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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 4  |  Page : 343-350

Risk factors for low birth weight among term newborns in Babil maternity and children teaching hospital


1 Department of Pediatrics, College of Medicine, University of Babylon, Babylon, Iraq
2 Babil Health Directorate, Hillah, Iraq

Date of Submission07-Jul-2021
Date of Acceptance31-Jul-2021
Date of Web Publication18-Dec-2021

Correspondence Address:
Mudher Hasan Noor
Department of Pediatrics, College of Medicine, University of Babylon, Babylon.
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_48_21

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  Abstract 

Background: Great importance has been attributed to birthweight all over the world because it is considered one of the best predictors of perinatal survival and a good indicator of life quality. Aims and Objectives: The aim of this study was to determine the risk factors for low birth weight among term babies in Babil maternity and children teaching hospital. Materials and Methods: This was a cross-sectional study conducted in Babil maternity and children teaching hospital. The study was carried out in the neonatal care unit from March 1, 2020 to August 31, 2020. Seven hundred and fifty-four term singleton live births were included in the study. All the neonates were checked for birth weight, and their gestational age was determined from maternal last menstrual period and early (first trimester) ultrasound examination and New Ballard score. Neonates with normal birth weight were considered as gestationally full term (≥37 weeks) with birth weight 2500–4000 g. Results: Babies with normal birth weight represent 87.9% of the study sample (663 babies). The number of term neonates with low birth weight was 69/754, with 9.2% and large for gestational age represent 2.9% of the study sample (22 babies). Low birth weight of 2100–2400 g represents 6.3% of the study sample (47 babies). Low birth weight of 1500–2000 g represents 2.9% of the study sample (22) babies. Age of mother, residency, family income, maternal education, antenatal care, bad obstetrical history, illnesses during pregnancy, and parental consanguinity were considered to be risk factors for low birth weight at P values of 0.05, <0.001, <0.001, <0.001, <0.001, <0.001, 0.001, 0.002, and <0.001, respectively. However, gender of the baby, parity, and paternal age were not considered to be risk factors. Conclusion: The problem of low birth weight among term babies is still common in our country. There was a higher incidence of low birth weight among term neonates in the rural areas and in mothers with low education level and those who live in families with low income. The most common associated risk factors associated with low birth weight were young age mothers, positive parental consanguinity, bad obstetrical history, and illnesses during pregnancy (e.g., hypertension, diabetes mellitus, and urinary tract infection).

Keywords: Low birth weight, risk factors, term newborns


How to cite this article:
Noor MH, Ibrahim AH. Risk factors for low birth weight among term newborns in Babil maternity and children teaching hospital. Med J Babylon 2021;18:343-50

How to cite this URL:
Noor MH, Ibrahim AH. Risk factors for low birth weight among term newborns in Babil maternity and children teaching hospital. Med J Babylon [serial online] 2021 [cited 2022 Jan 26];18:343-50. Available from: https://www.medjbabylon.org/text.asp?2021/18/4/343/332752




  Introduction Top


Definition of birth weight

The birth weight of an infant is the first weight recorded after birth, ideally measured within the first hours after birth, before significant postnatal weight loss has occurred.[1]

The size at birth reflects fetal growth and health as well as provides important information on the newborn infant.[2] Neonatal birth weight has been an important indicator of common concern in obstetrics and neonatology. This factor is critical for the study of adverse pregnancy outcomes and the prediction of neonatal mortality and morbidity.[3]

A birth weight between 5 pounds, 8 ounces (2500 g) and 8 pounds, and 13 ounces (4000 g) is considered normal for a full-term newborn. Babies who are smaller than this may be referred to as low birth weight or small for gestational age, and babies who are larger than this are considered to be large for gestational age.[4]

It is important to note that in some cases, low birth weight may be appropriate. For example, a baby born at 30 weeks gestation would “normally” weigh less than 5 pounds, 8 ounces.[5]

Classification of birth weight

According to gestational age

  • Small for gestational age (SGA): Birth weight less than the 10th percentile for a child born at that gestational age


  • Appropriate for gestational age (AGA): Birth weight from the 10th percentile to the 90th percentile relative to other babies born at that gestational age


  • Large for gestational age (LGA): Birth weight greater than the 90th percentile based on gestational age (also called fetal macrosomia)


  • According to weight

  • Extremely low birth weight (ELBW): Birth weight less than 2.2 pounds (1000 g)


  • Very low birth weight (VLBW): Birth weight less than 3.3 pounds (1500 g)


  • Low birth weight (LBW): Birth weight less than 5.5 pounds (2500 g)


  • Normal birth weight: Between 5 pounds, 8 ounces (2,500 g) and 8 pounds, 13 ounces (4000 g)


  • High birth weight (HBW): Birth weight of more than 8 pounds, 13 ounces. (4000 g).


