Distributions of birth weight in seven Dublin maternity units.

Abstract

Differences in birthweight distribution among babies born to Dublin residents during one year in seven maternity units were analysed. Large differences were found between the hospitals. The evidence indicated that most of the difference was attributable to the differing socioeconomic profile of the mothers in the hospitals. The socioeconomic gradients shown by the hospitals in the proportions of babies weighing < 2500 g, < 3000 g, and 3001-4499 g diverged with increasing socioeconomic disadvantage. Steepest gradients were found in hospitals where the socioeconomic disadvantage was greatest, and vice versa. The differences between the hospitals in the socioeconomic gradient of birthweight performance were tentatively ascribed to some sort of catchment area effect, which added to the disadvantage of the already most disadvantaged mothers. Differences in antenatal care and induction of labour between hospitals were not assessed but were thought unlikely to have made a major contribution to the differences in socioeconomic gradient.

Lalana Newborn Resuscitation

“…± 2 weeks, contrasted with Caucasian births which peaked 31% at 41 weeks gestation, mean gestation of 41.03 weeks S.D. ± 1.32 weeks, with a highly statistically significant difference of 3-4 weeks (p=0.001), while Norway reported mean gestation of 40 weeks 3 days [101,104,105,108]. The shortened gestation of 38 weeks at peak births among Asian-Indian babies results in smaller babies with lower average birth weight 2881g when compared to Caucasian newborns who with a longer gestation upto 42-44 weeks continue to gain weight by deposition of subcutaneous fat have birth weight around 3500g [101,105,106,108,110].…”

“…Congo, Egypt and Thailand with 400g less birth weight median, while Argentina, Brazil and France had birth weight less than 200g and Denmark, Germany with mean birth weights approximately 100 g less. WHO has also observed that differences in birth weight when adjusted to gestational age at birth between other countries is highly significant for all percentiles at birth, p=0.0018 at 5 th percentile to p<0.001 for 10 th , 25 th , 50 th , 75 th , 90 th and 95 th percentiles, reveals the wide variation in human fetal growth across ethnic Asian and Caucasian population, indicating that Asian and Caucasian perinatal definitions are mandated, taking into consideration the wide variation in mean birth weight gestation at birth and intrauterine growth pattern based on ethnicity that will result in improved perinatal and neonatal outcome among ethnic Asian population, presently comprising a majority four-fifths of world's nearly 8 billion population [106][107][108][109]. The Asian Indian peak births 32.6 % in 1983 cohort occurred at 39 weeks gestation with mean gestation of 38.86 weeks S.D.…”

“…± 1.32 weeks, with a highly statistically significant difference of 3-4 weeks (p=0.001), while Norway reported mean gestation of 40 weeks 3 days [101,104,105,108]. The shortened gestation of 38 weeks at peak births among Asian-Indian babies results in smaller babies with lower average birth weight 2881g when compared to Caucasian newborns who with a longer gestation upto 42-44 weeks continue to gain weight by deposition of subcutaneous fat have birth weight around 3500g [101,105,106,108,110]. The comparison of national and international intrauterine growth chart revealed that the 10 th percentile in the 2015-'17 South Indian cohort and the All India National Neonatal Perinatal Data base (NNPD) study with Lubchenco's were closely related, thereafter the Lubencho curve diverged from 32-33 weeks gestation with rapid weight gain of around 500 g at 37 weeks, then decreased by 200-300g weight gain at 40 weeks gestation.…”

“…However though the 90 th percentile growth curve in 2016-'17 Indian study was similar only till 32 weeks gestation to 90 th percentile World Health Organization (WHO) curve, it thereafter declined to below the 50 th percentile WHO curve at 40 weeks in contrast the 90 th percentile WHO curve continued to gain more than 1000g at 40 weeks gestation [104,108]. Also the 90 th percentile all India NNPD had the least growth potential corresponding to 50 th percentile WHO curve up till 37 weeks gestation and thereafter fell by over 250 g less but had a catch-up growth to the 90 th percentile South Indian 2015-17 curve at 40 weeks gestation [104,108,111].…”

“…Birth weight for gestational age is a commonly assessed perinatal outcome parameter and Small for Gestational Age (SGA) defined as weighing less than 10th percentile of birth weight for that gestation is also an indicator for Intrauterine Fetal Growth Restriction (IUGR), its importance is due to high associated perinatal and infant morbidity and mortality as well as future adult chronic non-communicable diseases such as cardiovascular disease, stroke, type II diabetes, obesity, other endocrine and metabolic disorders prominently linked to Small for Gestational Age (SGA) [115,116]. Invalidating international reference WHO percentile intrauterine growth curves which differs from the Indian intrauterine growth curves such that the 10 th percentile is almost 800 g below WHO 10 th percentile curve, while 50 th percentile South Indian curve corresponds to 10 th percentile WHO curve, that would mistakenly identify a large proportion of Appropriate for Gestational Age (AGA) Indian babies as small for Gestation Age (SGA) who have differing morbidity and mortality, emphasizing further why ethnic Asians require specific intrauterine growth charts to avoid inaccurate labeling of SGA newborns and their management, however these small for dates after birth feed avidly and gain weight [104,107,108,112]. Pooling of data as in the international WHO intrauterine growth curves do not represent variations among populations in a single intrauterine growth chart but only partially reflect the individual population included, hence ideally two separate ethnic Asian and Caucasian intrauterine growth charts are recommended [104,107,108,113,114].…”