The performance of various anthropometric assessment methods for predicting low birth weight in adolescent pregnant women

Barros, Denise Cavalcante de; Saunders, Cláudia; Santos, Marta Maria Antonieta de Souza; Líbera, Beatriz Della; Gama, Silvana Granado Nogueira da; Leal, Maria do Carmo

doi:10.1590/1809-4503201400030015

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Original Articles • Rev. bras. epidemiol. 17 (3) • Jul-Sep 2014 • https://doi.org/10.1590/1809-4503201400030015 copy

The performance of various anthropometric assessment methods for predicting low birth weight in adolescent pregnant women

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To evaluate the performance of various anthropometric evaluation methods for adolescent pregnant women in the prediction of birth weight.

Methods:

It is a cross-sectional study including 826 adolescent pregnant women. In the pre-pregnancy body mass index (BMI) classification, the recommendations of the World Health Organization were compared with that of the Brazilian Ministry of Health and the Institute of Medicine (IOM) of 1992 and 2006. The gestational weight gain adequacy was evaluated according to the classification of IOM of 1992, of 2006 and of the Brazilian Ministry of Health. The newborns were classified as low birth weight (LBW) or macrosomic. Multinomial logistic regression was used for statistical analysis and sensibility, specificity, accuracy, positive and negative predictive values were calculated.

Results:

The evaluation, according to the Brazilian Ministry of Health, showed the best prediction for LBW among pregnant women with low weight gain (specificity = 69.5%). The evaluation according to the IOM of 1992 showed the best prediction for macrosomia among pregnant women with high weight gain (specificity = 50.0%). The adequacy of weight gain according to the IOM of 1992 classification showed the best prediction for LBW (OR = 3.84; 95%CI 2.19 - 6.74), followed by the method of the Brazilian Ministry of Health (OR = 2.88, 95%CI 1.73 - 4.79), among pregnant women with low weight gain.

Conclusion:

It is recommended the adoption of the Brazilian Ministry of Health proposal, associated with BMI cut-offs specific for adolescents as an anthropometric assessment method for adolescent pregnant women.

Pregnancy in adolescence; Body mass index; Weight gain; Birth weight; Nutrition assessment; Anthropometry

Variables (n)	Birth weight (%)
Variables (n)	Low weight	Adequate		Total (n)	p-value
Age in years (799)					0.184
12 – 15	13.8	78.5	7.7	8.1 (65)
16 – 17	11.2	86.7	2.2	34.8 (278)
18 – 19	10.1	85.3	4.6	57.1 (456)
Caucasian (793)					0.806
Yes	11.3	84.4	4.3	50.2 (398)
No	10.1	86.1	3.8	49.8 (395)
Water supply source (799)					0.906
Piped water at home	10.9	85.2	3.9	92.1 (736)
Outside home	9.5	85.7	4.8	7.9 (63)
Years of school education (798)					0.189
Up to 3	7.1	92.9	0.0	3.5 (28)
4 to 5	11.0	81.6	7.4	17.0 (136)
6 or more	10.9	85.6	3.5	79.4 (634)
Prenatal medical visits (772)					0.002
Up to 4	26.7	70.0	3.3	7.8 (60)
5 to 6	10.8	85.4	3.7	34.7 (268)
7 or more	7.7	87.8	4.5	57.5 (444)
Type of birth labor (798)					0.342
Normal	11.3	85.3	3.4	66.4 (530)
Caesarean	9.3	85.4	5.2	33.6 (268)
Adequacy of gestational WG* (799)					0.000
Low	20.1	79.2	0.7	37.3 (298)
Adequate	5.9	89.2	4.9	36.0 (288)
High	4.2	88.3	7.5	26.7 (213)
Adequacy of gestational WG ** (799)					0.000
Low	19.6	80.0	0.4	35.0 (280)
Adequate	7.5	87.5	5.0	35.0 (280)
High	4.2	88.7	7.1	29.9 (239)
Adequacy of gestational WG *** (799)					0.000
Low	19.7	78.9	1.3	37.4 (299)
Adequate	6.2	89.4	4.4	34.2 (73)
High	4.4	88.5	7.0	28.4 (227)
Apgar acore at minute 1 < 7 (739)					0.000
Yes	24.8	67.3	7.9	13.7 (101)
Gestational Diabetes (789)					0.024
Yes	0.0	80.0	20.0	1.3 (10)
Gestational age < 37 weeks (799)					0.000
Yes	48.1	50.0	1.9	13.0 (104)
Infant death (791)					0.000
Yes	57.1	42.9	0.0	1.8 (14)
Global Total (799)	10.8	85.2	4	100.0

