title: New birth weight reference standards customised to birth order and sex of babies from South India.
abstract: BACKGROUND
  The foetal growth standards for Indian children which are available today suffer due to methodological problems. These are, for example, not adhering to the WHO recommendation to base gestational age on the number of completed weeks and secondly, not excluding mothers with risk factors. This study has addressed both the above issues and in addition provides birthweight reference ranges with regard to sex of the baby and maternal parity.
  
  
  METHODS
  Data from the labour room register from 1996 to 2010 was obtained. A rotational sampling scheme was used i.e. the 12 months of the year were divided into 4 quadrants. All deliveries in January were considered to represent the first quadrant. Similarly all deliveries in April, July and October were considered to represent 2nd, 3rd and 4th quadrants. In each successive year different months were included in each quadrant. Only those mothers aged 20-39 years and delivered between 24 to 42 weeks gestational age were considered. Those mothers with obstetric risk factors were excluded. The reference standards were fitted using the Generalized Additive Models for Location Scale and Shape (GAMLSS) method for Box-Cox t distribution with cubic spline smoothing.
  
  
  RESULTS
  There were 41,055 deliveries considered. When women with risk factors were excluded 19,501 deliveries could be included in the final analysis. The male babies of term firstborn were found to be 45 g heavier than female babies. The mean birthweights were 2934 g and 2889.5 g respectively. Similarly, among the preterm babies, the first born male babies weighed 152 g more than the female babies. The mean birthweights were 1996 g and 1844 g respectively.In the case of later born babies, the term male babies weighed 116 grams more than the females. The mean birth weights were 3085 grams and 2969 grams respectively. When considering later born preterm babies, the males outweighed the female babies by 111 grams. The mean birthweights were 2089 grams and 1978 grams respectively. There was a substantial agreement range from k=.883, (p<.01) to k=.943, (p<.01) between adjusted and unadjusted percentile classification for the subgroups of male and female babies and first born and later born ones.Birth weight charts were adjusted for maternal height using regression methods. The birth weight charts for the first born and later born babies were regrouped into 4 categories, including male and female sexes of the babies. Reference ranges were acquired both for term and preterm babies.With economic reforms, one expects improvement in birthweights. The mean (sd) birthweights of the year 1996 was 2846 (562) as compared to year 2010 (15 years later) which was 2907 (571). There was only a difference of 61 grams in the mean birthweights over one and a half decade.
  
  
  CONCLUSIONS
  New standards are presented from a large number of deliveries over 15 years, customised to the maternal height, from a south Indian tertiary hospital. Reference ranges are made available separately for first born or later born babies, for male and female sexes and for term and preterm babies.
authors: Department of Biostatistics, Christian Medical College and Hospital, Vellore 632004, India.
authors: Velusamy Saravana
authors: VS
authors: Kumar
authors: Lakshmanan
authors: L
authors: Jeyaseelan
authors: Tunny
authors: T
authors: Sebastian
authors: Annie
authors: A
authors: Regi
authors: Jiji
authors: J
authors: Mathew
authors: Ruby
authors: R
authors: Jose
mesh_terms: D000328:Adult; D001722:Birth Order; D001724:Birth Weight / Q000502:physiology*; D001827:Body Height / Q000502:physiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007194:India; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D016015:Logistic Models; D008297:Male; D010298:Parity; D012016:Reference Values; D012737:Sex Factors