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Randomized Controlled Trial
. 2016 May 17:16:110.
doi: 10.1186/s12884-016-0900-5.

Risk factors for small-for-gestational-age and preterm births among 19,269 Tanzanian newborns

Alfa Muhihi  1   2 , Christopher R Sudfeld  3 , Emily R Smith  3 , Ramadhani A Noor  4   3 , Salum Mshamu  4 , Christina Briegleb  5 , Mohamed Bakari  4 , Honorati Masanja  6 , Wafaie Fawzi  3   5   7 , Grace Jean-Yee Chan  3   8
Affiliations
Randomized Controlled Trial

Risk factors for small-for-gestational-age and preterm births among 19,269 Tanzanian newborns

Alfa Muhihi et al. BMC Pregnancy Childbirth. .

Abstract

Background: Few studies have differentiated risk factors for term-small for gestational age (SGA), preterm-appropriate for gestational age (AGA), and preterm-SGA, despite evidence of varying risk of child mortality and poor developmental outcomes.

Methods: We analyzed birth outcome data from singleton infants, who were enrolled in a large randomized, double-blind, placebo-controlled trial of neonatal vitamin A supplementation conducted in Tanzania. SGA was defined as birth weight <10th percentile for gestation age and sex using INTERGROWTH standards and preterm birth as delivery at <37 complete weeks of gestation. Risk factors for term-SGA, preterm-AGA, and preterm-SGA were examined independently using log-binomial regression.

Results: Among 19,269 singleton Tanzanian newborns included in this analysis, 68.3 % were term-AGA, 15.8 % term-SGA, 15.5 % preterm-AGA, and 0.3 % preterm-SGA. In multivariate analyses, significant risk factors for term-SGA included maternal age <20 years, starting antenatal care (ANC) in the 3(rd) trimester, short maternal stature, being firstborn, and male sex (all p < 0.05). Independent risk factors for preterm-AGA were maternal age <25 years, short maternal stature, firstborns, and decreased wealth (all p < 0.05). In addition, receiving ANC services in the 1(st) trimester significantly reduced the risk of preterm-AGA (p = 0.01). Significant risk factors for preterm-SGA included maternal age >30 years, being firstborn, and short maternal stature which appeared to carry a particularly strong risk (all p < 0.05).

Conclusion: Over 30 % of newborns in this large urban and rural cohort of Tanzanian newborns were born preterm and/or SGA. Interventions to promote early attendance to ANC services, reduce unintended young pregnancies, increased maternal height, and reduce poverty may significantly decrease the burden of SGA and preterm birth in sub-Saharan Africa.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12610000636055 , registered on 3(rd) August 2010.

Keywords: Birth weight; Preterm-AGA; Preterm-SGA; Risk factors; Tanzania; Term-SGA.

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Figures

Fig. 1
Fig. 1
Relative risk of term-SGA, preterm-AGA and preterm-SGA for maternal height categories as compared to ≥160.0 cm reference
See this image and copyright information in PMC

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