Eect of maternal hypertension on low birth weight

in Bangladesh
Md.Tawhid Alam, Md.Osman Goni, Iftikhar Ahmed Shovon
Md.Abdullah Al Fahim, Md.Rashel Khan, Mahmudul Hassan
Introduction
Low birth weight is one of the major causes of infant mortality in developing countries. Low birth
weight has been dened by WHO as weight at birth of < 2500 grams (5.5 pounds). Nearly (15-20)% of
newborn children are low birth weight which accounts for roughly 20 million worldwide. Among these
children nearly 9.1 million die each year. While the vast majority of low birth weight children have
normal outcomes, as a group they generally have higher rates of subnormal growth, illnesses, and neu-
rodevelopmental problems(Khan et al., 2018). LBW babies have higher probability of infection,disease,
handicapped condition during childhood and malnutrition(Khatun and Rahman, 2008).
On average 16.2% of newborn babies have low weight in Bangladesh (Islam Pollob et al., 2022).

There are many maternal risk factors & socio-economic factors that contribute to low birth weight ba-
bies.Among many maternal risk factors hypertension also known as high blood pressure is of our interest
in this study.A person with persistent systolic blood pressure of more than 140 & diastolic blood pressure
of more than 90 is identied as a hypertesive person. 1.13 billion people are hypertensive worldwide. 1
in every 5 women have hypertension WHO.

Hypertension during pregnancy is a major risk factor for maternal & neonatal mortality & morbidity
worldwide aecting up to 8% of all gestations (Roberts et al., 2003).
In addition, a study conducted by Getaneh et al. (2020) found that the odds of having low birth weight
newborns among women who had pregnancy induced hypertension was 3.89 times higher compared to
their counterparts.

Literature Review
In a study conducted by Negi et al. (2006) found that the maternal factors like antenatal care, parity,
inter pregnancy interval and bad obstetric history have signicant inuence on birth weight.

Karim et al. (2016) studied the maternal factors for low birth weight using Bangladesh demographic and
health survey 2011, the ndings of the study showed that Mothers' age, parents' education, antenatal
visits, poverty and under nutrition are the most important predictors for LBW infants.It also showed
that female children are more likely to be low birth weight than male children .

In a research conducted in Nigeria by Dahlui et al. (2016) concluded that paternal employment,geopolitical
zone, parity ,number of pregnancies and maternal weight aects birth weight. This study suggested that
improvement in antenatal care & socioeconomic indices for women in Nigeria is needed.

Odell et al. (2006) investigated the eects of hypertension on birth weight in Haitian & African-American
women and found that a strong relationship between hypertension and low birth weight exists.Haitian
women with hypertension were 6.8 times more likely to deliver low birth weight babies than those without
hypertension and for African-American women the risk is 2.9 times greater.

Although all these ndings are quite useful in explaining low birth weight, most of these research are
not very recent and were not conducted in Bangladesh while considering maternal hypertension as a risk
factor with latest available information.

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Objectives
In a developing country like Bangladesh low birth weight is of great public health concern that could po-
tentially increase childhood mortality and morbidity rates.The prevalence of hypertension in Bangladesh
is high, posing numerous mental and physical health risks especially during pregnancies . There are sev-
eral studies indicating that pregnancy related hypertension can cause preterm births.So, our objective is
to conduct a study to understand whether or not maternal hypertension has any signicant inuence over
low birth weight infants in Bangladesh. This study might help in reducing infant mortality, nutritional
deciency , growth stunting and many other complications due to low birth weight . Antenatal care can
be improved for mothers with hypertensive disorder ,helping them improve their health as well as their
future child's health which will eventually ensure a healthy future generation for the country.

Analysis Plan
In this study, our response variable is birth weight and our main explanatory variable is maternal
hypertension. To obtain an adjusted estimate of the association, we consider some potential confound-
ing variables based on literature review such as : Mother's age, Mother's education, Place of residence,
Nutritional state of mother, ANC visit etc.
From Table-1 we can get an initial idea about how the confounding variables are distributed across dif-
ferent levels of maternal hypertension. If the frequency of hypertension is more or less same among each
levels of other confounding variables then that variable might not be a confounder. We can also conduct
bivariate analysis by Pearson chi-square test to show signicant association between each covariates with
birth weight which is our variable of interest.

Table 1: Maternal hypertension level by other covariates.

Background Hypertensive disorder

Characteristics Categories Yes No
n(%) n(%)
<20 young
Mother's Age 20-34 middle
35-49 old
No education

Mother's education Primary

Secondary
Higher
Place of Urban
residence Rural
Nutritional state Underweight
of Normal
mother obesity and overweight
ANC visit Yes
during pregnancy No
Poor
Wealth index Middle
Rich
Dhaka
Khulna

Division Barisal
Sylhet
Chittagong
Rajshahi
Rangpur
Mymensingh

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After conducting the bivariate analysis, we shall proceed to t a Logistic Regression Model to obtain
adjusted eects of a factor on LBW after controlling the eect of other factors and identify possible
interaction eects among the factors.

Table 2: Binary Logistic Regression Model for LBW after adjusting confounding variables.

Factors Estimate St. Error OR 95% C.I. of OR

lower upper P-value
Hypertensive disorder
Yes
No
Age of mother's
Age <20
20-34
35+
Mother's education
No education
Primary
Secondary
Highest
Place of residence
Urban
Rural
Nutritional Status of mother
Underweight
Normal
Obesity and overweight
ANC visit during pregnancy
Yes
No
Wealth index
Poor
Middle
Rich
Division
Dhaka
Khulna
Barishal
Sylhet
Chittagong
Rajshahi
Rangpur
Mymensingh

3
 References
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