title: Determinants of low birth weight in urban Pakistan.
abstract: OBJECTIVE
  To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy.
  
  
  METHODS
  Cross-sectional study.ParticipantsFive hundred and forty mother-infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW.
  
  
  RESULTS
  Of 540 infants, 100 (18.5 %) weighed <or=2.5 kg. Umbilical cord BLL was not significantly associated with LBW. Maternal poor self-rated health (adjusted prevalence ratio (adjPR) = 1.83; 95 % CI 1.09, 3.07) and none or one prenatal visit (adjPR = 2.18; 95 % CI 1.39, 3.43) were associated with LBW. A statistically significant interaction between mothers' mid upper-arm circumference (MUAC) and dietary vitamin C intake was noted. Compared with mothers with MUAC above the median and dietary vitamin C intake above the 3rd quartile (>208.7 mg/d), infants of mothers with MUAC less than or equal to the median and dietary vitamin C intake >208.7 mg/d (adjPR = 10.80; 95 % CI 1.46, 79.76), mothers with MUAC above the median and vitamin C intake <or=208.7 mg/d (adjPR = 10.67; 95 % CI 1.50, 76.02) and mothers with MUAC less than or equal to the median and vitamin C intake <or=208.7 mg/d (adjPR = 13.19; 95 % CI 1.85, 93.79) more likely to give birth to an LBW infant.
  
  
  CONCLUSIONS
  In Pakistan, poor nutritional status and inadequate prenatal care were major determinants of LBW in this setting. Environmental factors including umbilical cord BLL were not significantly associated with LBW.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 430, Birmingham, AL 35294, USA. naveed@uab.edu
authors.forename: Naveed Zafar
authors.initials: NZ
authors.lastname: Janjua
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Delzell
authors.forename: Rodney R
authors.initials: RR
authors.lastname: Larson
authors.forename: Sreelatha
authors.initials: S
authors.lastname: Meleth
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kristensen
authors.forename: Edmond
authors.initials: E
authors.lastname: Kabagambe
authors.forename: Nalini
authors.initials: N
authors.lastname: Sathiakumar
mesh_terms: D000328:Adult; D000886:Anthropometry; D001205:Ascorbic Acid / Q000008:administration & dosage; D001724:Birth Weight / Q000502:physiology; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006297:Health Services Accessibility; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007854:Lead / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D016017:Odds Ratio; D010154:Pakistan; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D011297:Prenatal Exposure Delayed Effects; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D014505:Urban Population / Q000706:statistics & numerical data*
chemical_list: D007854:Lead; D001205:Ascorbic Acid