Prevalence and determinants of low-birth-weight neonates among women with pre-eclampsia at Moi Teaching and Referral Hospital, Kenya

Abstract

Introduction: Pre-eclampsia contributes to the prevalence of Low neonatal birth weight (LBW) which is a crucial measure of child’s vulnerability to risks of illnesses, growth and development, chronic diseases later in life and reduced chances of survival. There is paucity of information about prevalence and determinants of LBW neonates among women with Pre-eclamptic Toxaemia (PET) particularly in sub-Saharan Africa. Objective: To investigate the prevalence, determinants and immediate birth outcomes of low birth weight neonates born of women with PET at Moi Teaching and Referral Hospital (MTRH). Methods: A descriptive cross-sectional study involving 355 participants sampled consecutively was carried out at the postnatal ward of MTRH. Data was collected using interviewer administered questionnaires. A descriptive analysis was done for social demographic factors, obstetric factors, prevalence of LBW neonates and immediate birth outcomes. Chi square and Wilcoxon tests were used to determine the association between LBW and maternal factors at bivariate level. Multivariate analysis was done using logistic regression to determine factors associated with LBW. A p-value of < 0.05 was considered significant at 95% confidence level. Results: Mean age and parity of participants were 27.5 years and 2.25 respectively. Among the participants 277(76.1%) had severe PET while 87(23.9%) had mild to moderate PET. The prevalence of LBW neonates was 180(49.45%). A statistically significant association was observed between LBW and maternal age 15-19 years (OR =2.44, p=0.035), preterm births (aOR = 13.2, 95%C.I. =6.22-27.92, p<0.001), lack of antenatal care attendance (uOR = 5.5, 95%C.I. = 1.47-20.6, p=0.011), Hemolysis, Elevated liver enzymes and low platelets (HELLP) syndrome (aOR = 17.32, 95%C.I. =3.29-91.25 p=0.001) and twin gestation (aOR = 12.63, 95%C.I. =2.09-76.18, p=0.006). Neonatal birth outcomes were: 162(90%) live births, 17(9.44%) Fresh stillbirth and 1(0.56%) macerated. The mean APGAR scores were 6.44 (±2.773 SD) and 7.66 (±3.123 SD) at one and ten minutes respectively. Neonatal morbidities were: 51(28.73%) birth asphyxia, 38(21%) neonatal jaundice, 18(7.9%) hypothermia and 1(0.68%) neonatal sepsis. In 24 hours of birth, 107(59.18%) neonates were admitted to New Born Unit, 53(29.53%) were rooming in with their mothers while 20(11.29%) had died. Conclusion: The factors associated with the prevalence of LBW neonates among women with pre-eclampsia at MTRH were; preterm birth, HELLP syndrome, twin gestation, lack of antenatal care and teenage. Admission to the newborn unit related to and not limited to birth asphyxia was the commonest neonatal outcome. Recommendation: Awareness to be created to pregnant women particularly with twin pregnancy and other high risk cases on signs, symptoms and early diagnosis of preeclampsia and importance of prenatal care. Additionally, midwives to offer strict management of women with PET using available guidelines to prevent complications to more severe forms such as HELLP syndrome and prepare women with PET for adverse outcomes of the newborn.