  • These classifications are useful because they often correspond to methods in which clinical care and treatment are provided.[6]

    Epidemiology

    Great importance has been attributed to birthweight all over the world because it is considered one of the best predictors of perinatal survival and a good indicator of life quality. In developing countries, the high rate of babies born with this characteristic highlights its importance.[7]

    There is considerable variation in the prevalence of LBW across regions and within countries; however, the great majority of LBW births occur in low- and middle-income countries and especially in the most vulnerable populations.[8] Nevertheless, LBW is a global concern, as some high-income countries are also faced with high rates for their contexts (e.g. Spain, the UK, and Northern Ireland [UK], and the USA).[9] The average birth weight in babies of European heritage is 3.5 kg, though the range of normal is between 2.5 and 4.5 kg. Babies of south Asian and Chinese heritage weigh about 240 g less. The mean or average birth weight in the USA is 7 pounds, 8 ounces (3,402 g).[10]

    Causes of low birth weight

    LBW is either caused by preterm birth (i.e., a low gestational age at birth, commonly defined as younger than 37 weeks of gestation) or the infant being SGA (i.e., a slow prenatal growth rate), or a combination of both.[11] In general, risk factors in the mother that may contribute to LBW include:

    1. Young age


    2. Multiple pregnancies


    3. previous low birth weight baby


    4. preterm labor


    5. poor nutrition


    6. heart disease


    7. hypertension


    8. untreated celiac disease


    9. drug addiction


    10. alcohol abuse


    11. insufficient prenatal care[12],[13],[14]


    12. Stressful events have been demonstrated to produce significant effects on birth weight. Those mothers who have stressful events during pregnancy, especially during the first and second trimester, are at higher risk to deliver low-birth-weight babies.[15],[16]


    Causes of intrauterine growth restriction

    The ability to reach an optimal birth weight results from the interaction between the fetal growth potential and the environment. The fetus requires several substrates for normal growth, the most important being oxygen, glucose, and amino acids. Any persistent decrease in the availability of any of these substrates will limit the ability of the fetus to reach its growth potential. The availability of substrates necessary for fetal growth may be limited by pathological conditions affecting the mother, the placenta, and the fetus.[17]


      Materials and Methods Top


    Study design and settings

    This was a cross-sectional study conducted in Babil maternity and children teaching hospital, which serves both urban and rural areas.

    The study was carried out in the neonatal care unit from March 1, 2020 to August 31, 2020.

    Seven hundred and fifty-four term singleton live births were included in the study. All the neonates were checked for birth weight, and their gestational age was determined from maternal last menstrual period and early (first trimester) ultrasound examination and New Ballard score. Regarding ethical considerations, official agreement was obtained from the Research Ethical Committee, and Babil maternity and children teaching hospital directorate. Before collecting the information, the purpose of the study was explained to the parents and/or caregivers, privacy was considered and the parents were given the right to participate, or not, in the study without any reward.

    Inclusion criteria

    All newborn babies were delivered at Babil aternity and children teaching hospital by c/s or by normal vaginal deliveries.

    Exclusion criteria

    Our study excluded preterm neonates, stillbirths, and multiple pregnancies (twins and triplets)

    Questionnaire

    A detailed questionnaire form was prepared and consisted of three tables. The first one was to collect data concerning the babies' gender, maturity: term (37–42 weeks) and post-term (more than 42 weeks), and body weight: (1–2 kg, 2–2.4 kg, 2.5–4 kg, >4 kg).

    The second table was to collect information regarding the maternal age (15–20 years, 21–29 years, 30–40 years, more than 40 years), residency (urban and rural), educational level (illiterate, primary school, secondary school, higher education), obstetrical history (normal, previous history of LBW baby, abortion and early neonatal death), parity (primiparous and multiparous), illnesses during pregnancy (diabetes mellitus [DM], hypertension, and infections such as urinary tract infection [UTI] and toxoplasmosis), family income (low, enough, high), as well as parental consanguinity (related or not related).

