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Low Birth weight

Infants born with low birthweight (less than 2500gm) suffer from extremely high rates of morbidity and mortality from infectious disease and are underweight, stunted or wasted. It is also associated with impaired immune function, poor cognitive development and high risk of diarrhoea or pneumonia.
The main cause of low birthweight is prematurity (born before 37 weeks of gestation) and the main cause of low birthweight in developing country like Nepal is intrauterine growth retardation. In developing countries, low birthweight is due to poor maternal nutritional status at conception, low gestational weight gain due to inadequate dietary intake and short maternal figure. In these countries, mothers have low body mass index. Lack of food security, maternal and child care, sanitation and hygiene, education, gender discrimination and poverty can be considered as the causes of low birthweight.

It is an intergenerational problem. Young maternal age is also the root cause of LBW. There should be healthy bride campaign to delay marital age and pregnancy. We should promote good nutrition especially among non-pregnant girls. We should also improve coverage and quality of antenatal care programmes (encourage visits at least once per month for routine clinical assessments, especially for blood pressure, weight gain and breastfeeding counselling). Providing food supplements to all pregnant and lactating women, increase colostrum feeding, initiation of breastfeeding within one hour after delivery are also measures to remove low birth weight. In Nepal, adolescents become pregnant before their own growth is completed. Improvement in the growth of girls and in the nutritional status of young women and mothers may be essential elements reducing LBW.

Micronutrient deficiencies play a vital role in this connection. Good micronutrient status is important to birth outcome. The maternal environment is the most important determinant of birthweight.

Every year approximately 17 million infants in developing countries are born with LBW and those infants who survive have little chance of fully reaching their growth potential. Adults born with LBW face an increased risk of chronic diseases including high blood pressure, non-insulin dependent diabetes mellitus, coronary heart disease and stroke in adulthood.

Adolescents and adults born with LBW generally have less strength and lower lean body mass resulting in decreased work capacity and lost productivity. They suffer an increased risk of high blood pressure, obstructive lung disease, high blood cholesterol and renal damage. Thus a poorly growing foetus is an undernourished foetus prone to reduced growth, altered body proportions, and a number of metabolic and cardiovascular changes. In developing countries children are exposed to poor nutrition, high levels of infections and other conditions of poverty, thus their long term development is dependent to a large extent on the quality of their environment.

A woman’s pregnancy weight and nutritional status, coupled with the amount of weight gained during pregnancy, are extremely useful indicators for interventions to reduce LBW. WHO recommends that women in developing countries gain at least 1 Kg per month during the last two trimesters of pregnancy, resulting in a weight gain of at least 6 Kg. Many investigators agree that weight gain in the second and third trimester is of greater importance for insuring foetal growth than weight gain during the first trimester.

A child’s nutritional status was associated with the BMI of the mother, the socioeconomic status of the family, and the child’s own breastfeeding status. Micronutrient supplementation has been shown to increase children’s appetite, energy and growth.

Improving prepregnancy weight and weight gain during pregnancy are effective strategies which reduce and prevent LBW. Breastfeeding, appropriate complementary feeding, and adequate micronutrient status are especially important during infancy and early childhood. Improved dietary intake should be promoted among pregnant adolescents. The use of colostrum and exclusive breastfeeding during the first six months, and the continuation of breastfeeding until the age of two years is essential for the proper development of child.
(with inputs from SCN News)

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