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Factors affecting birthweight of rural Australian Aborigines.

AIM: To examine factors affecting birthweight of Aboriginal infants in the Kimberley region of north-west Australia. RESEARCH DESIGN: A retrospective study of maternal and infant health records obtained through routine data collection. SUBJECTS AND METHODS: Birthweight and length of 2959 infants born to 1822 women from 1986 to 1994 were analysed. Mothers and infants were matched using unique identification codes. Index births and subsequent births to the same mother were collated in order to examine relative birth order effects and to calculate birth intervals. RESULTS: Regression analysis showed significant associations between weight of the index birth and maternal age (p < 0.001), remoteness of locality (p < 0.01), sex of the infant (p < 0.001) and maternal height (p < 0.001). Length at birth was significantly associated with ethnicity of infant (Aboriginal vs Aboriginal/non-Aboriginal admixture, p < 0.05), sex (p < 0.001), remoteness (p < 0.01) and maternal height (p < 0.001). Similar associations were observed for second and subsequent births. Birth interval was not associated with birthweight or length. Low birthweight was also more common to Aboriginal mothers compared with mothers of Aboriginal/non-Aboriginal admixture (13.1% vs 9.2%; chi(2) = 5.1, p < 0.025) even though there were no differences in height between these two groups. Teenage mothers (< or =19 years) were no more likely to have low birthweight babies than older mothers. Of the variables examined, the only significant predictor of low birthweight was a previous low birthweight baby (relative risk = 4.45, p < 0.001). CONCLUSIONS: Short birth intervals and teenage births were not significant contributors to low birthweight in the present study. The high prevalence and duration of breastfeeding in the Kimberley may contribute to long average birth intervals. Pre-term birth, rather than intrauterine growth retardation, is likely to be the most common cause of low birthweight in this population.

Adolescent↗

Longitudinal study of birthweight and the incidence of breast cancer in adulthood.

A high birthweight has been associated with an increased risk of breast cancer later in life. The role of adult variables, possible effect modifiers and cancer characteristics has been little studied. We explored these in two large prospective cohort studies of women, the Nurses' Health Study (NHS) and the Nurses' Health Study II (NHS II). We collected information on birthweight from 152,608 female nurses participating in NHS and NHS II. During 10 years and 1.3 million person-years of follow-up, invasive breast cancer was newly diagnosed among 828 premenopausal and 2312 postmenopausal women. Data were analyzed using a Cox proportional hazards model. Premenopausal women with a birthweight of <5.5 lbs had a covariate-adjusted hazard ratio (HR) for breast cancer of 0.66 [95% confidence interval (CI) 0.47-0.93] compared with women born at 8.5 lbs or above. Adult height was the only factor explaining some of the association between birthweight and breast cancer incidence; after adjustment for height the HR was 0.73 (95% CI 0.51-1.03). The association between birthweight and the incidence of breast cancer was stronger among women with estrogen-receptor positive and progesterone-receptor positive breast cancer. Among postmenopausal women, no important association between the birthweight and the incidence of breast cancer was detected (HR comparing women with a birthweight of 5.5 lbs or less with women with a birthweight>8.5 lbs: 0.97; 95% CI 0.80-1.16). In these two large prospective cohorts, a low birthweight was associated with a decreased incidence of breast cancer among premenopausal women. This association was independent of other factors operating later in life, except for adult height.

Adult↗

Birthweight and perinatal mortality: II. On weight-specific mortality.

The study of perinatal mortality requires a sound understanding of the influence of birthweight on perinatal mortality. This paper discusses one aspect of this problem--the pattern of weight-specific mortality. Mortality is very high at the lowest birthweights, falls to a minimum within the range of the most frequent birthweights, but rises again for the heaviest birthweights. Such a curve is best displayed and modelled by plotting the ratio of deaths to survivors on a logarithmic scale. Transformed in this way, perinatal risk may be regarded as the sum of three components--one independent of birthweight, one which decreases linearly with birthweight and one which increases linearly with birthweight. These two lines appear to have slopes of equal magnitude. Each is shown to represent general susceptibility to perinatal problems, rather than the cumulative effect of diseases specific to low birthweight or to high birthweight.

