Nutritional effects of the siege on new-born babies in Sarajevo.

OBJECTIVE

To investigate the influence of maternal nutrition on perinatal mortality, morbidity, malformations and low birth weight (< 2500 grams).

DESIGN

All mothers and their babies born in Kosevo Hospital during three different time periods were sampled: September 1992 to February 1993 (pilot study), May 1993 to February 1994 (main study) and statistics compiled in 1991 (pre-war).

SETTING

Data were collected at the gynaecology and obstetric clinic, Kosevo hospital, city of Sarajevo.

SUBJECTS

A total of 920 babies were included in the pilot study, 1225 mothers of 1237 babies participated in the main study and birth data from 8676 babies born in 1991 were used as baseline data.

INTERVENTIONS

Birth outcome data were compiled for all three time periods. In the main study, a questionnaire was administered on arrival at the clinic in which mothers were asked to estimate their weight prior to pregnancy. Information on energy and protein intake was collected for all women by estimating weekly food intake during pregnancy. Mothers were weighed and had their heights measured within 12 hours of delivery. Women were divided into three groups based on their body mass index (BMI) using self-reported prepregnancy weight (underweight BMI < 21.5; normal weight BMI 21.5-25.6; overweight BMI > 25.6). Four groups were defined according to dietary intake during pregnancy (daily energy intake < 2755 kcal and 2755 + kcal; protein intake < 80 and 80 + grams).

RESULTS

Weight gain during pregnancy was low in overweight women (3.2 kg) compared with normal weight (10.4 kg) and underweight (11.7 kg) women. Underweight women had babies with the lowest mean birthweight (3072 grams) and the highest percentage of low birth weight babies (13.0%). Perinatal mortality increased from 15.8/1000 live births in 1991 (pre-war) to 36/1000 in May 1993-February 1994. Morbidity among babies increased from 3.4% to 8.2% in the same time period. There was a significant increase in babies born with malformations from 0.4% in the pre-war period to 3.0% in May 1993 to February 1994.

CONCLUSIONS

It is concluded that the war has had a deleterious effect on birth outcomes in Sarajevo.