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BMC Pregnancy Childbirth. 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.

Author information

1
Ifakara Health Institute, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania. selukundo@gmail.com.
2
Africa Academy for Public Health, CM Plaza Building, Mwai Kibaki Road, Mikocheni, P.O.Box 79810, Dar es Salaam, Tanzania. selukundo@gmail.com.
3
Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.
4
Africa Academy for Public Health, CM Plaza Building, Mwai Kibaki Road, Mikocheni, P.O.Box 79810, Dar es Salaam, Tanzania.
5
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA.
6
Ifakara Health Institute, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania.
7
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA.
8
Department of Medicine, Boston Children's Hospital, Boston, USA.

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

PMID:
27183837
PMCID:
PMC4869183
DOI:
10.1186/s12884-016-0900-5
[Indexed for MEDLINE]
Free PMC Article

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