    Data analysis

    Statistical analysis was carried out using SPSS version 23.0. Categorical variables were presented as frequencies and percentages. Continuous variables were presented as (mean ± standard deviation [SD]). Student’s t test was used to compare means between two groups. Pearson’s chi-square and Fisher exact tests were used to find the association between categorical variables. A value of P ≤ 0.05 was considered significant.


      Results Top


    During the study period, from March 1, 2020 to August 31, 2020, the total number of examined newborns was 754. Among those, the number of male gender babies was 390 with 51.7%, and the number of female babies was 364 with 48.3%. The number of babies whose parents live in rural areas was 275 with 36.5% , and for babies whose parents live in urban areas was 479 with 63.5%. The number of babies with low family income was 122 with 16.2%, and for those with enough family income was 554 with 73.5% , and for those with high family income was 78 with 10.3%, as shown in [Table 1].
    Table 1: Distribution of newborn babies according to sociodemographic characteristics (n = 754)

    Click here to view


    [Table 2] shows the distribution of newborn babies according to maternal characteristics including mother age, education, parity, smoking, antenatal care, past obstetrical history, and illness during pregnancy.
    Table 2: Distribution of newborn babies according to maternal characteristics (n = 754)

    Click here to view


    [Figure 1] shows distribution of newborn babies according to paternal consanguinity including (positive and negative). History of paternal consanguinity was positive in (39.9%) of study sample which represent 301 newborn babies.
    Figure 1: Distribution of newborn babies according to parental consanguinity

    Click here to view


    The distribution of newborn babies according to birth weight

    [Figure 2] shows distribution of newborn babies according to birth weight including (LBW (< 2500 g), normal birth weight (2500–4000 g) and LGA (> 4000 g)). LBW represent (9.2%) of study sample (69 babies), normal birth weight represent (87.9%) of study sample (663 babies) and LGA represent (2.9%) of study sample (22 babies).
    Figure 2: Distribution of newborn babies according to birth weight.

    Click here to view


    Regarding maternal age, there were significant differences between means of age of mother according to birth weight as shown in [Table 3]. Paternal age was found to be not significant risk factor with P-value of(0.482).
    Table 3: Mean differences of study variables according to birth weight (n = 732)

    Click here to view


    [Table 4] shows the association between birth weight including (LBW and normal birth weight) and socio-demographic characteristics of newborn babies including (gender, residence and family income). There was significant association between birth weight and residence and family income with P-value of (<0.001).Gender of the baby was found to be not significant risk factor with P-value of (0.2).
    Table 4: Association between birth weight and sociodemographic characteristics of newborn babies (n = 732)

    Click here to view


    [Table 5] shows the association between birth weight including (LBW and normal birth weight) and study variables including (mother education, parity, antenatal care, past obstetrical history, illness during pregnancy, paternal consanguinity and mother and father smoking history). Maternal educational level, past obstetrical history, illnesses during pregnancy, and parental consanguinity were found to be significant risk factors with P values of <0.001, <0.001, 0.001, and <0.001, respectively. Parity and father smoking were found to be not significant risk factors with P values of 0.406 and 0.988, respectively.
    Table 5: Association between birth weight and study variables (n = 732)

    Click here to view



      Discussion Top


    Our study demonstrated that the percentage of LBW in term neonates was 9.2%, which can be categorized as moderate according to country-specific rates of IUGR-LBW (low [<5%], moderate [(5%–10%], high [10%–15%], and very high [>15%]).[18]

    Our results were approximately similar to results done in other areas as Al-Hiali et al. showed 10.25%[19] and in Qatar 7.85%.[20]

    Our study demonstrated that mothers who live in rural areas and those with low education are associated with a high risk of delivering LBW babies. This is supported by previous studies conducted in Latin America,[21] India,[22] and Karachi, Pakistan.[23] This might be because, when a women’s educational level increases, she may be motivated to know health and risk factors, might have the interest to read and listen, watch any information sources, and make an informed decision about their health. Besides, women with some basic level of education can discuss more sensitive issues openly and had a better understanding of the complication associated with pregnancy. Other studies reported that birth weight is not statistically significant with the maternal level of education as in a study by Ubomba-Jaswa et al.[24]

    In this study, low family income is associated with an increased risk of SGA babies; this risk factor was reported by Britto et al.,[25] which reported that mothers of lower family income almost twice times higher to give LBW babies which could be explained by poor maternal nutritional intake among mothers with lower socioeconomic status.[26]

    Parity of the mothers was found to be not a risk factor in our study, unlike other studies as in a study by Garces et al.,[27] which show a significant association between the parity of women and incidence of SGA babies, as the infants of nulliparous women have lower body weight than women with one or more previous pregnancies.

