Maternal Investment in Determining Birth Weight: A Study in West Bengal

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Ind. J. Phys. Anthrop & Hum. Genet. Vol. 39, No. 2, (2020) : 87-107
MATERNAL INVESTMENT IN DETERMINING BIRTH
WEIGHT: A STUDY IN WEST BENGAL
NADIRA KALAM, NIVEDITA SOM AND SUBHO ROY
ABSTRACT
The objective of this investigation was to understand how maternal investment
determines birth weight of the last full term singleton live birth. We involved
130 mothers from Kolkata (70) and one adjoining district (60) of West Bengal
who delivered singleton live birth at term. Data were collected on socio-
demogra phic, reproductive char acteristics, antepart um care, reported
antepartum morbidities and lifestyle (consumption pattern and physical
activities) of mothers during the last pregnancy. Multivariate analyses were
conducted to understand the determinants of birth weight of children. The
results suggested that mothers’ educational attainment (below graduate),
occupational types (homemaker), religious affinity (Muslim), age at conception
(in case of the last child), ever use of oral contraceptives, parity, reported
antepartum morbidities, passive smoking and practice of food taboo showed
inverse association with birth weight of children. However, birth interval,
an tep a rt um care (u se o f iron-f oli c acid ta bl e ts and te tan us toxoid
immunization) and lifestyle of mothers showed positive association with birth
weight.
We conclude that socio-demographic, reproductive characteristics, antepartum
care, reported antepartum morbidities, lifestyle of mothers were likely to be
associated with birth weight of children. The findings of the study would
help the policy makers to understand the importance of implementation of a
comprehensive scheme for pregnant mothers that would not only emphasize
on utilization of antenatal services but also in developing the maternal health
awareness.
Keywords: Birth weight, maternal investment, Kolkata, West Bengal
INTRODUCTION
Globally, birth weight is considered to be one of the major risk factors for
morbidity and mortality of children. The World Health Organization estimated
Nadira Kalam, Department of Anthropology, University of Calcutta, 35, Ballygunge Circular Road,
Kolkata-700019, West Bengal; Nivedita Som , (Corresponding author), Department of Anthropology,
Vi ve k an an da Co ll e ge for Wo men , B ar isha, Ko lk ata -700008, We st Ben gal, Email :
nivsom.som@gmail.com and Subho Roy, Professor, Department of Anthropology, University of
Calcutta, 35, Ballygunge Circular Road, Kolkata-700019, West Bengal, Email: srayanth@gmail.com.

Ind. J. Phys. Anthrop & Hum. Genet. Vol. 39, No. 2, (2020)88
that more than 20 million low birth weight (LBW) children are born each year
in developing countries(Watanabe 2008, Blencowe et al., 2019). It is found
that about 72% of LBW children are born in Southern Asia, while about 22% of
LBW in sub Saharan Africa. In India, about 40% of LBW live births occur
every year; however, the incidence of LBW has declined from 20.4% to 16.4% in
the last decade (Khan et al., 2019)
Birth weight is largely associated with factors like, socio-economic milieu of
the family, duration of gestational period, intrauterine growth, maternal age,
nutritional status, antepartum care (including morbidities and lifestyle). Studies
in sub Saharan Africa revealed that lower level of maternal education (Adam et
al., 2019), resource poor condition of the family (Agorinya et al., 2018), maternal
age at conception (Agorinya et al., 2018; Endalamaw et al., 2018), short birth
interval (Endalamaw et al., 2018), lower gestational weeks (Muchemi et al.,
2015), twin pregnancy (Dahlui et al., 2013), maternal dietary prac tices
(Abubakari ,2019; Girma et al., 2019), inadequate intake of iron supplement
(Adam et al., 2019; Girma et al., 2019), reported antepartum morbidities
(anemia) (Agorinya et al., 2018) are significantly associated with odds of LBW
children. Such postnatal outcomes are largely associated with maternal
investment throughout the life. For example, better nutrition received by mothers
since her childhood or at the time of antepartum promotes the nutritional
investment in foetus that subsequently costs to the birth weight of the child.
Thus, LBW is one of the main indicators of lower maternal investment during
pregnancy. Again, reproductive history of mothers (like, birth spacing, healthy
pregnancy at proper age, parity, duration of lactation) also signifies the effect
of the maternal investment on the subsequent reproduction (Coall and Chisholm,
2003; Merklinger-Gruchala, 2019).
In Indian subcontinent, the incidence of LBW has been predicted by various
maternal factors. For example, a study in Pakistan showed that the odds of
LBW live birth increased with reduced intake of vitamin C among pregnant
mothers (Janjua et al., 2008). One recent study in Afghanistan reported that
the incidence of LBW was likely to be lower with increase in educational
attainment of mothers, birth spacing and economic status of family (Das Gupta
et al., 2019). In Nepal, the odds of LBW increased with preterm births, delayed
first antenatal care (ANC) visit, reduced number of ANC visit, lack of consumption
of balanced foods, and iron and calcium supplementation and with reported co-
morbidities (hypertension) during pregnancy (Bhaskar et al., 2015; Bansall et
al., 2019). Similarly, in Bangladesh, preterm births (<37 weeks) and other
maternal factors (like, delayed conception, advanced maternal age and
inadequate ANC visits) were found as the significant predictors of LBW (Kader
and Tripathi 2013; Mahumud et al., 2017).
A study in central India documented that reported antepartum morbidities
(like, anaemia, pregn ancy induced hypertensi on, haemorrhage) wer e
significantly associated with LBW (Jadhao et al., 2016). Taywade and Pisudde

