title: Maternal-fetal disproportion and birth asphyxia in rural Sarlahi, Nepal.
abstract: OBJECTIVE
  To assess the risk of birth asphyxia associated with maternal and newborn size.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Rural community in the Sarlahi district of Nepal.
  
  
  METHODS
  Mothers and newborns (n = 3189).
  
  
  METHODS
  Birth asphyxia, defined as an infant who failed to cry at birth, and who was unable to breathe or suckle normally after birth or had convulsions.
  
  
  RESULTS
  Birth asphyxia occurred in 78 of 1000 live births, and asphyxia-specific mortality was 11 per 1000 live births. After controlling for confounding factors, mothers with height shorter than 145 cm were more likely to have an infant with birth asphyxia compared with mothers 145 cm or taller (adjusted relative risk [RR], 1.5; 95% confidence interval [CI], 1.1-2.0). Mothers with mid-upper arm circumference smaller than 21.5 cm carried a higher risk of delivering an infant with birth asphyxia compared with those with arm circumference greater than 23 cm (adjusted RR, 1.5; 95% CI, 1.1- 2.0). Asphyxia was more common among newborns with head circumference greater than 33.5 cm than those with head circumferences 32.6 to 33.5 cm (adjusted RR, 1.6; 95% CI, 1.1-2.2). Birth weight was not independently associated with birth asphyxia; however, there was significant interaction between maternal stature and birth weight (P = .01); a 3300-g infant born to a mother shorter than 145 cm carried a 3.8 times higher asphyxia risk (95% CI, 2.2-6.5) than an infant of median weight (2620 g) born to a mother taller than 145 cm.
  
  
  CONCLUSIONS
  In rural Nepal, maternal stunting and wasting and large infant head circumference carried higher risk of neonatal asphyxia. Maternal-fetal disproportion resulted in a synergistic elevation in asphyxia risk.
authors: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD 21205, USA.
authors: Anne C C
authors: AC
authors: Lee
authors: Gary L
authors: GL
authors: Darmstadt
authors: Subarna K
authors: SK
authors: Khatry
authors: Steven C
authors: SC
authors: LeClerq
authors: Sharda Ram
authors: SR
authors: Shrestha
authors: Parul
authors: P
authors: Christian
mesh_terms: D001132:Arm / Q000033:anatomy & histology; D001238:Asphyxia Neonatorum / Q000401:mortality*; D001724:Birth Weight; D001827:Body Height; D002508:Cephalometry; D016000:Cluster Analysis; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D016015:Logistic Models; D009390:Nepal / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D012424:Rural Population