Demographic, socio-economic, obstetric, and behavioral factors associated with small-and large-for-gestational-age from a prospective, population-based pregnancy cohort in rural Nepal: a secondary data analysis.
Demographic, socio-economic, obstetric, and behavioral factors associated with small-and large-for-gestational-age from a prospective, population-based pregnancy cohort in rural Nepal: a secondary data analysis.
复制标题
DOI：
10.1186/s12884-022-04974-8
复制
发表时间：
2022-08-19
影响因子：
3.1
通讯作者：
中科院分区：
文献类型：
--
作者：
在南亚，三分之一的婴儿出生时小于胎龄（SGA）。风险因素在文献中有很好的描述，但许多研究是在高收入和中等收入国家进行的，或仅在设施分娩中测量SGA。描述低收入国家中大于胎龄儿（LGA）风险因素的流行率的研究较少。我们的目的是描述与SGA和LGA在人口为基础的队列的孕妇在尼泊尔农村的因素。这是一项基于社区的新生儿精油按摩试验的二次数据分析（22，545名女性，39，479例妊娠）。在入组时收集人口统计学、社会经济地位（SES）、病史/产科史和末次月经时间。在整个妊娠期间收集生命体征、疾病症状和产前护理（ANC），并测量活产新生儿体重。我们使用多项、多水平逻辑回归进行多变量分析，报告比值比（OR）和95%置信区间（CI）。结局是SGA、LGA与适合胎龄（阿加）的比较，并使用重新校准至分娩时的出生体重进行多重插补。SGA与未孕相关（OR：2.12 95% CI：1.93-2.34），妊娠/未经产（OR：1.86，95%CI：1.26-2.74），解释间隔小于18个月（OR：1.16，95%CI：1.07-1.27），妊娠中期食欲不振/呕吐（OR：1.27，95%CI：1.19-1.35）。更大的财富（或：0.78，95% CI：0.69-0.88）、妊娠晚期手/脸肿胀（OR：0.81，95% CI：0.69-0.94）、产次大于5（OR：0.77，95% CI：0.65-0.92）、胎儿性别为男性（OR：0.91，95% CI：0.86-0.98）和体重增加（OR：0.93/kg体重差异（95%CI：0.92-0.95）对SGA具有保护作用。4次或4次以上ANC访问（OR：0.53，95%CI：0.41-0.68）和晚期呼吸道症状（OR：0.67，95%CI：0.54-0.84）与LGA呈负相关，且母亲年龄< 18岁（OR：1.39，95%CI：1.03-1.87）和孕中期呼吸道症状（OR：1.27，95%CI：1.07-1.51）与LGA呈正相关。我们的研究结果与已知的SGA风险因素一致。因为LGA婴儿的患病率和死亡率在这一人群中很低，所以LGA状态可能并不表明潜在的疾病。改善和公平地获得高质量的产前保健，监测适当的妊娠期体重增加和增加对高危妊娠妇女的监测，可能会降低SGA婴儿的患病率并改善其结局。在Clinicaltrials.gov NCT 01177111上注册了本次要数据分析中使用的研究。在线版本包含补充材料，可通过10.1186/s12884-022-04974-8获得。
In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal. This is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery. SGA was associated with nulligravida (OR: 2.12 95% CI: 1.93–2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26–2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07–1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19–1.35). Greater wealth (OR: 0.78, 95% CI: 0.69–0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69–0.94) parity greater than five (OR: 0.77, 95% CI: 0.65–0.92), male fetal sex (OR: 0.91, 95% CI: 0.86–0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2nd and 3rd trimester, 95% CI: 0.92–0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41–0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54–0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03–1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07–1.51) were positively associated with LGA. Our findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies. The study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111. The online version contains supplementary material available at 10.1186/s12884-022-04974-8.
登录
查看更多内容
影响因子：
2.8
作者：
El Rafei, Rym;Abbas, Hussein A.;Yunis, Khalid A.
通讯作者：
Yunis, Khalid A.
DOI：
10.1093/ajcn/nqab086
发表时间：
2021-08-02
期刊：
The American journal of clinical nutrition
影响因子：
--
作者：
Bauserman MS;Bann CM;Hambidge KM;Garces AL;Figueroa L;Westcott JL;Patterson JK;McClure EM;Thorsten VR;Aziz SA;Saleem S;Goldenberg RL;Derman RJ;Herekar V;Somannavar M;Koso-Thomas MW;Lokangaka AL;Tshefu AK;Krebs NF;Bose CL;Women First Preconception Trial Study Group
通讯作者：
Women First Preconception Trial Study Group
影响因子：
3.3
作者：
Biks GA;Blencowe H;Hardy VP;Geremew BM;Angaw DA;Wagnew A;Abebe SM;Guadu T;Martins JSD;Fisker AB;Imam MA;Nettey OEA;Kasasa S;Di Stefano L;Akuze J;Kwesiga D;Lawn JE;Every Newborn-INDEPTH Study Collaborative Group
通讯作者：
Every Newborn-INDEPTH Study Collaborative Group
影响因子：
3.8
作者：
Jayasinghe IU;Koralegedara IS;Agampodi SB
通讯作者：
Agampodi SB
影响因子：
2.9
作者：
Khan, Nizamuddin;Mozumdar, Arupendra;Kaur, Supreet
通讯作者：
Kaur, Supreet