Asian Journal of Health Research (2022) 1(1): 30-35

Asian Journal of Health Research (2023) 2 (1) 4349

Asian Journal of Health Research

Journal Homepage: https://a-jhr.com
Published by Ikatan Dokter Indonesia Wilayah Jawa Timur

Original Research

Maternal Comorbidities with Full-Term Pregnancy Who Gave

Birth to Low Birth Weight Babies at Dr. Saiful Anwar Malang
General Hospital
I Wayan Agung Indrawan *, Obi Candra Kapisa
Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Brawijaya/ Saiful Anwar General Hospital, Malang,
East Java, Indonesia

ARTICLE HISTORY ABSTRACT

Received: 25 December 2022
Introduction: Stunting is a challenge for children's growth and development in the future,
Revised: 5 February 2023
Accepted: 19 February 2023 which has long-term impacts in the form of reduced cognitive abilities, decreased
productivity, and increased risk of infection and non-communicable diseases. Low birth
weight (LBW) is a major determinant of stunting in Indonesia. Various multidimensional
CORRESPONDING AUTHOR*
factors contribute to low birth weight, including maternal factors.
Obi Chandra Kapisa
[email protected] Material and Methods: Quantitative descriptive research was conducted at Dr. Saiful
Department of Obstetrics and Anwar general hospital from July 2021 to September 2022. The variables studied were
Gynaecology, Faculty of Medicine,
Universitas Brawijaya/ Saiful Anwar
age, education, occupation, parity status, medical history, number of antenatal care
General Hospital, Malang, East Java, controls, height, mother's body mass index, and baby's birth weight.
Indonesia
Results: Of the 54 full-term pregnant women, the majority who delivered LBW babies
were nulliparous (42.6%), aged 20-35 years during pregnancy (79.6%), had a history of
hypertension during pregnancy (25.9%), antenatal care visits 1-5 times (48.1%), high
KEYWORD
Full- term; Maternal; Pregnancy; Stunting school degree (48.1%), housewives (75.9%), height ranging between 151-160 cm (64.8%),
and BMI 18.5 to 25 kg/m 2 (51.9%).
Conclusion: Maternal factors that contribute to the birth of LBW babies include low
This is an open-access article
distributed under the terms of the Creative
parities, age 20 to 35 years during pregnancy, hypertension in pregnancy, infrequent
Commons Attribution 4.0 International License antenatal care visits, high school degree, work as a housewife, height ranging between
(https://creativecommons.org/licenses/by/4.0/) 151 -160 cm, and had a normal BMI. The representation of the mother's BMI and
educational level in this study differs from that in previous studies.

Cite this as: Indrawan IWA, Kapisa OC (2023) Maternal Comorbidities with Full-Term Pregnancy Who Gave Birth to Low Birth
Weight Babies at Dr. Saiful Anwar Malang General Hospital. Asian J Heal Res. 2 (1): 4349. doi:
https://doi.org/10.55561/ajhr.v2i1.85

INTRODUCTION development because it has long-term consequences:

decreased cognitive ability, reduced productivity, and
Low birth weight (LBW) is a weight at birth of less increased risk of infection and non-communicable
than 2500 grams. Infants with low birth weights (LBW) diseases in the future [2, 4–6]. Reducing the incidence of
have a higher chance of experiencing a decline in linear stunting is a critical indicator of the second Sustainable
growth. Additionally, LBW was linked to Development Goal of Zero Hunger. It is also the first of
underwhelming cognitive development and moderated the six goals of the Global Nutrition Targets for 2025,
growth of internal organs. This might impact cognitive with a reduction target of 40% by 2025 [5, 6].
abilities later in life and raise the risk of developing Various multidimensional factors contribute to
chronic illnesses. In Indonesia, low birth weight is the LBW, including poor maternal health and nutrition [6].
most important and dominant risk factor for stunting [1– Therefore, as a comprehensive prevention strategy to
3]. reduce the prevalence of LBW in Indonesia, it is
Stunting, defined by Z-score of less than -2 SD for necessary to overview several maternal risk factors that
body height to age ratio, is one of the most fundamental may contribute to it.
challenges in the journey of individual growth and

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Indrawan, Kapisa Asian Journal of Health Research (2023) 2 (1) 4349