Birth Weight↗

Economic costs of care in extremely low birthweight infants during the first 2 years of life.

OBJECTIVE: To assess the 2-yr costs of extremely low birthweight infants' (ELBWIs; birthweight, < 1000 g) care in relation to birthweight, outcome, and the costs of normal birthweight infants. DESIGN: Cost data were obtained from care-giving hospitals and by a parental questionnaire. Outcome data from the perinatal and neonatal periods and from the first 2 yrs for both ELBWIs and control infants had been prospectively collected to a national ELBWI register. PATIENTS: We studied 71 ELBWIs and 60 normal birthweight controls born in Helsinki University Hospital in 1996-1997. MEASUREMENTS: Collected data comprised costs resulting from care of ELBWIs and normal birthweight control infants and included hospital, outpatient care, medication, rehabilitation, auxiliary means, and travel costs; ancillary costs from daily care; parent's accommodation during hospitalization periods; and loss of earnings during the infant's first 2 yrs. MAIN RESULTS: The average total 2-yr healthcare cost was 104,635 Euros for surviving ELBWIs and 3,135 Euros for control infants. In ELBWIs, initial hospital costs alone accounted for 64% of total costs; the costs during the first and second postdischarge years accounted for 20% and 13%, respectively. The mean hospital cost of nonsurviving ELBWIs was 19,950 Euros. A normally developed ELBWI had costs 25-fold, a mildly disabled ELBWI had costs 33-fold, and a severely disabled ELBWI had costs 68-fold those of control infants. Birthweight correlated negatively with intensive care costs but did not correlate with costs after initial discharge. CONCLUSION: Total costs of ELBWIs decreased over time up to the age of 2 yrs, but even in normally developed ELBWIs, costs remained higher than those of normal birthweight infants. Low birthweight seemed to be related to increased initial hospital costs but not to annual costs after the first discharge.

Birth Weight↗

Reports of birthweight by adolescents and their mothers: comparing accuracy and identifying correlates.

Birthweight is associated with health outcomes throughout the lifespan. Official birthweight records are not always available, and researchers must rely on self-reports for birthweight information. This study evaluates the accuracy of adolescent self-reports of birthweight, using medical records as a standard, and compares it with maternal reports. It also examines potential correlates of accuracy. Respondents are 17-year-old adolescents and their mothers, who participated in a follow-up study of randomly selected samples from newborn discharge lists (1983-85) of two major hospitals in south-east Michigan. Nearly one-quarter of the adolescents stated that they did not know their own birthweight, with males twice as likely as females to respond 'don't know'. In addition, self-reports of birthweight among the remaining adolescents were inaccurate, and accuracy was inversely related to birthweight. While maternal reports of offspring's birthweight are highly accurate across diverse subgroups of the population, adolescent self-reports of birthweight are unlikely to be useful in medical research.

Adolescent↗

Determinants of birthweight inequalities: population-based study.

BACKGROUND: The aim of this paper is to study the whole spectrum of birthweight in a population-based birth cohort in order to document the role played by social factors, which complement physiological and behavioural factors, in the development of birthweight inequalities at the population level. METHODS: The analyses were performed with data from the 'Quebec Longitudinal Study of Child Development 1998-2002 (QLSCD)'. The study follows a representative sample (n = 2103) of the children born in 1998 in the Canadian province of Québec. RESULTS: Multivariate analyses adjusted for gestational age and mother's age indicate that mean birthweight was higher for boys than girls; improved with birth rank, mother's body mass index (BMI), and family socioeconomic status; and was lower for children of smoking mothers. Compared with children born to non-smoking mothers of higher socioeconomic status, the odds of having a low birthweight were between 6 and 12 times higher for children born to smoking mothers of lower or middle socioeconomic status. When maternal smoking status and mother's BMI are combined, socioeconomic status could still be seen to have a positive effect on mean birthweight except for overweight or obese smoking mothers, among whom the relationship between socioeconomic status and mean birthweight was reversed. In families of lower socioeconomic status, maternal smoking was the most important factor in birthweight inequalities, and in families of higher socioeconomic status, mother's BMI was the most important factor in birthweight inequalities. CONCLUSION: This research is not only important for children in developed nations, but also for those in developing countries, where high birthweight and obesity are becoming more prevalent.

