Bater Jorick, Lauer Jacqueline M, Ghosh Shibani, Webb Patrick, Agaba Edgar, Bashaasha Bernard, Turyashemererwa Florence M, Shrestha Robin, Duggan Christopher P
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2020 Jul 13;15(7):e0235626. doi: 10.1371/journal.pone.0235626. eCollection 2020.
Approximately 20.5 million infants were born weighing <2500 g (defined as low birthweight or LBW) in 2015, primarily in low- and middle-income countries (LMICs). Infants born LBW, including those born preterm (<37 weeks gestation), are at increased risk for numerous consequences, including neonatal mortality and morbidity as well as suboptimal health and nutritional status later in life. The objective of this study was to identify predictors of LBW and preterm birth among infants in rural Uganda.
Data were derived from a prospective birth cohort study conducted from 2014-2016 in 12 districts across northern and southwestern Uganda. Birth weights were measured in triplicate to the nearest 0.1 kg by trained enumerators within 72 hours of delivery. Gestational age was calculated from the first day of last menstrual period (LMP). Associations between household, maternal, and infant characteristics and birth outcomes (LBW and preterm birth) were assessed using bivariate and multivariable logistic regression with stepwise, backward selection analyses.
Among infants in the study, 4.3% were born LBW (143/3,337), and 19.4% were born preterm (744/3,841). In multivariable analysis, mothers who were taller (>150 cm) (adjusted Odds Ratio (aOR) = 0.42 (95% CI = 0.24, 0.72)), multigravida (aOR = 0.62 (95% CI = 0.39, 0.97)), or with adequate birth spacing (>24 months) (aOR = 0.60 (95% CI = 0.39, 0.92)) had lower odds of delivering a LBW infant Mothers with severe household food insecurity (aOR = 1.84 (95% CI = 1.22, 2.79)) or who tested positive for malaria during pregnancy (aOR = 2.06 (95% CI = 1.10, 3.85)) had higher odds of delivering a LBW infant. In addition, in multivariable analysis, mothers who resided in the Southwest (aOR = 0.64 (95% CI = 0.54, 0.76)), were ≥20 years old (aOR = 0.76 (95% CI = 0.61, 0.94)), with adequate birth spacing (aOR = 0.76 (95% CI = 0.63, 0.93)), or attended ≥4 antenatal care (ANC) visits (aOR = 0.56 (95% CI = 0.47, 0.67)) had lower odds of delivering a preterm infant; mothers who were neither married nor cohabitating (aOR = 1.42 (95% CI = 1.00, 2.00)) or delivered at home (aOR = 1.25 (95% CI = 1.04, 1.51)) had higher odds.
In rural Uganda, severe household food insecurity, adolescent pregnancy, inadequate birth spacing, malaria infection, suboptimal ANC attendance, and home delivery represent modifiable risk factors associated with higher rates of LBW and/or preterm birth. Future studies on interventions to address these risk factors may be warranted.
2015年，约有2050万婴儿出生时体重不足2500克（定义为低出生体重或LBW），主要集中在低收入和中等收入国家（LMICs）。低出生体重儿，包括早产（妊娠<37周）的婴儿，面临诸多不良后果的风险增加，包括新生儿死亡率和发病率，以及日后健康和营养状况不佳。本研究的目的是确定乌干达农村地区婴儿低出生体重和早产的预测因素。
数据来源于2014 - 2016年在乌干达北部和西南部12个地区进行的一项前瞻性出生队列研究。出生体重由经过培训的调查员在分娩后72小时内测量三次，精确到最接近的0.1千克。孕周根据末次月经首日（LMP）计算。使用双变量和多变量逻辑回归以及逐步向后选择分析评估家庭、母亲和婴儿特征与出生结局（低出生体重和早产）之间的关联。
在该研究的婴儿中,4.3%为低出生体重儿（143/3337），19.4%为早产儿（744/3841）。在多变量分析中，身高较高（>150厘米）（调整后的优势比（aOR）=0.42（95%置信区间=0.24,0.72））、多产妇（aOR = 0.62（95%置信区间=0.39,0.97））或生育间隔适当（>24个月）（aOR = 0.60（95%置信区间=0.39,0.92））的母亲生出低出生体重儿的几率较低。家庭粮食严重不安全（aOR = 1.84（95%置信区间=1.22,2.79））或孕期疟疾检测呈阳性（aOR = 2.06（95%置信区间=1.10,3.85））的母亲生出低出生体重儿的几率较高。此外，在多变量分析中，居住在西南部（aOR = 0.64（95%置信区间=0.54,0.76））、年龄≥20岁（aOR = 0.76（95%置信区间=0.61,0.94））、生育间隔适当（aOR = 0.76（95%置信区间=0.63,0.93））或产前检查（ANC）就诊次数≥4次（aOR = 0.56（95%置信区间=0.47,0.67））的母亲生出早产儿的几率较低；未婚或未同居（aOR = 1.42（95%置信区间=1.00,2.00））或在家分娩（aOR = 1.25（95%置信区间=1.04,1.51））的母亲生出早产儿的几率较高。
在乌干达农村，家庭粮食严重不安全、青少年怀孕、生育间隔不足、疟疾感染、产前检查不足和在家分娩是与低出生体重和/或早产率较高相关的可改变风险因素。未来有必要针对这些风险因素进行干预措施的研究。