MATERIAL AND METHODS of LBW babies was lower as the frequency of ANC visits
increased (Fig.2).
This quantitative descriptive study was conducted at The most educational level of mothers who gave
Dr. Saiful Anwar general hospital from July 2021 to birth to LBW babies was a High School degree (48.1%),
September 2022. Subjects were selected using the followed by mothers with a Junior High School degree
purposive sampling method, with a minimum subject (24.1%), mothers with educational level
based on the Slovin formula of 44. Between July 2021 Diploma/Bachelor degree (14 .8%), and mothers with
and September 2022, researchers interviewed pregnant primary school degree (13%). Based on the mother's
women who delivered LBW babies at Dr. Saiful Anwar occupation, housewives were the most gave birth to
Malang General Hospital using the Maternity Support LBW babies (75.9%), followed by mothers who worked
Service: Prenatal Screening Guide. The interviews were as employees (13%), civil servants or BUMN employees
recorded along with information from the medical (5.6%), entrepreneurs (3.7%), and the least were mothers
records [7]. who are still students (1.9%). Based on maternal height,
The variables studied were maternal parity status, women with a height of 151-160 cm is the most that gave
age at pregnancy, medical history, number of antenatal birth to LBW babies (64.8%), followed by mothers with
care (ANC) visits, educational degree, occupation, a height of 140-150 cm (25.9%), and women who gave
height, body mass index (BMI), and the baby's birth birth to the least LBW babies is the height of 161-170 cm
weight. The collected data were analyzed using (9.3%). Based on the body mass index (BMI), mothers
univariate analysis of each variable and presented as with a BMI of 18.5-25 kg/m2 were the most likely to give
distribution and percentage. This research was birth to LBW babies (51.9%), followed by mothers with
conducted in conjunction with the ethical process from a BMI of more than 25 kg/m 2 (29.6%), and mothers
the Health Research Ethics Commission, Faculty of with a BMI of less than 18.5 kg/m 2 (18.5%).
Medicine, Universitas Brawijaya.

DISCUSSION
RESULTS
In this study, out of 54 term pregnant women who
Fifty-four subjects of all full-term pregnant women gave birth to LBW babies, the majority of gestational age
who gave birth to LBW babies during July 2021- was 37-38 weeks, and birth weight was in the range of
September 2022 met the inclusion criteria. The majority 1500 to 2500 grams. This statement is similar to research
of subjects gave birth at 37-38 weeks (42.6%), followed conducted by Muchami et al. in 2015 and Momeni et al.
by 38-39 weeks gestation (33.3%), 39-40 weeks gestation in 2017 that the younger the gestational age, the higher
(13%), and 40-41 weeks gestation (11.1%). Subjects gave the risk of giving birth to LBW babies [8, 9]. This is
birth to more LBW babies with birth weights of 1500- because babies with shorter gestational ages have less
2500 grams (Low Birth Weight) (94.4%), compared with time to grow in the womb, whereas most babies gain
birth weights of 1000-1500 grams (Very Low Birth weight during the last week of pregnancy. Babies who
Weight) (5.55%). have shorter gestational ages also have much lower
Based on Table 1, the age of the mother during levels of antibodies than babies born with longer
pregnancy, most LBW babies were delivered by mothers gestations. This low antibody will make the baby
aged 20-35 years (79.6%), followed by mothers aged susceptible to infection, so it can have an impact on
more than 35 years (14.8%), and the least were mothers malnutrition [10, 11].
aged less than two twenty years (5.6%). The mother's Based on parity status, nulliparous mothers gave
medical history was grouped by organ system from the birth to the most LBW babies (42.6%). The distribution
collected data. Mothers who gave birth to LBW babies of LBW baby births decreases as the number of parity
were most those with a history of hypertension in mothers increases. This description is similar to the
pregnancy (25.9%), followed by mothers with a history research by Khan et al. in 2016 that 54% of mothers who
of cardiovascular disease and COVID-19 (16.7% gave birth to LBW babies in the study were primiparas,
respectively), a history of autoimmune disease (14.8%), followed by 2 and 3 parities (33%) and more than three
history of the haematological disease, placental parities (13%) [12]. Research by Momeni et al. in 2017
disorder, and neurological disease (respectively 7.4%), also revealed that lower parity was associated with a
history of metabolic disease and gastrointestinal disease higher risk of giving birth to LBW babies (OR: 0.85; P <
(respectively 5.6%), and the least were history of the 0.001) [9].
gynaecological disease (1.9%). The mechanism of this phenomenon is likely to
Based on the parity status, the distribution of LBW occur because mothers with lower parity have imperfect
babies born decreases as the number of parity increases physical growth and tend to be malnourished. The lower
(Fig.1). Based on the number of ANC visits, the number birth weight among babies born as the first child is a

