRefPubMed

21.

Chandran M, Tharyan P, Muliyil J, Abraham S: Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Incidence and risk factors. British Journal of Psychiatry. 2002, 181: 499-504. 10.1192/bjp.181.6.499.CrossRefPubMed

22.

Joseph A, Abraham S, Muliyil JP, George K, Prasad J, Minz S, Abraham VJ, Jacob KS: Suicide rates in rural India using verbal autopsies, 1994–9. BMJ. 2003, 326: 1121-22. 10.1136/bmj.326.7399.1121.CrossRefPubMedPubMedCentral

23.

Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad J, Minz S, Abraham VJ, Bose A: Suicides in young people in rural southern India. Lancet. 2004, 363: 1117-18. 10.1016/S0140-6736(04)15896-0.CrossRefPubMed

24.

Jacob ME, Abraham S, Surya S, Minz S, Singh D, Abraham VJ, Prasad J, George K, Kuruvilla A, Jacob KS: A community health programme in rural Tamil Nadu, India: the need for gender justice for women. Reprod Health Matters. 2006, 14: 101-8. 10.1016/S0968-8080(06)27227-6.CrossRefPubMed

25.

Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M: A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics. 2001, 108: E35-10.1542/peds.108.2.e35.CrossRefPubMed

26.

Ghosh S, Bhargava SK, Madhavan S, Taskar AD, Bhargava V, Nigam SK: Intra-uterine growth of North Indian babies. Pediatrics. 1971, 47: 826-30.PubMed

27.

Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M: A United States national reference for fetal growth. Obstet Gynecol. 1996, 87: 163-8. 10.1016/0029-7844(95)00386-X.CrossRefPubMed

28.

Kleinbaum DG, Kupper LL, Morgenstern H: Epidemiologic research: Principles and quantitative methods. 1982, Belmont CA: Lifetime Learning Publications, 160-9.

29.

Lawn J, McCarthy B, Ross SR: The healthy newborn: A reference manual for program managers. 1996, Centers for Disease Control and Prevention, Atlanta (GA)

30.

Sachs BP, Fretts RC, Gardner R, Hellerstein S, Wampler NS, Wise PH: The impact of extreme prematurity and congenital anomalies on the interpretation of international comparisons of infant mortality. Obstet Gynecol. 1995, 85: 941-946. 10.1016/0029-7844(95)00056-W.CrossRefPubMed

31.

Kramer MS, Platt RW, Yang H, Haglund B, Cnattingius S, Bergsjo P: Registration artifacts in international comparisons of infant mortality. Paediatr Perinat Epidemiol. 2002, 16: 16-22.CrossRefPubMed

32.

World Health Organization: International Statistical Classification of Diseases and Related Health Problems. Tenth revision. Geneva. 1993, 2: 121-349.

33.

Joseph KS: Incidence-based measures of birth, growth restriction and death can free perinatal epidemiology from erroneous concepts of risk. J Clin Epidemiol. 2004, 57: 889-97. 10.1016/j.jclinepi.2003.11.018.CrossRefPubMed

34.

Zhang X, Platt RW, Cnattingius S, Joseph KS, Kramer MS: Customized vs population-based fetal growth standards for predicting perinatal mortality. BJOG. 2007, 114: 474-77. 10.1111/j.1471-0528.2007.01273.x.CrossRefPubMed

35.

Gardosi J, Clausson B, Francis A: The use of customised versus population-based birthweight standards in predicting perinatal mortality. BJOG. 2007, 114: 1301-2. 10.1111/j.1471-0528.2007.01432.x.CrossRefPubMed

36.

Kierans W, Joseph KS, Lou Z, Platt R, Wilkins R, Kramer MS: Does one size fit all? The case for ethnic specific standards of fetal growth. BMC Pregnancy Childbirth. 2008, 8: 1-10.1186/1471-2393-8-1.CrossRefPubMedPubMedCentral

37.

Joseph KS, Fahey TJ, Platt RW, Liston RM, Lee SK, Sauve R, Liu S, Allen AC, Kramer MS: An alternate approach to the creation of fetal growth standards: Do singletons and twins need separate standards?. Am J Epidemiol. 2009,

38.

Mathai M, Jacob S, Karthikeyan NG: Birth weight standards for South Indian babies. Indian Pediatrics. 1996, 33: 203-9.PubMed

39.

