The problem of LBW babies

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By 2017-07-17

By Ranali Perera

Newborns with a birth weight of less than 2.5kg fall into the category of low birth weight (LBW) babies. If the weight is less than 1.5kg, it is considered as a very low birth weight, and if it is less than 1kg, an extremely very low birth weight. The weight is considered irrespective of the gestational age. Therefore, irrespective of whether it's a term or preterm baby, if the weight of the newborn is less than the cut-off of 2.5kg, the baby falls into the category of LBW babies.

Babies born with a low birth weight are a big burden to the health and economy of a country. It is a very significant issue especially in developing countries. According to the World Health Organization (WHO), the global prevalence of LBW is 15.5%, with over 95% in the developing countries. South Asia has the highest rate of low birth weight babies.

LBW is associated with high mortality and morbidity rates. Morbidity rate refers to the frequency of contracting illnesses in the future whereas mortality rate refers to the frequency of deaths. LBW contributes to about 60%-80% of neonatal deaths, according to the WHO. It should be noted that even though in most other countries, having a high LBW rate goes hand in hand with high rates of mortality, this is not so in Sri Lanka. The high standard of healthcare in our country has ensured that even if a baby is born with a lower birth weight, the complications associated with it are properly handled and the newborns are well taken care of. Currently in Sri Lanka, the LBW rate is around 16% to 18%. This means that for every 100 babies that are born, around 16 to 18 would be having a low birth weight.

Why is there such a high proportion of LBW babies in our country?

The reason for LBW is multi-factorial. However, it can be broadly divided as low birth weight associated with preterm babies and low birth weight in a baby born at term due to restricted intrauterine growth. In some situations, both factors may play a role. Preterm babies are babies born before 37 weeks of gestation. The earlier the delivery of the baby, the lower the birth weight would be. If the baby is having a restricted growth, the baby would be considered as 'small for gestational age'. Some babies, who are small for gestational age are small, because the parents are of smaller built.

The reason for smaller growth or for preterm delivery could be related to the baby, the mother or to the physical environment. In developed countries, LBW is more due to preterm delivery than that due to growth restriction, whereas it is the opposite in developing countries.

Risk factors for low birth weight babies:

  • Genetic factors:

  • Mother also being a LBW baby

  • Genetic syndromes in the baby that could lead to preterm/premature delivery or small for gestational age babies

  • Ethnicity (LBW is more common in Asian populations)

  • Medical conditions in the mother:

  • Hypertension (chronic or due to pregnancy)

  • Diabetes (chronic or due to pregnancy)

  • Infections (rubella, syphilis, malaria, gonorrhea, urinary tract infections, HIV)

  • Asthma

  • Kidney problems (Renal insufficiency)

  • Nutritional factors:

  • Mother being of a short stature

  • Low maternal body weight before pregnancy (BMI < 18.5kg/m2)

  • Inadequate weight gain during pregnancy

  • Nutritional deficiencies like iron deficiency

  • Psychosocial factors affecting the mother:

  • Stress and anxiety

  • Depression

  • Poor family support

  • Domestic violence and abuse

  • Environmental and lifestyle factors:

  • Air pollution

  • Smoking

  • Consumption of alcohol

  • Caffeine use

  • Cocaine and other substance abuse

  • Mother engaging in physically demanding work during pregnancy

  • Other factors:

  • Teenage pregnancy

  • Being unmarried

  • Multiple pregnancies (twins, triplets etc.)

  • Abnormalities in the uterus (womb) or placenta

  • Past delivery of LBW babies or preterm deliveries

  • Short (5 years) gap between pregnancies

Usually for the same gestational age, girls have a lower weight than boys and the first-born child would weigh lower than the others and twins would weigh less than singletons.

Why do we need to worry about LBW?

Being born with a low birth weight can render the child more susceptible to disastrous consequences at an early age and also in the long run. Not all those born with a lower birth weight, would face these outcomes, some may grow up to become normal healthy adults.

As I mentioned earlier, having a low weight at birth increases the neonatal morbidity and mortality rates. Also, the LBW rate has an association with the nation's general health care. This can be used as an indicator to monitor the general health condition of the country as not only does this reflect how well the women who later become mothers are, but also the future health condition of the population. The latter is due to the long term health effects of LBW.

Consequences of LBW:

  • Impaired immune functions of the newborn leading to increased risk of getting infections like diarrhoea and pneumonia

  • Poor cognitive development leading to substandard school performance

  • Inability to achieve their growth potential, thus leading to mothers with short stature or low BMI, which would again lead to an increased risk of a LBW child

In the long run, as adults, the children born with LBW would have:

  • Increased risk of developing non-communicable diseases (NCDs) like hypertension, diabetes, heart diseases and stroke

Eventually, this impacts the society with the higher disease burden and health care costs.

Babies born with a lower birth weight affects the short and long term health of that individual as well as the economy of the nation. With proper modification of the risk factors we can reduce the number of LBW babies. Ensuring that proper nutritional, psychological and social health of the mother is maintained not only during the pregnancy but from the childhood on, will help achieve this goal somewhat.

Appropriate care of the newborn with LBW immediately after pregnancy can reduce the mortality associated with this condition. This involves proper feeding, early detection and treatment of infections and maintenance of proper hygiene. Fortunately in Sri Lanka, with quality health care during child birth and pregnancy, the mortality rate has been reduced to a very low level.



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