    In this study, a significant relation was found between the age of mothers and LBW offspring; teenage mothers (less than 20 years old) were associated with an increased risk of delivering a baby with LBW and this is consistent to Lee[28] and Ferguson et al.[29] The association with young age may be related to women taking 2-year post-menarche or longer to reach their adult stature and pelvic dimensions. Also, adolescent mothers may have an even larger nutritional burden; a study in rural Nepal observed lighter newborns and a larger loss of mid-upper arm circumference in pregnancy among adolescent mothers than their older counterparts.[30]

    There was no significant difference was observed in this study between men and women. The female newborns with LBW were more than male newborns (31 [44.9%] male neonates and 38 [55.1%] female neonates). This was consistent with other studies which show an increased incidence of IUGR in female babies as in the studies by Melamed et al.[31] and Albar et al..[32] Quinones et al.[33] report that male fetuses with IUGR have similar outcomes when compared with female IUGR fetuses, and gender does not play a role in the perinatal outcome in the setting of fetal growth restriction.

    Bad obstetrical history (such as previous abortion, previous early neonatal death, previous LBW baby) was found to be a risk factor in our study. This was confirmed in a study by Rahul et al..[34] Another study done by Ashwani et al.[35] showed that history of previous abortion and stillbirth were not to be found significant risk factors.

    Our study demonstrated that maternal illnesses during pregnancy (gestational hypertension, gestational DM, UTI, and anemia) were found to be highly significant risk factors in this study. This was consistent with Ashwani et al.,[35] Rahul et al.,[34] and Tara et al.[36]

    There was statistically significant risk factor in our study regarding parental consanguinity. Similar to other studies as in Fariyal et al.[23] and Kramer et al.[37] But in Ghina,[38] no significant difference was observed in the decrease in birth weight between the first- and second-cousin marriages.

    In our study, no significant relation was found between paternal age and birth weight. This was consistent with Nahum et al.,[39] which showed that paternal age did not independently influence birth weight. Other studies found an association between advanced paternal age and increased risk of LBW as in Amina et al.[40] In the same study, infants who born to young adult and adolescent fathers had a heightened risk of low birth weight, preterm birth, and small size for gestational age.

    This study provides baseline information from a tertiary hospital in this region, which could help with possible interventions regarding maternal and newborn health in the future. We could not take more information on certain risk factors like weight gain during pregnancy because of lack of available data from the records. Interpregnancy interval, drug consumption during pregnancy, and history of TORCH infection during pregnancy were other risk factors that were not included in our study.


      Conclusion Top


    This study showed a higher incidence of LBW among term neonates in the rural areas and in mothers with low education level low income. The most common associated risk factors associated with LBW in term babies were gestational hypertension, gestational diabetes, urinary tract infection, and anemia during pregnancy. Smoking during pregnancy was associated with a high risk of birth weight. Poor antenatal care was associated with a higher incidence of low birth weight. Adolescent mothers were significant risk factors for LBW in our study.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
      References Top

    1.
    World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Tenth revision, 2nd ed. Geneva: World Health Organization; 2004.  Back to cited text no. 1
        
    2.
    Usher R, McLean F. Intrauterine growth of live-born Caucasian infants at sea level: Standards obtained from measurement in 7 dimensions of infants born between 25 and 44 weeks of gestation. J Pediatr 1969;74:901-10.  Back to cited text no. 2
        
    3.
    Bie HMAD, Oostrom KJ, Waal HADD. Brain development, intelligence and cognitive outcome in children born small for gestational age. Horm Res Paediatr2010;73:6-14. “New birth weight curves tailored to baby’s ethnicity | Toronto Star.” By Nicholas Keung, Immigration Reporter, Feb 15, 2012..  Back to cited text no. 3
        
    4.
    Erickson K, Kritz-silverstein D, Wingard DL, Barrett-connor E. Birth weight and cognitive performance in older women: The Rancho Bernardo study. Arch Womens Ment Health 2010;13:141-6.  Back to cited text no. 4
        
