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Birth weight of newborns is a common proxy measure of intrauterine growth, which is influenced by nutrition, environment, socio-economic status and lifestyle factors during the gestation period. The objectives of the present investigation were to understand the influences of maternal age, pregnancy order and seasonal variation in newborn low birth weight (LBW). Data of 13,423 newborn birth weight during the period from July 2007 to June 2010 were recorded from the Siliguri District Hospital of Darjeeling, West Bengal India. The information collected comprised of birth weight, type of pregnancy, maternal age, pregnancy order, month (season) of delivery and residential addresses. The overall mean (±SD) and prevalence of LBW were 2.71±0.41 kg and 19.19 percent (n=2576), respectively. The binary logistic regression analysis showed higher odds values (p<0.01) of LBW with mother’s age < 20 years (Odds: 1.416) and 1st pregnancy order (Odds: 1.636). However, births during spring season exhibited lower odds of LBW (Odds: 0.798) (p<0.01). The maternal age =<20 years and =<1st pregnancy order was associated with LBW (p<0.05). The ROC-AUC analysis showed that pregnancy order (AUC=0.553) was better surrogate associate measure than maternal age (AUC=0.544) for determination of LBW (p<0.05). Early detection in newborns can attain appropriate weight gain and this can be achieved through regular checkup effective implementation of ongoing intervention programmes and appropriate healthcare facilities to prevent intrauterine growth retardation. Address for correspondence: Dr. Nitish Mondal, Ph.D. Assistant Professor Department of Anthropology, Assam University (Diphu Campus), Diphu, District: Karbi Anglong 782 462, Assam, India Mobile: +91-9435508517 E-mail: nitishanth@gmail.com INTRODUCTION Birth weight of newborns is considered being a common proxy measure of intrauterine growth, influenced by socio-economic status, nutrition, environment, lifestyle factors and maternal health services during the gestation period (Christian 2009; Ludwig and Currie 2010; Sen et al. 2010; Yigwan et al. 2012; Amose and Degun 2014; Demelash et al. 2015; Kananura et al. 2017; Mahumud et al. 2017). Low birth weight (LBW) has been defined by the World Health Organization (WHO) as weight at birth of less than 2,500 gm. The LBW is the single most underlying risk factor leading to neonatal mortality and morbidity all over the world (WHO 2003). It has been estimated that 18 million LBW newborns are born worldwide with half of them being in South-Asia and a 20 times higher risk of death than heavier infants (UNICEF 2004). Studies have observed strong associations between LBW and an increased risk of mortality during the periods of neonatal, infancy and later adulthood. In fact, LBW is considered being a risk factor causing developmental retardation during childhood (UNICEF 2004; Mahumud et al. 2017). The prevalence of LBW is positively associated with different short and long-term adverse consequences apparent with fetal development and neonatal mortality and morbidity, inhibiting several significant physical growth and congenital development risk and causing chronic diseases in later life (UNICEF 2004; Sen et al. 2010; Adane et al. 2014; Demelash et al. 2015; Dahlui et al. 2016; Mahumud et al. 2017). The LBW is considered being public health issues in many of the developing countries including India (Bisai et al. 2007; Badshah et al. 2008; Bisai J Life Science, 10(1): 1-9 (2018) DOI: 10.31901/24566306.2018/10.01.221 © Kamla-Raj 2018 2 NITISH MONDAL, SIMA DEY AND JAYDIP SEN 2010; Sen et al. 2010; Bharati et al. 2011; Yilgwan et al. 2012; Adane et al. 2014; Bhaskar et al. 2015; Demelash et al. 2015; Dahlui et al. 2016; Saini et al. 2016; Kananura et al. 2017; Mahumud et al. 2017; Sudha et al. 2017; Kavle and Landry 2018). Children have only a single chance to develop and protection of that one chance demands the commitment that will not be superseded by any other priorities. Many factors observed to have profound effects during the period of gestation are related to maternal, physical and socio-economic environments. They have important roles in determining newborns birth weight and determining future health. Several studies have reported that LBW is affected by maternal nutrition or weight gain during pregnancy (Sen et al. 2010; Ludwig and Currie 2010; Yilgwan et al. 2012; Bhaskar et al. 2015; Demelash et al. 2015; Dahlui et al. 2016; Mahumud et al. 2017; Soltani et al. 2017; Kavle and Landry 2018), socio-economic status (Sen et al. 2010; Demelash et al. 2015; Mahumud et al. 2017; Budree et al. 2017; Sudha et al. 2017) and physical factors, maternal environment, physical activity and healthcare services (Li and Chang 2005; Elshibly and Schmalisch 2008; Demelash et al. 2015; Budree et al. 2017; Kananura et al. 2017; Wang et al. 2017). Maternal factors such as maternal age and pregnancy order are important determinants of birth weight. Significant number of studies have reported effects of maternal age and pregnancy order with newborn birth weight (Badshah et al. 2008; Elshibly and Schmalisch 2008; Christian 2009; Bisai 2010; Sen et al. 2010; Adane et al. 2014; Demelash et al. 2015; Mahumud et al. 2017; Wang et al. 2017). It has also been reported that a wide range of LBW-related morbidity/mortality is influenced by the external environment such as temperature, humidity and rainfall throughout the seasons (Murray et al. 2000; Lawlor et al. 2005; Onyiriuka 2006; Chodick et al. 2007; Strand et al. 2012; Hughes et al. 2014; Lei et al. 2016; Zhang et al. 2017). Infants born during late spring and summer are lighter than those born in winter, which might result from exposure to low winter temperatures during mid-gestation (Murray et al. 2000). Exposure to the low outdoor ambient temperature in the mid-trimester is also associated with LBW (Strand et al. 2012). Understanding the effects of maternal age, pregnancy order and environmental factors associated with birth outcomes, especially LBW will provide useful information to develop strategies for healthcare, appropriated surveillance, and preparedness to reduce related consequences necessary among populations. Identification of the suggested causal environmental factors may have public health implications in the development of primary prevention programs for LBWs in the developing countries such as India.

Association of Maternal Age, Pregnancy Order and Seasonal Variations in Low Birth Weight (LBW) in West Bengal, India