1. Relative impact of pre-eclampsia on birth weight in a low resource setting: A prospective cohort study.
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Nakimuli, Annettee, Starling, Jennifer E., Nakubulwa, Sarah, Namagembe, Imelda, Sekikubo, Musa, Nakabembe, Eve, Scott, James G., Moffett, Ashley, and Aiken, Catherine E
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GESTATIONAL age ,CASE-control method ,PREECLAMPSIA ,LOW birth weight ,BIRTH weight ,IMPACT of Event Scale ,QUESTIONNAIRES ,RESEARCH funding ,POVERTY ,LONGITUDINAL method - Abstract
Objectives: Low birth-weight is a major risk factor for perinatal death in sub-Saharan Africa, but the relative contribution of determinants of birth-weight are difficult to disentangle in low resource settings. We sought to delineate the relationship between birth-weight and maternal pre-eclampsia across gestation in a low-resource obstetric setting.Study Design: Prospective cohort study in a tertiary referral centre in urban Uganda, including 971 pre-eclampsia cases and 1461 control pregnancies between 28 and 42 weeks gestation.Main Outcome Measures: Nonlinear modeling of birth-weight versus maternal pre-eclampsia status across gestation. Models were adjusted for maternal-fetal characteristics including maternal age, parity, HIV status, and socio-economic status. Propensity score matching was used to control for the severity of pre-eclampsia at different gestational ages.Results: Mean birth-weight for pre-eclampsia cases was 2.48 kg (±0.81SD) compared to 3.06 kg (±0.46SD) for controls (p < 0.001). At 28 weeks, the mean birth-weight difference between pre-eclampsia cases and controls was 0.58 kg (p < 0.05), narrowing to 0.17 kg at 39 weeks (p < 0.01). Controlling for pre-eclampsia severity only partially explained this gestational difference in mean birth-weight between pre-eclampsia cases and controls. Holding gestational age constant, pre-eclampsia status predicted 7.1-10.5% of total variation in birth-weight, compared to 0.05-0.7% for all other maternal-fetal characteristics combined.Conclusions: Pre-eclampsia is the dominant predictor of birth-weight in low-resource settings and hence likely to heavily influence perinatal survival. The impact of pre-eclampsia on birth-weight is smaller with advancing gestational age, a difference that is not fully explained by controlling for pre-eclampsia severity. [ABSTRACT FROM AUTHOR]- Published
- 2020
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