An analysis of intra-uterine growth retardation in rural Malawi

Objective. (1). To describe the sex-specific, birth weight distribution by gestational age of babies born in a malaria endemic, rural area with high m aternal HIV prevalence; (2) to assess the contribution of maternal health, nutritional status and obstetric history on intra-uterine growth retardatio n (IUGR) and prematurity. Methods. Information was collected on all women attending antenatal service s in two hospitals in Chikwawa District, Malawi, and at delivery if at the hospital facilities. New-borns were weighed and gestational age was assesse d through post-natal examination (modified Ballard). Sex-specific growth cu rves were calculated using the LMS method and compared with international r eference curves. Results: A total of 1423 live-born singleton babies were enrolled; 14.9% ha d a birth weight < 2500 g, 17.3% were premature (< 37 weeks) and 20.3% had IUGR. A fall-off in Malawian growth percentile values occurred between 34 a nd 37 weeks gestation. Significantly associated with increased IUGR risk we re primiparity relative risk (RR) 1.9; 95% CI 1.4-2.6), short maternal stat ure (RR 1.6; 95% CI 1.0 -2.4), anaemia (Hb < 8 g/dl) at first antenatal vis it (RR 1.6; 95% CI 1.2-2.2) and malaria at delivery (RR 1.4; 95% Cl 1.0 - 1 .9). Prematurity risk was associated with primiparity (RR 1.7; 95% CI 1.3-2 .4), number of antenatal visits (RR 2.2; 95% CI 1.6-2.9) and arm circumfere nce < 23 cm (RR 1.9; 95% CI 1.4-2.5)- HIV infection was not associated with IUGR or prematurity. Conclusion: The birth-weight-for-gestational-age, sex-specific growth curve s should facilitate improved growth monitoring of new-borns in African area s where low birth weight and IUGR are common. The prevention of IUGR requir es improved malaria control, possibly until late in pregnancy, and reductio n of anaemia.