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Indrawan, Kapisa Asian Journal of Health Research (2023) 2 (1) 4349

Table 1. Characteristics of Research Subjects

Characteristics N %
Mother's Gestational Age (weeks)
37 - 38 23 42,6
38 - 39 18 33,3
39 - 40 7 13.0
40 - 41 6 11,1
Baby's Birth Weight (grams)
1000 – 1500 (LBW) 3 5.55
1500 - <2500 (VLBW) 51 94.4
Age (years)
<20 3 5,6
20 – 35 43 79.6
>35 8 14,8
Medical History
Hypertension in Pregnancy 14 25,9
Cardiovascular 9 16,7
COVID-19 9 16,7
Autoimmune 8 14,8
Haematology 4 7,4
Placental Abnormalities 4 7,4
Neurology 4 7,4
Metabolic 3 5,6
Digestion 3 5,6
Gynaecology 1 1,9
Education
Primary School 7 13.0
Junior High School 13 24,1
Senior High School 26 48,1
Diploma/Bachelor degree 8 14,8
Occupation
Housewife 41 75.9
Government employees 3 5,6
Employee 7 13.0
Self-employed 2 3,7
Student 1 1,9
Height (cm)
140-150 14 25,9
151-160 35 64,8
>160 5 9,3
BMI (kg/m 2)
< 18.5 10 18.5
18.5 – 25 28 51.9
>25 16 29,6

direct consequence of the physiological condition of the a different mother's immune environment, thereby
primigravida's body, which will increase more efficiently contributing relatively to growth restriction [13, 14].
in each subsequent pregnancy. The uteroplacental blood Based on the age during pregnancy, mothers aged
flow, responsible for delivering oxygen and nutrients to 20-35 gave birth to the most LBW babies (79.6%). This
the fetus, will be greater during subsequent pregnancies description is similar to the research conducted by Khan
compared to a primigravid uterus. In addition, there et al. in 2016, which showed that most mothers who
may be structural factors that limit uterine capacity in gave birth to LBW babies were between 20 and 30 years
the first pregnancy, and thereafter the size of the uterus old (82%), followed by mothers over 30 years old (12%),
will increase in proportion to the protein content in and fewest were mothers aged less than 30 years (6%)
subsequent pregnancies. Firstborns are also exposed to [12].

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30
25
20
15
10
5
0
1-5 6 - 10 > 10
Number of ANC Controls

Fig. 2. Distribution of LBW Babies Based on the Number of ANC Visits.

