Maternal risk factors for low birth weight infants: A nested case-control study of rural areas in Kurdistan (western of Iran)


Low Birth Weight, Nested Case Control, Risk Factors, Iran


Infant mortality is among the most important indicators of health and development in global communities. One of the causes of neonatal mortality is low birth weight. This study aims at evaluating the risk factors for LBW in infants.This study was carried out using a nested case-control study in rural areas of Kurdistan province in western Iran in 2015. The selection of case and control groups was based on the nesting using the risk set sampling approach. In total, 182 and 364 subjects were selected for the case group and the control group respectively. Data analysis was performed using the Stata-12 software with the point and spatial estimation of OR using the conditional logistic regression method.The multivariate logistic regression analysis performed shows that the maternal gestational age, the mother’s health history during pregnancy, any medication abuse by the mother, any mental stress during pregnancy, are LBW risk factors (P <0.05). Prevention of LBW is possible by identifying effective factors and performing appropriate interventions in infants with low birth weight. The causes of LBW in global communities are changing rapidly. Mothers with the risk factors reported in this study should be identified and specially treated.


[1] Alexander G, Wingate M, Mor J, Boulet S. Birth outcomes of Asian‐Indian‐Americans. International Journal of Gynecology & Obstetrics 2007;97:215-20.
[2] Zhang Y, Lin L, Cao Y, Chen B, Zheng L, Ge R-S. Phthalate levels and low birth weight: a nested case-control study of Chinese newborns. The Journal of pediatrics 2009;155:500-4.
[3] Demelash H, Motbainor A, Nigatu D, Gashaw K, Melese A. Risk factors for low birth weight in Bale zone hospitals, South-East Ethiopia: a case–control study. BMC pregnancy and childbirth 2015;15:264.
[4] Moraes ABd, Zanini RR, Riboldi J, Giugliani ERJ. Risk factors for low birth weight in Rio Grande do Sul State, Brazil: classical and multilevel analysis. Cadernos de saude publica 2012;28:2293-305.
[5] Moradi G, Khazaei Z, Esmailnasab N, Roshani D, Zokaii M, Ghaderi E, et al. The relationship between maternal diseases during pregnancy and low birth weight: A nested case-control study in rural areas of Kurdistan province (West of Iran). International Journal of Pediatrics 2017;5:5501-14.
[6] Organization WH. Global nutrition targets 2025: wasting policy brief. 2014.
[7] Rahmani K, Zokaei M, Bidarpoor F, Babahajiani S, Nessaei P, Moradi G. Children mortality rate trend in kurdistan province during 2007 to 2011. Iranian Journal of Epidemiology 2014;10:65-72.
[8] Xia W, Zhou Y, Zheng T, Zhang B, Bassig BA, Li Y, et al. Maternal urinary manganese and risk of low birth weight: a case–control study. BMC public health 2016;16:142.
[9] Teklehaimanot N, Hailu T, Assefa H. Prevalence and factors associated with low birth weight in Axum and Laelay Maichew districts, North Ethiopia: a comparative cross sectional study. Int J Nutr Food Sci 2014;3:560-6.
[10] Khazaei S, Mansori K, Khazaei Z, Sani M, Ayubi E. Infant and young child feeding status in Iran compared the different United Nation Regions. International Journal of Pediatrics 2016;4:3639-41.
[11] Goodarzi E, Ghaderi E, Khazaei S, Alikhani A, Ghavi S, Mansori K, et al. The prevalence of transient and permanent congenital hypothyroidism in infants of Kurdistan Province, Iran (2006-2014). International Journal of Pediatrics 2017;5:4309-18.
[12] Derakhshi B, Esmailnasab N, Ghaderi E, Hemmatpour S. Risk factor of preterm labor in the west of iran: a case-control study. Iranian journal of public health 2014;43:499.
[13] Khanal V, Sauer K, Karkee R, Zhao Y. Factors associated with small size at birth in Nepal: further analysis of Nepal Demographic and Health Survey 2011. BMC pregnancy and childbirth 2014;14:32.
[14] Lim JW, Chung S-H, Kang DR, Kim C-R. Risk factors for cause-specific mortality of very-low-birth-weight infants in the Korean neonatal network. Journal of Korean medical science 2015;30:S35-S44.
[15] Wacholder S, Silverman DT, McLaughlin JK, Mandel JS. Selection of controls in case-control studies: II. Types of controls. American journal of epidemiology 1992;135:1029-41.
