Maternal-fetal disproportion and birth asphyxia in rural Sarlahi, Nepal

Anne C C Lee, Gary L. Darmstadt, Subarna K. Khatry, Steven C. LeClerq, Sharda Ram Shrestha, Parul S Christian

Research output: Contribution to journalArticle

Abstract

Objective: To assess the risk of birth asphyxia associated with maternal and newborn size. Design: Cohort study. Setting: Rural community in the Sarlahi district of Nepal. Participants: Mothers and newborns (n=3189). Outcome Measure: Birth asphyxia, defined as an infant who failed to cry at birth, and who was unable to breathe or suckle normally after birth or had convulsions. Results: Birth asphyxia occurred in 78 of 1000 live births, and asphyxia-specific mortality was 11 per 1000 live births. After controlling for confounding factors, mothers with height shorter than 145 cm were more likely to have an infant with birth asphyxia compared with mothers 145 cm or taller (adjusted relative risk [RR], 1.5; 95% confidence interval [CI], 1.1-2.0). Mothers with mid-upper arm circumference smaller than 21.5 cm carried a higher risk of delivering an infant with birth asphyxia compared with those with arm circumference greater than 23 cm (adjusted RR, 1.5; 95% CI, 1.1- 2.0). Asphyxia was more common among newborns with head circumference greater than 33.5 cm than those with head circumferences 32.6 to 33.5 cm (adjusted RR, 1.6; 95% CI, 1.1-2.2). Birth weight was not independently associated with birth asphyxia; however, there was significant interaction between maternal stature and birth weight (P=.01); a 3300-g infant born to a mother shorter than 145 cm carried a 3.8 times higher asphyxia risk (95% CI, 2.2-6.5) than an infant of median weight (2620 g) born to a mother taller than 145 cm. Conclusions: In rural Nepal, maternal stunting and wasting and large infant head circumference carried higher risk of neonatal asphyxia. Maternal-fetal disproportion resulted in a synergistic elevation in asphyxia risk. Trial Registration: clinicaltrials.gov Identifier: NCT00115271.

Original languageEnglish (US)
Pages (from-to)616-623
Number of pages8
JournalArchives of Pediatrics and Adolescent Medicine
Volume163
Issue number7
DOIs
StatePublished - Jul 2009

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Nepal
Asphyxia
Mothers
Parturition
Confidence Intervals
Head
Live Birth
Newborn Infant
Birth Weight
Arm
Growth Disorders
Rural Population
Seizures
Cohort Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Maternal-fetal disproportion and birth asphyxia in rural Sarlahi, Nepal. / Lee, Anne C C; Darmstadt, Gary L.; Khatry, Subarna K.; LeClerq, Steven C.; Shrestha, Sharda Ram; Christian, Parul S.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 163, No. 7, 07.2009, p. 616-623.

Research output: Contribution to journalArticle

Lee, Anne C C ; Darmstadt, Gary L. ; Khatry, Subarna K. ; LeClerq, Steven C. ; Shrestha, Sharda Ram ; Christian, Parul S. / Maternal-fetal disproportion and birth asphyxia in rural Sarlahi, Nepal. In: Archives of Pediatrics and Adolescent Medicine. 2009 ; Vol. 163, No. 7. pp. 616-623.
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abstract = "Objective: To assess the risk of birth asphyxia associated with maternal and newborn size. Design: Cohort study. Setting: Rural community in the Sarlahi district of Nepal. Participants: Mothers and newborns (n=3189). Outcome Measure: Birth asphyxia, defined as an infant who failed to cry at birth, and who was unable to breathe or suckle normally after birth or had convulsions. Results: Birth asphyxia occurred in 78 of 1000 live births, and asphyxia-specific mortality was 11 per 1000 live births. After controlling for confounding factors, mothers with height shorter than 145 cm were more likely to have an infant with birth asphyxia compared with mothers 145 cm or taller (adjusted relative risk [RR], 1.5; 95{\%} confidence interval [CI], 1.1-2.0). Mothers with mid-upper arm circumference smaller than 21.5 cm carried a higher risk of delivering an infant with birth asphyxia compared with those with arm circumference greater than 23 cm (adjusted RR, 1.5; 95{\%} CI, 1.1- 2.0). Asphyxia was more common among newborns with head circumference greater than 33.5 cm than those with head circumferences 32.6 to 33.5 cm (adjusted RR, 1.6; 95{\%} CI, 1.1-2.2). Birth weight was not independently associated with birth asphyxia; however, there was significant interaction between maternal stature and birth weight (P=.01); a 3300-g infant born to a mother shorter than 145 cm carried a 3.8 times higher asphyxia risk (95{\%} CI, 2.2-6.5) than an infant of median weight (2620 g) born to a mother taller than 145 cm. Conclusions: In rural Nepal, maternal stunting and wasting and large infant head circumference carried higher risk of neonatal asphyxia. Maternal-fetal disproportion resulted in a synergistic elevation in asphyxia risk. Trial Registration: clinicaltrials.gov Identifier: NCT00115271.",
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