Demographic, socio-economic, obstetric, and behavioral factors associated with small-and large-for-gestational-age from a prospective, population-based pregnancy cohort in rural Nepal: a secondary data analysis

Background In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk f...

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Vydáno v:	BMC pregnancy and childbirth Ročník 22; číslo 1; s. 652 - 13
Hlavní autoři:	Hazel, Elizabeth A., Mohan, Diwakar, Zeger, Scott, Mullany, Luke C., Tielsch, James M., Khatry, Subarna K., Subedi, Seema, LeClerq, Steven C., Black, Robert E., Katz, Joanne
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	London BioMed Central 19.08.2022 Springer Nature B.V BMC
Témata:	Adolescent Babies Birth Weight Births Blood pressure Cohort analysis Cohort study Data Analysis Data collection Demography Female Gastrointestinal diseases Gestational Age Gynecology Households Humans Hypertension Illnesses Infant, Newborn Infant, Newborn, Diseases Infant, Small for Gestational Age Infections Large-for-gestational age Male Maternal and Child Health Medicine Medicine & Public Health Menstruation Nepal Nepal - epidemiology Population Population-based studies Pregnancy Prenatal care Prospective Studies Reproductive Medicine Risk factors Small-for-gestational age Socioeconomic Factors Tetanus Tobacco Vagina Weight Gain Womens health Nepal Large-for-gestational age Small-for-gestational age Cohort study Nepal
ISSN:	1471-2393, 1471-2393
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Abstract	Background In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal. Methods This is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery. Results SGA was associated with nulligravida (OR: 2.12 95% CI: 1.93–2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26–2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07–1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19–1.35). Greater wealth (OR: 0.78, 95% CI: 0.69–0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69–0.94) parity greater than five (OR: 0.77, 95% CI: 0.65–0.92), male fetal sex (OR: 0.91, 95% CI: 0.86–0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2 nd and 3 rd trimester, 95% CI: 0.92–0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41–0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54–0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03–1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07–1.51) were positively associated with LGA. Conclusions Our findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies. Trial Registration The study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111.
AbstractList	In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal.BACKGROUNDIn South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal.This is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery.METHODSThis is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery.SGA was associated with nulligravida (OR: 2.12 95% CI: 1.93-2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26-2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07-1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19-1.35). Greater wealth (OR: 0.78, 95% CI: 0.69-0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69-0.94) parity greater than five (OR: 0.77, 95% CI: 0.65-0.92), male fetal sex (OR: 0.91, 95% CI: 0.86-0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2nd and 3rd trimester, 95% CI: 0.92-0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41-0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54-0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03-1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07-1.51) were positively associated with LGA.RESULTSSGA was associated with nulligravida (OR: 2.12 95% CI: 1.93-2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26-2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07-1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19-1.35). Greater wealth (OR: 0.78, 95% CI: 0.69-0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69-0.94) parity greater than five (OR: 0.77, 95% CI: 0.65-0.92), male fetal sex (OR: 0.91, 95% CI: 0.86-0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2nd and 3rd trimester, 95% CI: 0.92-0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41-0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54-0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03-1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07-1.51) were positively associated with LGA.Our findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies.CONCLUSIONSOur findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies.The study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111.TRIAL REGISTRATIONThe study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111. Background In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal. Methods This is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery. Results SGA was associated with nulligravida (OR: 2.12 95% CI: 1.93–2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26–2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07–1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19–1.35). Greater wealth (OR: 0.78, 95% CI: 0.69–0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69–0.94) parity greater than five (OR: 0.77, 95% CI: 0.65–0.92), male fetal sex (OR: 0.91, 95% CI: 0.86–0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2nd and 3rd trimester, 95% CI: 0.92–0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41–0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54–0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03–1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07–1.51) were positively associated with LGA. Conclusions Our findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies. Trial Registration The study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111. In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal. This is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery. SGA was associated with nulligravida (OR: 2.12 95% CI: 1.93-2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26-2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07-1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19-1.35). Greater wealth (OR: 0.78, 95% CI: 0.69-0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69-0.94) parity greater than five (OR: 0.77, 95% CI: 0.65-0.92), male fetal sex (OR: 0.91, 95% CI: 0.86-0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2 and 3 trimester, 95% CI: 0.92-0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41-0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54-0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03-1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07-1.51) were positively associated with LGA. Our findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies. The study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111. Background In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal. Methods This is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery. Results SGA was associated with nulligravida (OR: 2.12 95% CI: 1.93–2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26–2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07–1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19–1.35). Greater wealth (OR: 0.78, 95% CI: 0.69–0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69–0.94) parity greater than five (OR: 0.77, 95% CI: 0.65–0.92), male fetal sex (OR: 0.91, 95% CI: 0.86–0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2 nd and 3 rd trimester, 95% CI: 0.92–0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41–0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54–0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03–1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07–1.51) were positively associated with LGA. Conclusions Our findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies. Trial Registration The study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111. Abstract Background In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal. Methods This is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery. Results SGA was associated with nulligravida (OR: 2.12 95% CI: 1.93–2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26–2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07–1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19–1.35). Greater wealth (OR: 0.78, 95% CI: 0.69–0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69–0.94) parity greater than five (OR: 0.77, 95% CI: 0.65–0.92), male fetal sex (OR: 0.91, 95% CI: 0.86–0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2nd and 3rd trimester, 95% CI: 0.92–0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41–0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54–0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03–1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07–1.51) were positively associated with LGA. Conclusions Our findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies. Trial Registration The study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111.
