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Muhihi A, Sudfeld CR, Smith ER, Noor RA, Mshamu S, Briegleb C, Bakari M, Masanja H, Fawzi W, Chan GJY. Risk factors for small-for-gestational-age and preterm births among 19,269 Tanzanian newborns. BMC Pregnancy Childbirth 2016; 16:110. [PMID: 27183837 PMCID: PMC4869183 DOI: 10.1186/s12884-016-0900-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 05/07/2016] [Indexed: 11/11/2022] Open
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 3rd 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 1st 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 3rd August 2010.
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Affiliation(s)
- Alfa Muhihi
- Ifakara Health Institute, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania. .,Africa Academy for Public Health, CM Plaza Building, Mwai Kibaki Road, Mikocheni, P.O.Box 79810, Dar es Salaam, Tanzania.
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Emily R Smith
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Ramadhani A Noor
- Africa Academy for Public Health, CM Plaza Building, Mwai Kibaki Road, Mikocheni, P.O.Box 79810, Dar es Salaam, Tanzania.,Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Salum Mshamu
- Africa Academy for Public Health, CM Plaza Building, Mwai Kibaki Road, Mikocheni, P.O.Box 79810, Dar es Salaam, Tanzania
| | - Christina Briegleb
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Mohamed Bakari
- Africa Academy for Public Health, CM Plaza Building, Mwai Kibaki Road, Mikocheni, P.O.Box 79810, Dar es Salaam, Tanzania
| | - Honorati Masanja
- Ifakara Health Institute, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Grace Jean-Yee Chan
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.,Department of Medicine, Boston Children's Hospital, Boston, USA
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