89Birth weight and maternal investment
(2017) reported that maternal age (<20 years or >30 years), nuclear family,
poor standard of living, absence of sanitary latrine were likely to increase the
odds of LBW in Maharashtra. In Tripura, factors like, administration of tetanus
toxoid and regular intake of iron and folic acid tablets during pregnancy lowers
the odds of LBW (Bhattacharjya et al., 2015). Metgud et al. (2012) showed that
exposure to passive smoking, weight gain during pregnancy, birth interval <2
years, early age at first pregnancy and previous history of having child with
LBW were the significant determinants of LBW in rural Karnataka.
In West Bengal, studies revealed that factors like, low gestation, poor
economic status, higher parity, rural residence, inadequate food intake and
irregular consumption of iron and folic acid tablets, obstetric complications,
reported anaemia, addiction to tobacco during pregnancy significantly increased
the odds of LBW (Dasgupta and Basu, 2011; Manna et al., 2013; Kumar et al.,
2018; Chouhan, 2019).
It appears from the review of literature that LBW is a complex phenomenon
and is guided by a plethora of factors, ranging from reproductive history to
socio-economic condition to lifestyle variables. These factors are not universal,
varies widely across the country. Thus, studying the determinants associated
with birth weight would help to understand the overall scenario of health risk
among the children who are the potential human resource of a country. Thus,
we aimed to understand how maternal investment determines birth weight of
the last full term singleton live birth.
MATERIALS AND METHODS
Study area
We conducted this study in the districts of Kolkata and North 24 Paraganas,
West Bengal. Kolkata is a metropolitan city and also the state capital of West
Bengal. The district of North 24 Paraganas is located adjacent to the city of
Kolkata. We chose one public health institution (Nil Ratan Sarkar Medical College
and Hospital) from the city of Kolkata as the study unit. This hospital is located
in the central part of the city, has good infrastructure and facilities and caters
to the needs of a large section of the people. In North 24 Paraganas, the study
was conducted in a health centre (Patulia Health Centre), which is located at
the Khardah Municipality area under the jurisdiction of Barrackpore subdivision.
Both the study areas were selected due to operational convenience.
Study participants
Initially, a total of 165 study participants (mothers) were approached for this
study based on the sole inclusion criteria (i.e. they had delivered singleton live
birth at term).The age of these study participants ranged 15-45 years. Only 70
study participants (those who delivered their last child within the last three
days) were recruited from Nil Ratan Sarkar Medical College and Hospital (NRS),

