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Category: Volume 08 Issue 01 January 2020
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Title: Study of Maternal Risk Factors in Small for Gestational Age (SGA) Babies with Fetal Malnutrition

Authors: Dr Bapu Yelam M.D, Dr Saira Merchant M.D., Mrs. Jiji Yelam M.Sc.(Nursing), Dr Abhishek Madhura M.D, Dr Harshavardhan Khandait, MBBS

 DOI: https://dx.doi.org/10.18535/jmscr/v8i1.134

Abstract

Introduction: Maternal risk factors for fetal malnutrition (FM) included adverse age, primiparity, low pre-pregnancy weight and height, a bad obstetric history and pregnancy induced hypertension. Malnutrition in the newborn might be missed if intrauterine growth curves only are used for assessment. The CAN Score is a simple and rapid clinical scoring system for diagnosing fetal malnutrition in Small for Gestational Age (SGA) babies.

Aim: The aim of the study is to assess association of high risk factors in mother like anemia, malnutrition low BMI, pre-eclampsia, multiple pregnancy, maternal age (<18yrs),maternal weight (<40kg) and height, socioeconomic status and prevalence of FM in SGA babies.

Subjects and Methods: This is a prospective hospital based study carried out at the Neonatology unit of Tertiary Care Institute in Government Medical College, Nagpur. Baby-Mother pairs who met the inclusion criteria for the study were recruited consecutively. Relevant biodata is recorded and babies nutritional status were assessed using the Clinical Assessment of Nutritional Status Score chart. Data were entered into a Microsoft Excel sheet and analyzed using standard statistical tools.

Results: In present study 903 term SGA neonates and mothers, 477(52.8%) (weight <2.5 kg) were males and 426(47.2%) were females. The prevalence of FM in SGA babies is 34.21%. Analysis of maternal risk factors showed maternal age <18 yrs and >30 yrs, BMI <18, Anemia and PIH were associated with high occurrence of FM and statistically significant (P<0.006).

Conclusion: The prevalence of FM is high in high risk mothers and highlights the need for evolving appropriate interventions and strategies for its Prevention. Screening Programmes to identify the high risk mothers in early pregnancy so that medical and nutritional interventions can be started early to overcome the damaging effects of these risk factors. These interventions will have great long term impact on improving child survival.

Keywords: Fetal malnutrition, prevalence, risk factors.

References

  1. Allen MC. Developmental outcomes and follow up of small for gestational infants. Semin Perinatol 1984,8:123-56.
  2. Barker DJ, Gluckman PD, Godfrey KM, et al. Fetal nutrition and cardiovascular disease in adult life.Lancet1993;341:938-41.
  3. Kramer MS. Determinants of low birth weight: methodological assessment and metaanalysis.Bull WHO 1987;65:663-737.
  4. Spencer N, Logan S.Social influences on birth weight. Arch Dis Child fetal Neonatal Ed2002;86:F6-7.
  5. WHO Chronicle 32:200-201,1978.
  6. Lockwood CJ and Weiner S. Assessment of fetal growth. Clin perinatol 13:2-35,1986.
  7. Georgieff MK and Sasanow SR. Nutritional assessment of the neonate. Clin Perinatol 13:72- 89, 1986
  8. Metcoff J. Clinical assessment of nutritional status at birth. Fetal malnutrition and SGA are not synonymous. Pediatr  Clin North Am 41:875-91,1994.
  9. Jayant D and Rajkumar J. Study of the prevalence and high risk factors for fetal malnutritution in term newborn. Ann Trop Paediatr , 19:273-77,1999.
  10. Scott KK and Usher RH. Fetal malnutrition: Its incidence causes and effects .Am J Obstet Gynaecol 94: 951-63,1966.
  11. Sankhyan N, Sharma VK, Singh S, Detection of fetal malnutrition using “CANSCORE”. Indian J.Pediatr.76:903-906,2009.
  12. Onyiriuka, Okolo AA. Small for gestational age, ponderal index and neonatal polycythaemia: A study of their association with maternal hypertension among Nigerian womwn. Ann Afr Med 2005;4:154-9.
  13. Roberts JM, Cooper DW. Pathogenesis and genetics of preeclampsia. Lancet 2001:357:53-6.(14).
  14. Roberts JM, Redman CW. Preeclampsia: More than pregnancy-induced hypertension. Lancet 1993:341:1447-51.(15).
  15. World –Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva: World Health Organization;1997.p.6(16).
  16. Chin chu et al, Composition of associated high risk factors and perinatal outcome between symmetric and asymmetric fatal intrauterine growth retardation, Am J Obstet Gynecol June1991.
  17. Galbraith et al, Altman DG, Hytten FE. Intrauterine growth retardation; lets be clear about it. Br J. Obstet Gynacol;96:1127,1989.
  18. Deodhar J, Jarad R.Study of the prevalence of and high risk factors in the etiology of fetal malnutrition in Nigeria. Pediatr Int 49:150-155,2007.
  19. Adebami OJ, Oyedeji GA, Owa. JA, Oyelami OA. Maternal factors in the etiology of fetal malnutrition in Nigeria. Pediatr Int.49:150-155,2007
  20. N. Ezenwa, V.C. Ezeaka.Is canscore a good indicator of fetal malnutrition in preterm newborn. Alex J Med 2017.
  21. Almarzoki JM, Rana DJ. Comparative study between clinical assessment of nutritional status score (CAN Score) and anthropometry in the assessment of fetal malnutrition. Int Res J Med Sci.2015,3(7):8-12.
  22. Kamath MK, Raoss, Shenoy RD. Assessment of fetal malnutrition by body mass index and intrauterine growth curves :a comparative study. Int J Contemp Pediatr.10 may 2016
  23. Jarai I.J. Mestyan K Schuktz A, Laxar M, Halasz I Krasy. Body size and neonatal hypoglycaemia in intrauterine growth retardation. Early Hum Dev1:25-38,1977.
  24. Mehta S, Tendon A, Dua T, Kumari S, Singh SK. Clinical assessment of nutritional status at birth, Indian Pediatr.35:423-428,1998.
  25. Preeti Waghmare et al: Assessment of fetal malnutrition by CAN Score.Vol9,Jan2012.
  26. Leeladhar et al. Detertion an fetal malnutrition by CAN Score at birth and its comparison with other methods in determining intrauterine growth. Pediatric infection disease Conference 2010.
  27. Ayse A, Korknaz. Ozlem O Teksam, Murat M, Yurdakok, Sule S Yigit and Gulsevin G. Tekinalp Turk J.Pediatr 53(3);261-8,201.

Corresponding Author

Dr Bapu Yelam

Assistant Professor, Dept of Paediatrics, Govt Medical College, Nagpur, Maharashtra, India 440003