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

BMC Pregnancy Childbirth. 2016 May 17:16:110. doi: 10.1186/s12884-016-0900-5.

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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Birth Weight*
  • Body Height
  • Double-Blind Method
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Small for Gestational Age*
  • Male
  • Maternal Age
  • Multivariate Analysis
  • Pregnancy
  • Premature Birth / etiology*
  • Premature Birth / prevention & control
  • Regression Analysis
  • Risk Factors
  • Socioeconomic Factors
  • Tanzania
  • Term Birth
  • Vitamin A / therapeutic use
  • Vitamins / therapeutic use
  • Young Adult

Substances

  • Vitamins
  • Vitamin A

Associated data

  • ANZCTR/ACTRN12610000636055