1. Low Birth Weight: The Indian Perspective Prof. H.P.S. Sachdev

2. DEFINITIONS WHO (1995) - Based on Global Data Perinatal & Neonatal Morbidity & Mortality Later Growth & Development LBW - Below 2500 g VLBW - Below 1500 g OnlyBirth weight crude proxy for fetal growth Only measure in Developing Countries Focus – Optimal fetal development

3. Global LBW Prevalence (%) Asia21 Oceania20 Africa15 Latin America11 North America 7 USSR 7 Europe 6 Global17

4. Presentation Format Implications Epidemiology Time Comparison Body Composition Some Interventions Public Health Issues

5. Implications of LBW Morbidity and Mortality Subsequent Development Long term Growth Adult Degenerative Diseases

6. Growth in Weight in Delhi LBW Boys Source: Indian Pediatrics 1995; 32: 963

7. Epidemiology

8. LBW Prevalence (%) in South Asia

9. Variation in LBW Prevalence Inter Regional Socio-economic Urban Rural Varies from 10% to 56% Preterms 7.1% to 22.3%

10. Multicentric Data National Neonatology Forum (1995/ 2002) Institutional Data on 37082 / 66512 Births LBW - 33% / 31.6% VLBW - 3.3% / 3.3% Preterm - 12.3% / 14.7% ? Overestimates: Underprivileged and High Risk Population

11. Multicentric and Other Data CSSM (1995): 14 District Based Data on 27069 Births - 18.4%, Reliability ?? 2.7% - MP, 5.1%-AS, 25%-TN, 40%-OR National Family Health Survey(99): 23% (Newborn Weight Recorded in 30% of 32,393 Births; Based on Recall: Bias) Community surveys 8% - 19%

12. Heterogeneous Population Type: Heterogeneous Population Born Too Small (Intrauterine Growth Retarded or SFD; <2SD) OR Born Too Soon (Preterm <37 Weeks)

13. LBW Type NNF Data Predominantly Term IUGR Contrast: Developed Overwhelming Preterm

14. Intrauterine Growth Curves Comparison

16. Gestational Distribution Preterms India 7.1% to 22.3% (12.3%) Developed - 5% At 36 weeks births 2% (West) vs 3-12% Maximum Deliveries 40-41 W vs 39-40W Variation (Socio-economic)

17. Time Comparison

18. Trends in Low Birth Weight 1962 1986 1969-73 1989-93 1969 1994 1988 1995 74g Mean Wt78g52g126g Mean Gest ? ? Preterm 0.7W 21-16% 0.8W 20-15% 0.3W 14-10% 0

19. Male Subscapular Trend mm Gestation (Weeks) P<0.01

20. Positive Trend in Birth Weight Improvement possible in current scenario Both intrauterine growth and gestation contributory

21. Birth Weight Changes in Developed

22. Change in BW Comparable (33-100 g) But Prevalence Less Persistence in Differences Racial Inter-country (ICE Multi-centric)

23. Body Composition

24. Early Life Origin of Diabetes Bhargava, Sachdev, et al. N Engl J Med 2004;350:865-75. FATNESSFATNESS

25. Birth Weight and Infant Fat r=0.62; r 2 =0.38; p<0.001

26. Fat Indices Comparison

27. Some Interventions

28. Adolescent Pregnancy Indirect Influence Wt, Ht & Nutrition In U.P. LBW- 67% Preterm - 33% Mean Marriage Age (Yr)

29. Results of Systematic Reviews on Macronutrient Supplementation & BW SupplementOutcome: systematic review NWMD (Random) 95%CISource Balanced protein/energy 13:13352629–10, 60 Kramer 2000 Isocaloric balanced protein 3:3966–64–124, 3 Kramer 1996 High protein2:2529–58–146, 30 Kramer 1996

30. Food Supplement Consumption ICDS Data Source: Nayar et al. Indian Pediatrics 1997

31. Results of Systematic Reviews on Micronutrient Supplementation and BW SupplementOutcome: systematic review NWMD (Random) 95%CISource Folate1:21149–86–107, –64 Mahomed 1999 Iron1:20197–30–90, 150 Mahomed 1999 Zinc3:7113619–104, 141 Mahomed 1997 Magnesium4:71482510, 102 Makrides & Crowther 2001

32. Effect of Smoking Cessation on LBW (Lumley et al 1999)

33. Public Health Issues

34. Does “One Birth Size Fit All” ? Realistic Prevalence & Time Trends  Surveillance: NNF, Surveys, Sentinel, ICDS Mix Sustainable Interventions vs Isolated Body Composition esp. Interven Studies Predominantly Growth Retarded: Requirements in Exclusively Breast Fed