[16] Holakouie Naieni K, Ostovar A, Danesh A, Sadjedinejad S, Ghalichee L, Moradi G, et al. Comparison of Nested Case-control and Cohort Analysis Methodologies using a District TB Registry Data. Iranian Journal of Epidemiology 2010;6:1-6.
[17] Muchemi OM, Echoka E, Makokha A. Factors associated with low birth weight among neonates born at Olkalou District Hospital, Central Region, Kenya. Pan African Medical Journal 2015;20.
[18] Badshah S, Mason L, McKelvie K, Payne R, Lisboa PJ. Risk factors for low birthweight in the public-hospitals at Peshawar, NWFP-Pakistan. BMC public health 2008;8:197.
[19] Rezaeian M, Goujani R, Sheikh Fathollahi M, Vaziri Nejad R, Manshori A, Razi S. A comparative study on prevalence of preterm birth and low birth weight in Iranians and Afghans races in Rafsanjan Nik-nafs hospital in 2011-2012. Journal of Rafsanjan University of Medical Sciences 2014;13:67-82.
[20] Rosa MId, Pires PDS, Medeiros LR, Edelweiss MI, Martínez-Mesa J. Periodontal disease treatment and risk of preterm birth: a systematic review and meta-analysis. Cadernos de saude publica 2012;28:1823-33.
[21] Ghavi A, Fadakar Sogheh K, Niknami M, Kazemnejad Leili E. Survey associated maternal‏‏ Factors with low-weight infants in Women referred‎ to health centers in Rasht. Journal of Holistic Nursing And Midwifery 2011;21:35-9.
[22] Roudbari M, Yaghmaei M, Soheili M. Prevalence and risk factors of low-birth-weight infants in Zahedan, Islamic Republic of Iran. Eastern Mediterranean Health Journal 2007;13:838-45.
[23] Batist ES. A case-control study of risk factors for low birth weight in the Western Cape: Winelands/West Coast region: University of the Western Cape; 2003.
[24] Raghunath D, Kujur A, Dixit S, Sabnani S, Yadav S, Saroshe S. Multivariate Analysis of the Factors affecting Low Birth Weight-A Case-Control Study in a Tertiary hospital of Central India. Annals of Community Health 2016;4:18-24.
[25] Elhassan EM, Abbaker AO, Haggaz AD, Abubaker MS, Adam I. Anaemia and low birth weight in Medani, Hospital Sudan. BMC research notes 2010;3:181.
[26] Feresu SA, Harlow SD, Woelk GB. Risk factors for low birthweight in Zimbabwean women: a secondary data analysis. PloS one 2015;10:e0129705.
[27] Sharma SR, Giri S, Timalsina U, Bhandari SS, Basyal B, Wagle K, et al. Low birth weight at term and its determinants in a tertiary hospital of Nepal: A case-control study. PloS one 2015;10:e0123962.
[28] Smith GC, Pell JP, Dobbie R. Interpregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study. Bmj 2003;327:313.
[29] Rahmani E, Ahmadi S, Motamed N, Khormoji NN. The Relation Between Vaginal Bleeding During Pregnancy and Preterm Birth in Patients Admitted to Martyrs Hospital in Persian Gulf. INTERNATIONAL JOURNAL OF WOMENS HEALTH AND REPRODUCTION SCIENCES 2016;4:171-5.
[30] Eshraghian M, ABOU AJ, Ghafari Z, RAJAEI S. The Effects of Riskfactor of Pregnancy Period on Infant’s Weight. 2008.
[31] Ghahfarokhi SG, Sadeghifar J, Mozafari M. A model to predict low birth weight infants and affecting factors using data mining techniques. 2018.
[32] Huang H, Coleman S, Bridge JA, Yonkers K, Katon W. A meta-analysis of the relationship between antidepressant use in pregnancy and the risk of preterm birth and low birth weight. General hospital psychiatry 2014;36:13-8.
[33] Karimi A, Daliri S, Sayeh Miri K. The relationship between violence during pregnancy and low birth weight: a meta-analysis study. Journal of hayat 2016;22:216-28.
[34] ANSARI H, Parisai Z, RAHIMI E, Rakhshani F. Relationship between violence exposure pregnancy and neonatal low birth weight: A case-control study. 2008.
[35] Janssen PA, Holt VL, Sugg NK, Emanuel I, Critchlow CM, Henderson AD. Intimate partner violence and adverse pregnancy outcomes: a population-based study. American journal of obstetrics and gynecology 2003;188:1341-7.
[36] El Kady D, Gilbert WM, Xing G, Smith LH. Maternal and neonatal outcomes of assaults during pregnancy. Obstetrics & Gynecology 2005;105:357-63.
[37] Leung W-C, Wong Y, Leung T, Ho P. Pregnancy outcome following domestic violence in a Chinese community. International journal of gynecology & obstetrics 2001;72:79-80.
[38] Fang J, Madhavan S, Alderman M. The influence of maternal hypertension on low birth weight: differences among ethnic populations. Ethnicity & disease 1999;9:369-76.
[39] Kelly TF. Maternal Medical Disorders of Fetal Significance. Avery's Diseases of the Newborn (Tenth Edition): Elsevier; 2018. p. 104-18. e3.