Birth Weight↗

Intergenerational studies of human birthweight from the 1958 birth cohort. 1. Evidence for a multigenerational effect.

OBJECTIVE: To investigate possible multigenerational influences on birthweight. DESIGN: Data from the longitudinal study of one week's births in 1958 up to the age of 23 years, the British National Child Development Study, were utilized. These provide socio-biological information on the parents of the cohort, on the cohort members from birth onwards, and on the pregnancies and the birthweight of any babies born to the cohort members. MAIN OUTCOME MEASURE: The main outcome was the birthweight of babies born to the cohort members, for whom complete intergenerational data were available for 1638 firstborn. Multiple regression modelling was used to investigate any associations between their birthweight and characteristics of their parents and grandparents. RESULTS: Significant positive associations were found between babies' birthweight and parental birthweight but not gestational age. For the babies born to female cohort members additional findings included associations between their birthweight and the height of the maternal grandmother and the social class of the maternal grandfather, even after adjustment for such strong predictors of birthweight as maternal weight, smoking habit in pregnancy and baby's sex and birth order. CONCLUSION: These results thus offer support for a multigenerational influence on birthweight passed through the maternal line.

Birth Weight↗

The relation between fetal abdominal circumference and birthweight: findings in 3512 pregnancies.

OBJECTIVES: To establish the relation between fetal abdominal circumference and birthweight in a large population of fetuses; to identify whether the error in estimating birthweight by abdominal circumference varied with the magnitude of abdominal circumference; and to establish whether adding femur length to abdominal circumference caused a clinically important reduction of error in predicting birthweight. DESIGN: A retrospective study. SETTING: The ultrasound department of a teaching maternity hospital offering a tertiary referral service. SAMPLE: From 3512 nondiabetic women with a normally formed singleton fetus, an abdominal circumference measurement of the infant was made within seven days of delivery; of these, 1213 had a femur length measurement performed at the same time. RESULTS: There was a linear relation between abdominal circumference and birthweight. There was a strong inverse correlation between the proportional error in predicting birthweight from the abdominal circumference and the magnitude of the abdominal circumference. Both the Campbell and Wilkin equation (abdominal circumference alone) and the Hadlock equation (abdominal circumference and femur length) were associated with systematic errors, especially with larger birthweight infants. The median absolute errors for the two equations were not significantly different overall (6.98% and 6.86% respectively), although the Hadlock equation was significantly more accurate in predicting birthweight in infants weighing greater than 4500 g. However, no threshold value of abdominal circumference or of estimated fetal weight using the Hadlock equation had a positive predictive value in estimating infants of > 4500 g of greater than 35%. CONCLUSIONS: Prediction of birthweight should be by abdominal circumference alone. Table 1 presents robust estimates of the error of predicting birthweight using fetal abdominal circumference.

Abdomen↗

Customised birthweight: coefficients for an Australian population and validation of the model.

BACKGROUND: Published birthweight references in Australia do not fully take into account constitutional factors that influence birthweight and therefore may not provide an accurate reference to identify the infant with abnormal growth. Furthermore, studies in other regions that have derived adjusted (customised) birthweight references have applied untested assumptions in the statistical modelling. AIMS: To validate the customised birthweight model and to produce a reference set of coefficients for estimating a customised birthweight that may be useful for maternity care in Australia and for future research. METHODS: De-identified data were extracted from the clinical database for all births at the Mater Mother's Hospital, Brisbane, Australia, between January 1997 and June 2005. Births with missing data for the variables under study were excluded. In addition the following were excluded: multiple pregnancies, births less than 37 completed week's gestation, stillbirths, and major congenital abnormalities. Multivariate analysis was undertaken. A double cross-validation procedure was used to validate the model. RESULTS: The study of 42,206 births demonstrated that, for statistical purposes, birthweight is normally distributed. Coefficients for the derivation of customised birthweight in an Australian population were developed and the statistical model is demonstrably robust. CONCLUSIONS: This study provides empirical data as to the robustness of the model to determine customised birthweight. Further research is required to define where normal physiology ends and pathology begins, and which segments of the population should be included in the construction of a customised birthweight standard.