Ngoc NT, Merialdi M, Abdel-Aleem H, Carroli G, Purwar M, Zavaleta N, Campódonico L, Ali MM, Hofmeyr GJ, Mathai M, Lincetto O, Villar J: Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries. Bull World Health Organ. 2006, 84: 699-705. 10.2471/BLT.05.027300.CrossRefPubMedPubMedCentral

40.

Public Health Agency of Canada: Canadian Perinatal Health Report 2008 Edition. 2008, Ottawa: Minister of Public Works and Government Services Canada

41.

Kramer MS: Energy and protein intake in pregnancy. Cochrane Database Syst Rev. 1997, CD000032-2

42.

Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD: Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. 1999, 354: 1955-61. 10.1016/S0140-6736(99)03046-9.CrossRefPubMed

43.

Gould JB, Madan A, Qin C, Chavez G: Perinatal outcomes in two dissimilar immigrant populations in the United States: a dual epidemiologic paradox. Pediatrics. 2003, 111: e676-82. 10.1542/peds.111.6.e676.CrossRefPubMed

44.

Madan A, Palaniappan L, Urizar G, Wang Y, Fortmann SP, Gould JB: Sociocultural factors that affect pregnancy outcomes in two dissimilar immigrant groups in the United States. J Pediatr. 2006, 148: 341-6. 10.1016/j.jpeds.2005.11.028.CrossRefPubMed

45.

Alexander GR, Wingate MS, Mor J, Boulet S: Birth outcomes of Asian-Indian-Americans. Int J Gynaecol Obstet. 2007, 97: 215-20. 10.1016/j.ijgo.2007.02.017.CrossRefPubMed

46.

Joseph KS, Kramer MS, Marcoux S, Ohlsson A, Wen SW, Allen AC, Platt R: Determinants of preterm birth rates in Canada from 1981 through 1983 and from 1992 through 1994. N Engl J Med. 1998, 339: 1434-9. 10.1056/NEJM199811123392004.CrossRefPubMed

47.

Ananth CV, Joseph KS, Oyelese Y, Demissie K, Vintzileos AM: Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000. Obstet Gynecol. 2005, 105: 1084-9.CrossRefPubMed

48.

World Health Organization: Appropriate technology for birth. Lancet. 1985, 2 (8452): 436-7.

49.

Kramer MS, McLean FH, Boyd ME, Usher RH: The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. JAMA. 1988, 260: 3306-8. 10.1001/jama.260.22.3306.CrossRefPubMed

50.

Goldenberg RL, Davis RO, Cutter GR, Hoffman HJ, Brumfield CG, Foster JM: Prematurity, postdates, and growth retardation: the influence of use of ultrasonography on reported gestational age. Am J Obstet Gynecol. 1989, 160: 462-70.CrossRefPubMed

51.

Joseph KS, Huang L, Liu S, Ananth CV, Allen AC, Sauve R, Kramer MS: Reconciling the high rates of preterm and postterm birth in the United States. Obstet Gynecol. 2007, 109: 813-22.CrossRefPubMed

52.

Joseph KS, Barker S, Dale S, Lee L, McMaster R, Miyazaki L: Preterm birth in British Columbia – In Focus Report. British Columbia Perinatal Health Program. Vancouver. 2008, [http://www.bcphp.ca//sites/bcrcp/files/publications/BCPHP_PretermBirthInBC.pdf]

53.

Ellertson C, Elul B, Ambardekar S, Wood L, Carroll J, Coyaji K: Accuracy of assessment of pregnancy duration by women seeking early abortions. Lancet. 2000, 355: 877-81. 10.1016/S0140-6736(99)10170-3.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/9/5/prepub

Title: Perinatal outcomes in a South Asian setting with high rates of low birth weight
Authors: Kuryan George
Jasmin Prasad
Daisy Singh
Shanthidani Minz
David S Albert
Jayaprakash Muliyil
K S Joseph
Jyothi Jayaraman
Michael S Kramer
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2009
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/1471-2393-9-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perinatal outcomes in a South Asian setting with high rates of low birth weight

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2009

Impact of change in maternal age composition on the incidence of Caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999–2005

Neonatal care in rural Karnataka: healthy and harmful practices, the potential for change

Causes of death and associated conditions (Codac) – a utilitarian approach to the classification of perinatal deaths

Evaluation of changes in postnatal care using the "Parents' Postnatal Sense of Security" instrument and an assessment of the instrument's reliability and validity

Development and evaluation of a Chinese-language newborn feeding hotline: A prospective cohort study

Design of FitFor2 study: the effects of an exercise program on insulin sensitivity and plasma glucose levels in pregnant women at high risk for gestational diabetes