Bill & Melinda Gates Foundation

Born Too Small: The Weight of Newborn Health

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April 09, 2013

To mark the critical first 28 days of a newborn’s life–the neonatal period (when a baby is most at risk)– in the lead up to the Global Newborn Health Conference, Gary Darmstadt and others will be sharing, via Twitter, 28 days of “Did You Know?” facts about newborn health. Follow @gdarmsta, share the facts widely using #Newborn2013 and we can work towards saving newborn lives together.  

Eating for two. It’s a good excuse used by millions of pregnant women to have that second helping to make sure they are getting enough food for their baby to be healthy, well-nourished, and normal in birth weight.

What happens if a baby does not have a normal birth weight, if he or she is born with low birth weight (born weighing less than 2,500 grams, essentially less than a 5 pound bag of sugar)? Unfortunately, far too many babies are born too small, particularly in low-income countries. Prevalence of low birth weight is highest in South Asia, with sub-Saharan Africa a close second. And it’s not because of missing a second helping of lunch or dinner.

Many factors influence the likelihood of having a baby with low birth weight. 

The consequences of being born "too small" are pretty severe, both for chances of survival and life-long risks, particularly in low-income countries:

  • Low birth weight infants are more likely to die in the first month of life as well as in infancy and early childhood.
  • Babies who are born with low birth weight and survive are more likely to continue to grow poorly after birth, remain underweight and stunted in early childhood, andface educational and neuro-developmental delays.
  • Low birth weight babies grow into shorter adults, often with health problems such as higher blood pressure, heart disease, and other metabolic problems.
  • Low birth weight girls tend to grow into women with short stature and an under-developed pelvis, leading to obstetric complications during childbirth.

So, what are those factors that can lead to devastating consequences like these?

Often this is an intergenerational phenomenon. It starts with a malnourished girl, who grows into a poorly nourished teen, who far too frequently becomes pregnant in her adolescent years, becoming ever more likely to give birth to a low birth weight infant. This child, born too small, will most likely have slow growth due the same poor nutritional environment faced by her mother, suffering from stunted physical and neuro-developmental growth throughout childhood, and thus the cycle begins again as she enters her reproductive years with poor nutritional status.

Of course a mom’s health status is also important. More than just a second helping of dinner is necessary for a healthy pregnancy.

Early and regular prenatal care is needed to identify, prevent, and appropriately manage the array of infections that are common in areas where low birth weight is also common. Conditions such as syphilis, malaria, HIV and other sexually transmitted infections, if left untreated, also increase the chances that a baby will be born too soon or too small. Iron and folic acid supplementation is also needed during pregnancy to prevent maternal anemia and neural tube defects in the baby.

Social factors also influence the chance of a baby being born with low birth weight. In certain cultures, child marriage is a common risk factor as girls and teenagers are married and expected to start bearing children before their bodies are developed enough to provide full nutrition to a baby or to accommodate the passage of a normal birth weight baby, resulting in birth complications.

Additionally, a woman’s status in the household is highly correlated with the nutritional status of her young children. And as a woman’s status goes up, the likelihood that her children will be malnourished goes down.

So when we are talking about newborn health at the upcoming Global Newborn Health Conference, we can’t simply talk about interventions at birth focusing on the newborn. The first 28 days of life is part of a much bigger and complex system with so many other influential factors, one of which is nutrition. And that is, in turn, influenced by education, social status, and even grandmothers’ nutrition.

Do you want to get involved? Join Gary’s team and support a project on Catapult.org raising money for community-based nutrition groups in Cambodia which work with women to increase their ability to grow their own food and improve the nutrition and health of their families.

 
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