Australia↗

Prenatal weight gain patterns and infant birthweight associated with maternal smoking.

BACKGROUND: Maternal smoking during pregnancy is recognized as an important and modifiable risk factor for low infant birthweight. The objective of this study was to compare the effects of maternal smoking status on prenatal weight gain and infant birthweight, and to determine if maternal weight gain mediates the effect of smoking cessation on infant birthweight. METHODS: This prospective study of 341 white, non-Hispanic pregnant smokers, never smokers, and women who stopped smoking during pregnancy used multivariate analysis of variance to evaluate prenatal weight gain patterns. Multiple regression was used to investigate the effects of smoking status and maternal weight gain on infant birthweight. RESULTS: Women who stopped smoking gained on average 39.68 lb during pregnancy. Smokers gained 32.75 lb, and never smokers gained 34.16 lb. Women who stopped gained significantly more weight than both smokers and never smokers (p = 0.01). Rates of weight gain differed significantly beginning in the second trimester, when women who stopped smoking gained more weight than never smokers (2.57 lb, 99% CI = 0.46, 8.07) and continued during the third trimester, with those who stopped smoking gaining more weight than both smokers (4.31 lb, 99% CI = 1.88, 12.00) and never smokers (1.25 lb, 99% CI = 0.56, 10.49). Infant birthweight differences were significant for women who stopped smoking versus continuing smokers (292 g, 99% CI = 145, 440) and for never smokers versus continuing smokers (253 g, 99% CI = 104, 401). Controlling for baseline maternal body mass index and infant gender, smoking status and weight gain each contributed significantly to infant birthweight (p < 0.001). No evidence of interaction between smoking status and weight gain on infant birthweight was found. CONCLUSIONS: Maternal smoking status significantly affects prenatal weight gain and infant birthweight, but smoking cessation protects against lower birthweight through mechanisms other than increased maternal weight gain or different weight gain patterns.

Adult↗

The effects of parity on birthweight using successive pregnancies.

OBJECTIVE: Accurate assessment of the difference in birthweight between first and second live-births to the same woman having excluded the effects of physiological factors known to affect birthweight. DESIGN: Retrospective longitudinal observational study. SETTING: Three large obstetric units in the East Midlands of the United Kingdom. SUBJECTS AND METHODS: Women in whom data were recorded for their first two pregnancies on the UK East Midlands Obstetric database which resulted in the delivery of a liveborn, singleton and congenitally normal baby. Six thousand five hundred and thirty such cases were identified, of which 3457 had complete datasets and delivered both babies at term (259 to 300 days). An analysis was performed of changes between the paired pregnancies of physiological factors known to affect birthweight. Regression analyses were used to enable prediction of the second birthweight with the knowledge of the first birthweight. RESULTS: The mean crude birthweight difference between first and second pregnancies was an increase of 138 g. Significant differences between the paired pregnancies were found in maternal booking visit weight, blood pressure, maternal age and gestation at delivery. Independent factors affecting difference in birthweight were gestation at delivery, maternal booking weight and baby's sex. Regression towards the mean was demonstrated which meant that a woman delivering a first baby weighing more than 3720 g could expect a lighter baby for her second delivery provided that all other factors remained constant. CONCLUSIONS: In general terms a woman is more likely to deliver a heavier baby in her second pregnancy than in her first pregnancy. However, maternal physiological factors differ in the two pregnancies and these differences have additional effects on birthweight. The effects of both these observations are tempered by regression towards the mean which has a profound influence in predicting the likely change in birthweight between first and second pregnancies. Clinical decisions should not be based on the assumption that a second baby will inevitably be heavier than the first baby.

Birth Order↗

Birthweight-specific trends in perinatal mortality by hospital category in South Australia, 1985-1990.

OBJECTIVE: To investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985-1990 period. DESIGN: Analysis of birthweight-specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors. SUBJECTS: 114 725 singleton births of at least 400 g birthweight (or at least 20 weeks' gestation) born in hospitals in the 1985-1990 period and notified to the perinatal data collection. MAIN OUTCOME MEASURE: The relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period. RESULTS: Births at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birth-weights, there was a higher risk at non-level-3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500-2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight. CONCLUSIONS: The greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500-2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.

