In a recent study published in Communications Medicine, researchers examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of low birth weight (LBW) in India.

Study: Effects of COVID-19 pandemic on low birth weight in a nationwide study in India. Image Credit: Zetar Infinity/Shutterstock.com

Introduction

The COVID-19 pandemic has severely impacted essential maternal and neonatal health services worldwide, leading to a decline in facility-based births and an increase in home births.

Globally, one in four newborns has LBW, with 95% of such births occurring in middle- and low-income countries. LBW infants are likely to have developmental delays, behavioral issues, and cognitive impairment.

About the study

In the present study, researchers evaluated whether birth outcomes were affected during the COVID-19 pandemic in India. They used data from the Indian National Family Health Survey between 2019 and 2021.

The sample included nearly 636,700 households from all districts in the country. The first phase of the survey was conducted from June 17, 2019, to January 30, 2020.

The second phase was conducted between January 2, 2020, and April 30, 2021. The primary outcomes were birth weight and LBW.

Children born in April 2020 or later were included in the pandemic cohort, and those born before 2020 formed the pre-pandemic cohort. Births between January and March 2020 were excluded from the primary analysis.

Pregnancy data were available for 232,920 children. Those with missing birth weight data were excluded. Multivariable linear and logistic models assessed the birth weight and LBW outcomes, respectively. The odds of LBW were compared between the pandemic and pre-pandemic periods.

Analyses were adjusted for gender, maternal age and education, household wealth index, rural residence, religion, caste, and birth order of the child.

Findings

The analytic sample comprised 204,615 children; most children (92%) were born before the COVID-19 pandemic.

There were significant differences in birth weight and LBW prevalence between the two cohorts. On average, the pandemic cohort had a 45 g lower birth weight than the pre-pandemic cohort. The odds of LBW were higher in the pandemic cohort.

In the pandemic cohort, more children were from rural areas, Hindu households, socially disadvantaged scheduled castes and tribes, and the poorest wealth groups; their mothers were younger and had more years of schooling.

Births in the pandemic were associated with an 11 g lower birth weight; Hindu religion, gender, and scheduled caste or tribe were negatively associated with birth weight.

Maternal age, rural residence, and birth order were positively associated with birth weight. Children from wealthier households and those born to educated mothers had a higher birth weight.

The pandemic cohort had 1.08-fold higher odds of LBW. Children born to educated mothers and those from wealthier households had lower odds of LBW.

Children born to mothers with primary education had marginally higher odds of LBW than those born to mothers with secondary education.

The odds of LBW were higher for infants in scheduled caste or tribe households and non-Hindu households than for those in other communities and Hindu households.

Furthermore, the team evaluated the outcomes by serially including births from January to March 2020 in the pre-pandemic cohort.

The results were not significantly different from the primary analysis when children born in January and February 2020 were included. Likewise, including all births from January to March 2020 produced consistent findings.

Conclusions

In sum, the study assessed LBW prevalence during the COVID-19 pandemic in India. The findings show that the birth weight reduced by 11 g during the pandemic, while the incidence of LBW surged.

The study’s limitations include its observational nature, which precludes causal inference, and the lack of COVID-19 infection status of mothers. Besides, birth weight data were based on medical records or the mother’s recall, which could have led to recall bias.