Low Birth Weight: The Indian Perspective

1. Low Birth Weight: The Indian Perspective Prof. H.P.S. Sachdev

2. DEFINITIONS • WHO (1995) - Based on Global DataPerinatal & Neonatal Morbidity & Mortality Later Growth & Development • LBW - Below 2500 g VLBW - Below 1500 g • Birth weight crude proxy for fetal growth Only measure in Developing Countries • Focus – Optimal fetal development

3. Global LBW Prevalence (%) Asia 21 Oceania 20 Africa 15 Latin America 11 North America 7 USSR 7 Europe 6 Global 17

4. Presentation Format • Implications • Epidemiology • Time Comparison • Body Composition • Some Interventions • Public Health Issues

5. Implications of LBW • Morbidity and Mortality • Subsequent Development • Long term Growth • Adult Degenerative Diseases

6. Growth in Weight in Delhi LBW Boys Source: Indian Pediatrics 1995; 32: 963

7. Epidemiology

8. LBW Prevalence (%) in South Asia

9. Variation in LBW Prevalence • Inter Regional • Socio-economic • Urban Rural Varies from 10% to 56% Preterms 7.1% to 22.3%

10. Multicentric Data • National Neonatology Forum (1995/ 2002) Institutional Data on 37082 / 66512 Births LBW - 33% /31.6% VLBW - 3.3% /3.3% Preterm - 12.3% /14.7% • ? Overestimates: Underprivileged and High Risk Population

11. Multicentric and Other Data • CSSM (1995): 14 District Based Data on 27069 Births - 18.4%, Reliability ?? 2.7% - MP, 5.1%-AS, 25%-TN, 40%-OR • National Family Health Survey(99): 23% (Newborn Weight Recorded in 30% of 32,393 Births; Based on Recall: Bias) • Community surveys 8% - 19%

12. Type: Heterogeneous Population • Born Too Small (Intrauterine Growth Retarded or SFD; <2SD) OR • Born Too Soon (Preterm <37 Weeks)

13. LBW Type • NNF Data • Predominantly Term IUGR • Contrast: Developed Overwhelming Preterm

14. Intrauterine Growth Curves Comparison

16. Gestational Distribution • Preterms India 7.1% to 22.3% (12.3%) Developed - 5% • At 36 weeks births 2% (West) vs 3-12% • Maximum Deliveries 40-41 W vs 39-40W • Variation (Socio-economic)

17. Time Comparison

18. Trends in Low Birth Weight Mean Gest ? 0.8W 0.3W 0 0.7W 20-15% 14-10% Preterm 21-16% 74g Mean Wt 78g 52g 126g ? 1988 1962 1969 1969-73 1986 1989-93 1995 1994

19. Male Subscapular Trend mm P<0.01 Gestation (Weeks)

20. Positive Trend in Birth Weight • Improvement possible in current scenario • Both intrauterine growth and gestation contributory

21. Birth Weight Changes in Developed

22. Birth Weight Changes in Developed • Change in BW Comparable (33-100 g) But Prevalence Less • Persistence in Differences Racial Inter-country (ICE Multi-centric)

23. Body Composition

24. Early Life Origin of Diabetes F A T N E S S Bhargava, Sachdev, et al. N Engl J Med 2004;350:865-75.

25. Birth Weight and Infant Fat r=0.62; r2=0.38; p<0.001

26. Fat Indices Comparison

27. Some Interventions

28. Adolescent Pregnancy Mean Marriage Age (Yr) • Indirect Influence Wt, Ht & Nutrition • In U.P. LBW- 67% Preterm - 33%

29. Results of Systematic Reviews on Macronutrient Supplementation & BW

30. Food Supplement Consumption ICDS Data Source: Nayar et al. Indian Pediatrics 1997

31. Results of Systematic Reviews on Micronutrient Supplementation and BW

32. Effect of Smoking Cessation on LBW (Lumley et al 1999)

33. Public Health Issues

34. Does “One Birth Size Fit All” ? • Realistic Prevalence & Time Trends • Surveillance: NNF, Surveys, Sentinel, ICDS • Mix Sustainable Interventions vs Isolated • Body Composition esp. Interven Studies • Predominantly Growth Retarded: Requirements in Exclusively Breast Fed