MATERNAL FACTORS ASSOCIATED WITH INTRAUTERINE GROWTH RESTRICTION

Authors

  • Taj Muhammad
  • Asmat Ara Khattak
  • Shafiq -ur- Rehman
  • Muhammad Amjad Khan
  • Afzal Khan
  • Muhammad Aqeel Khan

Abstract

Background: Intrauterine growth restriction is a major neonatal health issue. Maternal factors havebeen found to have greater impact on IUGR. Studying these factors can help in reducing the mortalityand morbidity associated with IUGR. Methods: This Case-control study was conducted at thedepartment of Paediatrics Post-graduate medical institute Lady Reading Hospital Peshawar from March2008-April 2009. Small-for-gestational age (SGA, i.e., IUGR cases and n=200) live born babies werecompared with appropriate-for-gestational age (AGA, i.e., controls and n=200) babies. Informationregarding socio-demographics of mothers, gestational age and birth weight of baby, maternal clinicalcharacteristics, and medical and obstetric complications during pregnancy was recorded on a predesigned proforma. Data analysis was done through SPSS-16. To find the maternal factors associatedwith the intrauterine growth restriction, multivariable logistic regression was used. We also did twodifferent sets of logistic regression analysis for Symmetric and Asymmetric SGA babies as Cases.Results: After adjusting for other variables in the multivariable model we found that the mothers ofIUGR babies were of younger age (OR=0.8, CI=0.7–0.9), were poor (OR=2.5, CI=1.4–4.4) andunderweight (OR=3.5, CI=1.1–5.7) and had anaemia (OR=2.7, CI=1.3–5.4) in the index pregnancy,and had history of Previous IUGR birth (OR=9.7, CI=3.3–18.3) and placenta previa (OR=3.2, CI=1.1–6.6). There was an interaction between pregnancy induced hypertension and parity of mother with aprimary-para mother with pregnancy induced hypertension (PIH) having an increased risk for IUGRbabies (OR=10.1, CI=1.0–23.2). Conclusion:. The studied factors need special attention in hospitalbased settings in order to improve the perinatal outcome in IUGR babies.Keywords: intrauterine growth restriction, pregnancy induced hypertension, maternal malnutrition,anaemia

References

Cochran WD, Lee KG. Assessment of the newborn. In: Cloherty

JP, Eichenwald EC, Stark AR. Manual of Neonatal Care 5th Ed.

Philadelphia: Lippincott Williams & Wilkins; 2004.p. 49–54.

Allen MC. Developmental outcome and follow-up of small-forgestational infants. Semin Perinatol 1984; 8:123–56.

Fitzhardinge PM & Steven EM. The small-for-date infant. II.

Neurological and intellectual sequelae. Pediatrics 1972;50: 50–7.

Kleijer ME, Dekker GA, Heard AR. Risk factors for intrauterine

growth restriction in a socio-economically disadvantaged region.

J Matern Fetal Neonatal Med 2005;18:23–30

Fikree FF, Berendes HW, Midhet F, Souza R, Hussain R. Risk

factors for intrauterine growth retardation:results of a

community-based study from Karachi.J Pak Med Assoc

;44:30–4.

Villar J, Khoury M J, Finucane FF, Delgado HL. Differences in

the epidemiology of prematurity and intrauterine growth

retardation. Early Hum Dev 1986;14:307–20

Khan DBA, Bari V, Chisty IA. Ultrasound in Diagnosis &

Management of intra uterine Growth Retardation. J Coll

Physicians Surg Pak 2004;14:601–4.

Jamal M, Khan N. Maternal factors associated with low birth

weight. J Coll Physicians Surg Pak 2003;13:25–8.

Malik S, Ghidiyal RG, Udani R, Waingankar P. Maternal

biosocial factors affecting low birth weight. Indian J Pediatr

;64:373–7.

Stoll BJ, Adams-Chapman I. The high-risk infant. In: Behrman

RE, Kleigman RM, Jensen HB. Nelson Textbook of Pediatrics

th ed. Philadelphia: WB Saunders; 2007.p. 698–710.

J Ayub Med Coll Abbottabad 2010;22(4)

http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Taj.pdf 69

Xiong X, Mayes D, Demianczuk N, Olson DM, Davidge

ST, Newburn-Cook C, et al. Impact of pregnancy-induced

hypertension on fetal growth. Am J Obstet Gynaecol

;180:207–13.

Brodsky D, Christou H. Current Concepts in Intrauterine Growth

Restriction. J intensive Care Med 2004;19:307–19.

Zeitlin JA, Ancel PY, Saurel-Cubizolles MJ, Papiernik E. Are

risk factors the same for small for gestational age versus other

preterm births? Am J Obstet Gynecol 2001;185:208–15.

Lubchenco L, Hansman C, Dressler M, Boyd E. Intrauterine

growth as estimated from liveborn birth weight data at 24 to 42

weeks of gestation. J Pediatr 1962;32:793–800.

Landmann E, Reiss I, Misselwitz B, Gortner L. Ponderal index

for discrimination between symmetric and asymmetric growth

restriction: Percentiles for neonates from 30 weeks to 43 weeks

of gestation. J Matern Fetal Neonatal Med 2006;19:157–60.

Dubowitz L, Dubowitz V, Goldberg C. Clinical assessment of

gestational age in the newborn infants. J Pediatr 1970;77:1–10.

Ferraz EM,Gray RH,Cunha TM. Determinants of preterm

delivery and intrauterine growth retardation in North-East Brazil.

Int J Epidemiol 1990;19:101–8.

Thompson JMD, Clark PM, Robinson E, Pattison NS, Glavish N,

Wild CJ, et al. Risk factors for small-for-gestational-age babies:

The Auckland birthweight collaborative study. J Paediatr Child

Health 2001;37:369–75.

Kramer MS. Determinants of low birth weight: methodological

assessment and metanalysis. Bull WHO 1987; 65:663–737.

Radhakrishnan S,Srivastava AH,Modi UJ.Maternal determinants

of intra-uterine growth retardation. J Indian Med Assoc

;87(6):130–2.

Mavalankar DV, Gray RH, Trivedi CR, Parikh VC. Risk factors

for small for gestational age birth in Ahmedabad, India. J Trop

Pediatr 1994;40:285–90.

Godfrey K, Robinson S, Barker DJ, Osmond C, Cox V. Maternal

nutrition in early and late pregnancy in relation to placental and

fetal growth. BMJ 1996; 312:410–4.

Rondo PHC, Abbott R, Rodrigues LC, Tomkins AM. The

influence of maternal nutritional factors on intrauterine growth

retardation in Brazil. Paediatr Perinat Epidemiol 1997;11:152–66.

Kumari S, Shendurnikar N, Jain S, Kanodia K, Jain R, Mullick

DN. Outcome of babies with special reference to some maternal

factors. Indian Pediatr 1989;26:241–5.

Downloads

Published

2010-12-01

Most read articles by the same author(s)