	Pre-gestational nutritional status classification method
	WHO (2007)*	IOM (2009)		IOM (1992)
Pre-gestational nutritional status (n = 826)	% of mothers	% of mothers	% of concordance with the WHO (2007)	% of mothers	% of concordance with the WHO (2007)
Low weight	2.5	3.3	99.3	36.6	66.0
Adequate	83.9	86.9	95.5	55.3	60.5
Overweight	11.5	8.5	95.5	5.9	94.2
Obesity	2.1	1.3	99.3	2.2	99.6
Total			94.8		60.2
K			0.80 (95%CI 0.74 – 0.86)		0.23 (95%CI 0.18 – 0.28)
Adjusted k			0.93		0.47 (95%CI 0.40 – 0.54)

Birth weight	Weight gain adequacy	Se (%)	Sp (%)	PPV (%)	NPV (%)	Accuracy (%)
Low weight	IOM (1992)*	68.6	66.4	19.7	5.4	66.6
	IOM (2009)**	62.8	68.3	19.2	6.1	67.7
	(MOH, 2006)***	61.6	69.5	19.5	6.2	68.6
Macrosomia	IOM (1992)*	25.4	50.0	92.6	97.3	26.3
	IOM (2009)**	28.8	43.8	92.6	97.6	29.4
	(MOH, 2006)***	29.9	31.3	91.4	98.2	30.0

Birth weight situation	Model of regression by gestational weight gain adequacy
	Model 1 - IOM (1992)*		Model 2 - IOM (2009)**		Model 3 - MOH (2006)***
	Raw OR	Adjusted OR	Raw OR	Adjusted OR	Raw OR	Adjusted OR
Low weight1
Low gestational weight gain	3.84 (2.19 – 6.74)	3.66 (2.22 – 6.05)	2.85 (1.82 – 4.46)	2.62 (1.76 – 3.90)	2.88 (1.73 – 4.79)	2.60 (1.62 – 4.16)
Up to 5 prenatal medical visits	2.07 (1.35 – 3.16)	1.69 (1.16 – 2.45)		1.76 (1.21 – 2.55)		1.74 (1.18 – 2.56)
Less than 6 years of school education	0.60 (0.15 – 2.43)	0.21 (0.22 – 2.10)		0.23 (0.23 – 2.16)		0.22 (0.23 – 2.13)
Macrosomia2
Over gestational weight gain	1.56 (1.04 – 4.49)	1.55 (1.04 – 4.45)	1.59 (1.05 – 3.87)	1.56 (1.03 – 3.87)	2.42 (1.05 – 6.84)	2.37 (1.03 – 6.80)
Up to 5 prenatal medical visits	0.73 (0.30 – 1.78)	0.92 (0.37 – 2.33)		0.91 (0.36 – 2.32)		0.93 (0.36 – 2.40)
Less than 6 years of school education	1.76 (0.96 – 3.30)	2.80 (1.46 – 5.37)		2.98 (1.49 – 5.94)		3.61 (1.67 – 7.80)

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[1] Corresponding author: Denise Barros Rua Leopoldo Bulhões, 1480, sala 103 Prédio Joaquim Alberto Cardoso de Melo Manguinhos, CEP: 21041-210, Rio de Janeiro, RJ, Brasil E-mail: barrosdc@ensp.fiocruz.br