    5.
    Quinn J-A, Munoz FM, Gonik B, Frau L, Cutland C, Mallett-Moore T, et al. Preterm birth: Case definition & guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine2016;34:6047-56.  Back to cited text no. 5
        
    6.
    Gill SV, May-Benson TA, Teasdale A, Munsell EG. Birth and developmental correlates of birth weight in a sample of children with potential sensory processing disorder. BMC Pediatr 2013;13:29.  Back to cited text no. 6
        
    7.
    Coria-Soto IL, Bobadilla JL, Notzon F. The effectiveness of antenatal care in preventing intrauterine growth retardation and low birth weight due to preterm delivery. Int J Qual Health Cart1996;8:13-20.  Back to cited text no. 7
        
    8.
    Kim D, Saada A. The social determinants of infant mortality and birth outcomes in western developed nations: A cross-country systematic review. Int J Environ Res Public Health 2013;10:2296-335.  Back to cited text no. 8
        
    9.
    March of Dimes, The Partnership for Maternal, Newborn & Child Health, Save the Children, WHO. Born Too Soon: The Global Action Report on Preterm Birth. Geneva: World Health Organization; 2012. Available from: http://whqlibdoc.who.int/publications/2012/9789241503433_eng.pdf. [Last accessed on 2014 Oct 13].  Back to cited text no. 9
        
    10.
    Janssen PA, Thiessen P, Klein MC, Whitfield MF, MacNab YC, Cullis-Kuhl SC. Standards for the measurement of birth weight, length and head circumference at term in neonates of European, Chinese and South Asian ancestry. Open Med 2007;1: e74-88.  Back to cited text no. 10
        
    11.
    Rizzo N, Simonazzi G, Curti A. Obstetrical risk factors of LBW. Ital J Pediatr 2015;41:A35.  Back to cited text no. 11
        
    12.
    Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, et al. Celiac disease and reproductive disorders: Meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Human Reprod Update 2014;20:582-93.  Back to cited text no. 12
        
    13.
    Saccone G, Berghella V, Sarno L, Maruotti GM, Cetin I, Greco L, et al. Celiac disease and obstetric complications: A systematic review and metaanalysis. Am J Obstet Gynecol 2015;214:225-34.  Back to cited text no. 13
        
    14.
    Ryckman KK, Feenstra B, Shaffer JR, Bream ENA, Geller F, Feingold E, et al. Replication of a genome-wide association study of birth weight in preterm neonates. J Pediatr 2012;160: 19-24.e4.  Back to cited text no. 14
        
    15.
    Hedegaard M, Henriksen TB, Secher NJ, Hatch MC, Sabroe S. Do stressful life events affect duration of gestation and risk of preterm delivery? Epidemiology 1996;7:339-45.  Back to cited text no. 15
        
    16.
    Zhu P, Tao F, Hao J, Sun Y, Jiang X. Prenatal life events stress: Implications for preterm birth and infant birthweight. Am J Obstetr Gynecol 2010;34:34.e1-8.  Back to cited text no. 16
        
    17.
    Narang A, Chaudhuri MK, Kumar P. Small for gestational age babies: Indian Scene. Indian J Pediatr 1997;64:221-4.  Back to cited text no. 17
        
    18.
    deonis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J ClinNutr 1998;52:S83-93.  Back to cited text no. 18
        
    19.
    Al-Hiali SJ, Al-Ani ZR, Al-Kaseer E, Al-Ani IR. Low birth weight in Western Iraqi. Postgrad Med J 2010;9:312-5.  Back to cited text no. 19
        
    20.
    Abdulkader ZM, Rahman S ur, Nimeri N. The incidence of low birth weight and intrauterine growth restriction in relationship to maternal ethnicity and gestational age at birth: A PEARL study analysis from the State of Qatar. Qatar Med J 2012;2012:32-7.  Back to cited text no. 20
        
    21.
    Ferraz EM, Gray RH, Cunha TM. Determinants of preterm delivery and intrauterine growth retardation in north-East Brazil. Int J Epidemiol1990;19:101-8.  Back to cited text no. 21
        
    22.
    Mavalankar DV, Gray RH, Trivedi CR. Risk factors for preterm and term low birth weight in Ahmedabad, India. Int J Epidemiol 1992;21:263-72.  Back to cited text no. 22
        