Birth Weight↗

Effect of birthweight on pneumonia-specific and total mortality among infants in the highlands of Papua New Guinea.

A cohort of 1711 children born in Tari, Southern Highlands Province, Papua New Guinea was followed to determine the effect of birthweight on total and cause-specific mortality at varying ages during infancy. Mean birthweight was 3.04 kg, males were significantly heavier than females and first offspring significantly lighter than other offspring. Children weighing < or = 2.5 kg at birth accounted for 15% of all births and 32% of all deaths and were 2.7 times more likely to die in infancy than heavier children. Infant mortality was negatively associated with birthweight (p < 0.001). Mortality was very high among children with birthweight < or = 2 kg and was lowest in the 3.1-3.5 kg birthweight category. Pneumonia mortality declined with increasing birthweight in the 1-5 month age group, but in the 6-11 month age group the risk of death from pneumonia was the same among children with birthweight > 3.5 kg as those with birthweight < or = 2.5 kg. While control of infectious diseases will have a marked impact on infant mortality in the short term, longer-term interventions aimed at improving socioeconomic status are needed to improve nutritional status of both adults and children (including birthweight) and hence sustain the lower mortality levels achieved in young children.

Cause of Death↗

Intergenerational effects of high socioeconomic status on low birthweight and preterm birth in African Americans.

As socioeconomic status (SES) increases, the incidence of low birthweight and preterm birth decreases irrespective of social class. However, low birthweight remains twice as high for African-American women as for white women even when SES is controlled. This study examines to what extent second generation high SES African-American women experience improvement in birthweight and gestational age. One hundred eighty-nine former Meharry students were surveyed. Identified were 934 births that are the children and grandchildren of these students who matriculated at Meharry. These infants are compared with a cohort of white mothers from a study in the School of Public Health at Yale University. Low birthweight was reduced in the third generation high SES African-American children (6.9%) from the second generation (11.4%) but remained higher than white children (3.3%). Results showed that African-American third generation children remained at higher risk for low birthweight than were white children (relative risk [RR], 1.78; 95% confidence interval [CI], 1.03, 3.09). Similar results were observed for preterm delivery where the increased risk to third generation African-American children was 3.16 (1.89, 5.27). Persistent strong ethnic differences in birthweight in this high SES cohort (OR = 3.16, 95% CI, 1.89-5.27) support a conclusion that African-American women have birthweight distributions that are somewhat lighter than white women. This may explain a portion of current ethnic differences in birthweight. It is also possible that persistent psychosocial and behavioral factors continue to negatively influence birthweight, even in second generation high SES African-American mothers. This explanation will require identification of powerful risk factors, which are largely unrelated to those presently under investigation.

Adult↗

[Decline in birthweight-specific infant mortality rates of singleton livebirths in the 1990s in Japan].

OBJECTIVE: This study investigated the decline in birthweight-specific infant mortality rates in Tohoku, Tokai and Kyushu regions between 1989 to 1990 and 1995 to 1998. METHODS: Information for both births and infant deaths from any diseases were collected for two periods in the Tohoku, Tokai and Kyushu regions. The first involved a cohort of singleton livebirths (n = 404, 158) in the three regions in 1989, whose birth certificates were linked with infant death certificates. The second was for singleton livebirths (n = 1,503,230) in the same regions between 1995 and 1998, and infant deaths from any diseases were identified based on vital statistics. RESULTS: Overall infant mortality rate from any diseases declined 16%, from the 3.86/1000 of the first group to the 3.24/1000 of the second group. A shift to a lower birthweight distribution weakened the improvement in the overall mortality rate, so that birthweight standardized mortality rates were reduced more than crude ones. Based on birthweight adjusted relative risk, neonatal, postneonatal and infant mortality rates for each birthweight group were improved by almost uniform ratio, that is 31%, 12% and 23% respectively. Improvement of survival of infants with birthweight of a 2500 or more accounted for most of the decline in the infant mortality rates in the 1990s. Mortality rates from "certain conditions originating in the perinatal period" and "congenital anomalies" decreased remarkably, whereas the sudden infant death syndrome increased. CONCLUSIONS: We conclude that reduction of mortality rates in the infant period in Japan in the 1990s was attributable to decline in birthweight-specific mortality rates and weakened by a shift to a lower birthweight distribution over time. Normal birthweight infants showed the greatest improvement.

