Intrauterine growth restriction in a low-income country: Risk factors, adverse perinatal outcomes and correlation with current WHO Multicenter Growth Reference

ObjectiveTo determine risk factors and adverse perinatal outcomes including nutritional status in the first week of life for newborns with intrauterine growth restriction-low birth weight (IUGR-LBW) in settings lacking facilities for routine intrauterine growth monitoring.MethodsA cross-sectional study of all infants in an inner-city hospital in Lagos, Nigeria. IUGR-LBW was defined as full-term (gestational age ≥ 37 weeks) infant with low birth weight (< 2500 g). Nutritional/growth status at enrolment was determined by z-scores for length-for-age (HAZ), head circumference-for-age (HCZ), weight-for-age (WAZ) and weight-for-length (WHZ) based on current World Health Organization's Multicentre Growth Reference (WHO-MGR). Factors and adverse outcomes associated with IUGR-LBW were explored with multivariable logistic regression analyses.ResultsSome 145 (4.3%) infants were IUGR-LBW out of 2619 eligible singletons enlisted for this study. IUGR-LBW was significantly associated with teenage mothers (OR:2.90, 95% CI:1.22-6.89), lack of antenatal care (OR:1.88, 95% CI:1.33-2.65) and female gender (OR:1.38, 95% CI: 0.98-1.93; p = 0.062). The incidence of adverse outcomes across gestational age showed significant linear trend only for low five-minute Apgar scores (p = 0.024) and WAZ (p = 0.065). IUGR-LBW was associated with poor nutritional status across all four indices (p < 0.001) as well as low 5-minute Apgar scores (p = 0.095), sepsis (p = 0.053), hyperbilirubinemia (p < 0.001) and admission into special care baby unit (p = 0.009) after multivariable logistic regression analyses.ConclusionsIUGR-LBW correlates with poor nutritional status in the first week of life based on WHO-MGR and affected infants can be detected early for effective surveillance in resource-poor settings. Improved prenatal care among teenage mothers is necessary for reducing IUGR-LBW burden.