    23.
    Berendes HW, Fikree FF. Risk factors for term intrauterine growth retardation: A community-based study in Karachi. Bull World Health Organ 1994;72:581-7.  Back to cited text no. 23
        
    24.
    Ubomba-Jaswa P, Ubomba-Jaswa SR. Correlates of low birth weight in Botswana. South African J Demography 1996;6:64-73.  Back to cited text no. 24
        
    25.
    Britto RPdA, Florêncio TMT, Benedito Silva AA, Sesso R, Cavalcante JC, Sawaya AL. Influence of maternal height and weight on low birth weight: A cross-sectional study in poor communities of Northeastern Brazil. PLoS One 2013;8:e80159.  Back to cited text no. 25
        
    26.
    Shrivastava RS, Shrivastava PS. A longitudinal study of maternal and socioeconomic factors influencing neonatal birth weight in pregnant women attending an Urban Health Centre. Saudi J Health Sci 2013;2:87-92.  Back to cited text no. 26
      [Full text]  
    27.
    Garces A, Perez W, Harrison MS, Hwang KS, Nolen TL, Goldenberg RL, et al. Association of parity with birthweight and neonatal death in five sites: The Global Network’s Maternal Newborn Health Registry study. Reprod Health 2020;17:182.  Back to cited text no. 27
        
    28.
    Lee KS, Ferguson RM, Corpuz M, Gartner LM. Maternal age and incidence of low birth weight at term: A population study. Am J Obstet Gynecol 1988;158:84-9.  Back to cited text no. 28
        
    29.
    Moerman ML. Growth of the birth canal in adolescent girls. Am J Obstetr Gynecol 1982;143:528-32.  Back to cited text no. 29
        
    30.
    Katz J, Khatry SK, LeClerq SC, West KP, Christian P. The post-partum mid-upper arm circumference of adolescents is reduced by pregnancy in rural Nepal. Mater Child Nutr 2010;6:287-95.  Back to cited text no. 30
        
    31.
    Melamed N, Yogev Y, Glezerman M. Fetal gender and pregnancy outcome. J Mater Fetal Neonat Med. 2010;23:338-44.  Back to cited text no. 31
        
    32.
    Albar L, Puertas A, Valverde M. Fetal sex and perinatal outcomes. J Mater Fetal Neonat Med 2010;23:338-44.  Back to cited text no. 32
        
    33.
    Quiñones JN, Stamilio DM, Coassolo KM, Macones GA, Odibo AO. Is fetal gender associated with adverse perinatal outcome in intrauterine growth restriction (IUGR)? Am J Obstet Gynecol 2005;193:1233-7.  Back to cited text no. 33
        
    34.
    Surve R, Jain A. Risk factors associated with intrauterine growth restriction (IUGR) in neonates: A matched case–control study in tertiary care hospital. Pravara Med Rev2019;11 (September–November).  Back to cited text no. 34
        
    35.
    Ashwani N, Rekha NA, Babu MS, Suresh Kumar C, Tejo Pratap O. Maternal risk factors associated with intrauterine growth restriction: Hospital based study. Int J Med Res Rev 2016;4:2125-9.  Back to cited text no. 35
        
    36.
    Manandhar T, Prashad B, Nath Pal M. Risk factors for intrauterine growth restriction and its neonatal outcome. Gynecol Obstet 2018;8:2.  Back to cited text no. 36
        
    37.
    Kramer MS. Determinants of low birthweight: Methodological assessment and meta-analysis. Bull WHO 1987;65:663-737.  Back to cited text no. 37
        
    38.
    Mumtaz G, Tamim H, Kanaan M, Khawaja M, Khogali M, Wakim G, et al. Am J Epidemiol 2007;165:742-52.  Back to cited text no. 38
        
    39.
    Nahum GG, Stanislaw H. Relationship of paternal factors to birth weight. J Reprod Med 2003;48:963-8.  Back to cited text no. 39
        
    40.
    Alio AP, Salihu HM, McIntosh C, August EM, Weldeselasse H, Sanchez E, et al. The effect of paternal age on fetal birth outcomes. Am J Men Health 2012;6:427-35.  Back to cited text no. 40
        


        Figures

      [Figure 1], [Figure 2]
     
     
        Tables

      [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



     

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