Abstract
Background/objectives
To estimate the risks of term-small for gestational age (SGA), preterm-appropriate for gestational age (AGA), and preterm SGA associated with maternal height and body mass index (BMI) and to calculate the population attributable fractions (PAF) of term SGA, preterm AGA, and preterm SGA associated with maternal short stature.
Subjects/methods
A population-based cohort of 13,230 women with pre-pregnancy height and weight followed from 2012 to 2016 in Sylhet, Bangladesh. We analyzed data of 2655 singleton live born infants. The babies born <37 weeks of gestation were considered preterm and weight <10th percentile of Intergrowth sex-specific gestational age were considered SGA. Risk factors for term SGA, preterm AGA, and preterm SGA were examined using multinomial logistic regression that estimated relative risk ratios (RRR) and 95% confidence intervals (CI).
Results
Maternal short stature <145 cm was significantly associated with term SGA (RRR 1.88, 95% CI 1.37, 2.58; p < 0.001), preterm AGA (RRR 1.45, 95% CI 1.02, 2.05; p < 0.05), and preterm SGA (RRR 14.40, 95% CI 1.82, 113.85; p < 0.05). Maternal underweight status (BMI < 18.5 kg/m2) was significant predictor of term SGA (RRR 1.32, 95% CI 1.10, 1.59; p < 0.01), and preterm AGA (RRR 1.39, 95% CI 1.12, 1.71; p < 0.01). PAF for maternal short stature were 23.2, 7.3, and 73.9% for term SGA, preterm AGA, and preterm SGA, respectively.
Conclusions
To address the problem of undernutrition, Bangladesh needs to strengthen implementation of its multi-sectoral nutrition program comprising nutrition specific and sensitive interventions. Implementation of the program with high coverage and quality would improve maternal nutrition and perinatal outcomes including preterm births and SGA.
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Acknowledgements
We acknowledge the contribution of the study women and the dedication of Projahnmo field team. Projahnmo is a research partnership of Johns Hopkins University, the Bangladesh Ministry of Health and Family Welfare and other Bangladeshi institutions including ICDDR,B, and Shimantik.
Author contributions
RK and AHB conceived and designed the analysis. AHB, ACL, DKM, SDG, AQ, LCM were involved in project implementation and conduct of study procedures. SDG developed and maintained the database with LCM. MR conducted data cleaning and analyses with RK. RK drafted the first version of the manuscript. All authors read, provided technical input and approved the final manuscript.
Funding
The study was funded by grants from the NICHD (R01 HD066156-02).
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Khanam, R., Lee, A.C., Mitra, D.K. et al. Maternal short stature and under-weight status are independent risk factors for preterm birth and small for gestational age in rural Bangladesh. Eur J Clin Nutr 73, 733–742 (2019). https://doi.org/10.1038/s41430-018-0237-4
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DOI: https://doi.org/10.1038/s41430-018-0237-4
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