This description is also similar to a study conducted uteroplacental causes the fetus to go hungry, resulting in
by Yilgwan et al. in 2009 at the Jos Teaching Hospital, LBW fetal growth [17,18].
Nigeria, where the majority of mothers who gave birth Based on the number of ANC visits, mothers who
to LBW babies were in the age group of 20-35 years had one to five ANC visits had the most LBW babies
(88%), followed by mothers aged 35 years and above (26%). As the frequency of ANC increases, the number
(8.6%), and only three (3.4%) were less than 20 years old of LBW babies decreases. This description is not in
[15]. The biological mechanism of maternal age that accordance with the research conducted by Dai et al. in
causes LBW is probably due to low socioeconomic 2014, which revealed that women with 6 to 10 ANC
conditions, increased nutritional needs during visits were less likely to have LBW babies compared to
pregnancy, low education, and low body mass index. women who had less than 5 ANC visits (OR = 0.52, 95%
Whereas in older mothers, the possibility of LBW is CI: 0.38-0.71). However, no protective effect was found
caused by biological factors such as chromosomal for LBW in women with more than 10 ANC visits (OR:
anomalies, pre-eclampsia, and diabetes [9,16]. -0.82, 95% CI: 0.57-1.18) [19]. However, our findings
In this study, the medical history of the mothers who are consistent with the statement in the Banchani and
gave birth to the most LBW babies were those with a Tenkorag study in 2020, which revealed that the number
history of hypertension during pregnancy (25.9%). of ANC visits at least 8 had a protective effect on the
According to Muchemi et al., comorbidities during occurrence of LBW (OR=0.72, p>0.01). This study also
pregnancy are significantly associated with low birth states that the incidence of LBW is not only determined
weight babies. These comorbidities include by the number of ANC visits but also by their quality.
hypertension, pre-eclampsia, eclampsia, bleeding, Respondents who received a higher quality of care
placenta previa, placental abruption, premature rupture were 26% less likely to give birth to LBW babies. Some
of membranes, anemia, tuberculosis, malaria, and HIV literature indicates that the content of care is more
in pregnancy [8]. This description is similar to a study important than the number of contacts or ANC visits.
conducted in Yogyakarta, Indonesia, by Wahyuni and Antenatal care, especially quality. Antenatal care will
Elika in 2018, that there was a relationship between promote optimal maternal and fetal health because the
preeclampsia and LBW at Wonosari Hospital, mother will receive information about the importance of
Gunungkidul, with the results showing that women who nutrition or receive interventions such as giving iron
experience preeclampsia are 2.114 times more likely to supplements, vitamins, and the tetanus vaccine [20].
give birth with LBW compared to women who do not This study found that 48.1% of mothers who gave
have preeclampsia. birth to LBW babies had a high school education degree.
The same thing was also found by Nakimuli et al. in This description is almost similar to the research
2020 that mean birth weight was significantly lower conducted by Momeni et al., which revealed that the
among pre-eclamptic cases (2.48 kg ± 0.81 SD) education level of mothers who gave birth to LBW
compared to normotensive pregnancies (3.06 kg ± 0.46 babies the most was high school level (36.5%) [9].
SD) (p<0.001). Hypertension in pregnancy causes However, this description is not in accordance with the
placental abnormalities, vasospasm, and endothelial research conducted by Dai et al. in 2014, which revealed
injury, resulting in an insufficient invasion of the blood that junior high school or lower eductional level was
vessel walls by the extravillous trophoblast. This would more related to LBW (p<0.0001) because mothers with
prevent spiral artery remodelling and thus reduce that level of education had a lower number of ANC
uteroplacental blood flow. Reduced blood flow to the visits than those with higher levels of education [19]. The

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relationship between the mother's educational level and by mothers with a BMI of more than 25 kg/m2 (45%),
the incidence of LBW can be caused by differences in and mothers with a BMI of less than 18.5 kg/m2 (5.1%)
the ability to receive information about health services [25]. However, research by Amaha and Woldeamanuel
[9]. showed different characteristics, that mothers with BMI
Based on the data on the mother's occupation, it was less than 18.5 kg/m2 gave birth to more LBW babies
found that most LBW babies were born to housewives (p=0.0001). This study also stated that each unit
(75.9%), and the least were mothers who were still increase in BMI reduced the likelihood of stunting by 4%
students (1.9%). This description is similar to a study [26].
conducted by Kandel et al. in 2021, which gets a higher
percentage of LBW among housewives compared to CONCLUSION
other jobs. However, this finding was not statistically
significant [21]. According to Sharma et al., this is The majority of full-term mothers who gave birth to
because daily household chores, such as fetching water LBW babies at Dr. Saiful Anwar General Hospital
with large buckets, lifting heavy loads, and washing between July 2021 and September 2022 were
clothes/utensils for an extended period of time, are nulliparous, age during pregnancy was 20 to 35 years,
classified as heavy physical activities, which are the had a history of hypertension during pregnancy, had one
proximity factors to the birth of LBW babies [22]. Patil to five ANC visits, had a high school educational degree,
et al. also explained that women with high work works as a housewife, height of 151-160 cm, and had a
intensity had a higher risk of LBW births compared to normal BMI. These descriptions are mostly similar to
women with lower work intensity (RR: 1.48, 95% CI: several previous studies, except for the description of the
1.11-1.98) [23]. Research conducted by Sari and Soili mother's educational level and BMI.
states that 30% of mothers who work as entrepreneurs,
students, and housewives have 1.67 times the risk (OR:
ACKNOWLEDGMENT
1.67, 95% CI 1.40-1.98) of experiencing depression
during pregnancy, one of which resulted in LBW births
We thank all the authors of the articles reviewed in
(OR: 1.56, 95% CI 1.36-1.79) [24].
this article.
The mother's nutritional status is an important
determinant of fetal growth and birth weight. Short
maternal stature is one of the risk factors indicating a CONFLICT OF INTEREST
lack of maternal nutritional status, which increases the
risk of LBW [25]. Based on data on the mother's height, The authors declare there is no potential conflict of
mothers with a height of 151-160 cm are the most who interest.
gave birth to LBW babies (64.8%). This description is
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