ArticleNumber	652
Author	Khatry, Subarna K. Tielsch, James M. Hazel, Elizabeth A. Mullany, Luke C. LeClerq, Steven C. Black, Robert E. Mohan, Diwakar Katz, Joanne Zeger, Scott Subedi, Seema
Author_xml	– sequence: 1 givenname: Elizabeth A. surname: Hazel fullname: Hazel, Elizabeth A. email: ehazel1@jhu.edu organization: Department of International Health, Johns Hopkins Bloomberg School of Public Health – sequence: 2 givenname: Diwakar surname: Mohan fullname: Mohan, Diwakar organization: Department of International Health, Johns Hopkins Bloomberg School of Public Health – sequence: 3 givenname: Scott surname: Zeger fullname: Zeger, Scott organization: Department of International Health, Johns Hopkins Bloomberg School of Public Health – sequence: 4 givenname: Luke C. surname: Mullany fullname: Mullany, Luke C. organization: Department of International Health, Johns Hopkins Bloomberg School of Public Health – sequence: 5 givenname: James M. surname: Tielsch fullname: Tielsch, James M. organization: George Washington University Milken Institute School of Public Health – sequence: 6 givenname: Subarna K. surname: Khatry fullname: Khatry, Subarna K. organization: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Nepal Nutrition Intervention Project-Sarlahi – sequence: 7 givenname: Seema surname: Subedi fullname: Subedi, Seema organization: Department of International Health, Johns Hopkins Bloomberg School of Public Health – sequence: 8 givenname: Steven C. surname: LeClerq fullname: LeClerq, Steven C. organization: Department of International Health, Johns Hopkins Bloomberg School of Public Health – sequence: 9 givenname: Robert E. surname: Black fullname: Black, Robert E. organization: Department of International Health, Johns Hopkins Bloomberg School of Public Health – sequence: 10 givenname: Joanne surname: Katz fullname: Katz, Joanne organization: Department of International Health, Johns Hopkins Bloomberg School of Public Health
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/35986258$$D View this record in MEDLINE/PubMed
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CitedBy_id	crossref_primary_10_1136_bmjpo_2023_002229 crossref_primary_10_1371_journal_pone_0304841 crossref_primary_10_1186_s12884_025_07373_x crossref_primary_10_1002_hsr2_70093 crossref_primary_10_1136_bmjopen_2022_066934 crossref_primary_10_1016_j_envres_2024_119212
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DOI	10.1186/s12884-022-04974-8
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Keywords	Large-for-gestational age Small-for-gestational age Cohort study Nepal
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Snippet	Background In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies... In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in... Background In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies... Abstract Background In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many...
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SubjectTerms	Adolescent Babies Birth Weight Births Blood pressure Cohort analysis Cohort study Data Analysis Data collection Demography Female Gastrointestinal diseases Gestational Age Gynecology Households Humans Hypertension Illnesses Infant, Newborn Infant, Newborn, Diseases Infant, Small for Gestational Age Infections Large-for-gestational age Male Maternal and Child Health Medicine Medicine & Public Health Menstruation Nepal Nepal - epidemiology Population Population-based studies Pregnancy Prenatal care Prospective Studies Reproductive Medicine Risk factors Small-for-gestational age Socioeconomic Factors Tetanus Tobacco Vagina Weight Gain Womens health
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Title	Demographic, socio-economic, obstetric, and behavioral factors associated with small-and large-for-gestational-age from a prospective, population-based pregnancy cohort in rural Nepal: a secondary data analysis
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