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July 6, 2009

Maternal-Fetal Disproportion and Birth Asphyxia in Rural Sarlahi, Nepal

Author Affiliations

Author Affiliations: International Center for Advancing Neonatal Health (Drs Lee and Darmstadt), and Center for Human Nutrition (Mr LeClerq and Dr Christian), Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal (Dr Khatry and Mssrs LeClerq and Shrestha).

Arch Pediatr Adolesc Med. 2009;163(7):616-623. doi:10.1001/archpediatrics.2009.75

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