Birth Weight↗

Racial differences in birthweight-specific neonatal mortality in Alaska: 1987-1996.

OBJECTIVES: This study compared the neonatal mortality in the Alaska Native and non-native (primarily white) population in Alaska for a 10-year period (1987-1996). METHODS: Natality, mortality, and cause of death data were obtained from the State of Alaska's Bureau of Vital Statistics (BVS). Birthweight-specific and preventable birthweight-specific mortality were analyzed for babies < 1500 grams, 1500-2499 grams, and > or = 2500 grams birthweight. RESULTS: The low birthweight (LBW) and very low birthweight (VLBW) rates were similar for the Alaska Native and non-native populations. The neonatal mortality rate for the Alaska Native population was higher than for the non-native population (6.4 per 1,000 live births for Alaska Native vs. 4.1 for non-native for 1987-1991; 5.5 for Alaska Native vs. 3.5 for non-native for 1992-1996). Birthweight-specific mortality was higher in the Alaska Native population for all birthweight groups. The exclusion of non-preventable conditions accentuated the differences in mortality rates between the Alaska Native and non-native population for infants < 2500 grams birthweight. CONCLUSION: The higher neonatal mortality in the Alaska Native population is associated with a higher overall and preventable birthweight-specific neonatal mortality. The differences are therefore likely to reflect differences in access to and quality of perinatal care.

Alaska↗

Birthweight-adjusted Dubowitz methods: reducing misclassification of assessments of gestational age in a Zimbabwean population.

OBJECTIVE: To evaluate the performance and the utility of using birthweight-adjusted scores of the Dubowitz method of estimating gestational age in a Zimbabwean population. DESIGN: A validation study. SETTING: Harare Maternity Hospital, from October to December 1999. SUBJECTS: 364 African newborn infants with a known last menstrual period (LMP), within the first 56 hours of life. MAIN OUTCOME MEASURES: Differences between regression lines and variances explained by Dubowitz scores obtained by examining newborn infants compared to gestational age calculated from the last menstrual period, in models with and without the addition of birthweight. RESULTS: The Dubowitz method was a good predictor of gestational age, useful in differentiating term from pre-term infants. The beta coefficients from regression lines with and without addition of birthweight differed significantly from each other (z = 2.83, p < 0.01). Our regression line without adding birthweight was Y(LMP gestational age) = 23.814 + 0.301* score. Addition of birthweight to the regression models improved prediction of gestational age, Y(LMP gestational age) = 23.512 + 0.219* score + 0.0015* grams, and accounted for 69% of the variance compared to 66% in models without birthweight. CONCLUSION: The introduction of birthweight improves estimation of gestational age, correcting for the overestimation reported for the original Dubowitz methods and the error caused by low birthweight. We recommend the use of our birthweight-adjusted Dubowitz maturity scales for studies of prematurity, and for routine clinical practice.

Adolescent↗

Birthweights of Nigerian children.

A retrospective study of birthweights, the incidence, and possible aetiology of low birthweight in 31,490 Nigerian children, delivered in two hospitals at Ibadan, is reported. The important findings were: (a) mean birthweights for males (3,000 gm), and for females (2,880 gm) in a non-teaching hospital were significantly higher than 2,980 gm and 2,860 gm for males and females respectively in the teaching hospital; (b) the mean birthweights for boys were significantly higher than those for girls in both hospitals; (c) these mean birthweights, though generally higher than previous reports from Nigeria, were significantly lower than those for North American Caucasian and Negro babies, and of babies of three different racial groups in Malaysia. Other interesting, though expected findings were: (a) a high incidence of low birthweight (15.5 per cent) and (b) a high incidence of small for dates babies (60 per cent). It is suggested that since birthweights, the incidence of low birthweight and its aetiology are vital in the planning of health care in any country, a prospective study involving many urban and rural areas of the country and including factors known to influence birthweight should be undertaken.

Birth Weight↗