Ind. J. Phys. Anthrop & Hum. Genet. Vol. 39, No. 2, (2020)90
Kolkata and 60 participants (those who had their last child less than two years
old) from the Patulia Health Centre. The birth weight of the children was collected
from the official records of both the public health institutions. In NRS, the birth
weight (children born within last three days) was collected from the records of
hospital, while in Patulia Health Centre, the birth weight (children aged less
than two years old ) were recorded from the health card of the respective child
who came to visit the health centre for immunization or check up. All these
study participants voluntarily agreed to participate in this study. Only 35
participants (21%) from Patulia Health Centre were excluded from the study as
they could not report the birth weight of their own child. Verbal informed consent
was obtained from the participating mothers. The written informed consent
was received from the authorities of both the NRS Hospital and the Patulia
Health Centre.
Data collection
Each participant was interviewed for socio-demographic characteristics,
reproductive history, antepartum care, reported anterpartum morbidities and
lifestyle (consumption pattern and physical activities) with respect to their last
full term singleton live birth using a pre-tested schedule. This cross-sectional
study was conducted during the months of May to June in the year 2017. The
face to face interview was done by a same sex interviewer (NK).
Data types
Socio-demographic characteristics: Socio-demographic characteristics including
participants’ ages at time of interview and marriage (years), educational levels
and occupational types of both participants and their spouses, and monthly
household expenditure (in Indian Rupees) were recorded.
Reproductive history: Reproductive history including the participants’ ages
at first conception and last conception (years), gestational age of last live birth
(weeks), birth interval (months), parity, ever use of oral contraceptives, mode of
delivery of the last child were recorded.
Antepartum care, morbidities during last pregnancy: Data on antepartum
care during the last pregnancy were collected. The participants were asked to
understand whether they administered tetanus toxoid (TT) injection and iron
and folic acid tablets, the number and interval of TT injection administered,
and the centre from where TT immunization have been taken and the centre
where the participants visited for antenatal check up during the last pregnancy.
Data on reported antepartum morbidities were recorded.
Consumption pattern: The participants were asked to report the food items
consumed during the last pregnancy. Several foods (like carbohydrates, animal
protein, milk and milk products, vegetables, fruits, highly processed foods) were
included in the schedule to record the patterns of food consumption among the

91Birth weight and maternal investment
participants. The participants were further asked whether they remained on
special diet during the last pregnancy. Additionally, information on passive
smoking and practice of food taboo were collected. Each question had a choice
with two binary responses (yes or no).
Physical activities: Physical activities of the participants (regular physical
exercise, sitting light work, sitting moderate work, standing light work, standing
moderate work, standing heavy work and walking a distance) during the last
pregnancy were recorded using a pretested schedule. Each of the activities was
presented with binary response choices (i.e. yes or no). The participants were
asked to respond whether they perform these activities at least three days in a
week during the months of last pregnancy. Sitting light work includes reading
book, working on computer, watching television, listening music while sitting.
Sitting moderate work includes mopping the floor, cooking, cleaning utensils
and washing clothes while sitting. Standing light work indicates cooking while
standing. Standing moderate work indicates cleaning home, dusting while
standing. Standing heavy work denotes picking heavy weight while standing
(e.g. collecting water from well while standing). Walking a distance denotes
walking for work.
Statistical analyses
Descriptive statistics were used to understand the trend in socio-demographic
characteristics, reproductive history, antepartum care, reported antepartum
morbidities and intrapartum problems, lifestyle (physical activities and
consumption pattern) of the mothers. The quartile distribution of birth weight
of the child and gestational age were estimated. Frequencies of both normal
and low birth weight (LBW) were calculated with respect to parity, ages of
mothers at first conception, at the respective conception and gestational age.
LBW was defined by World Health Organization as the birth weight less than
2500grams (United Nations Children’s Fund, & World Health Organization
2004). Chi square test was applied to examine the association of the birth weight
of the last full term singleton live birth with parity, ages of mothers at first
conception as well as for respective live birth, and gestational age. Binary logistic
regression analysis was conducted to predict the occurrence of LBW. Here, birth
weight of the last full term singleton live birth (in binary category: normal birth
weight and low birth weight) was used as dependent variable. Other variables
like socio-demographic characteristics, reproductive history, antepartum care
and reported antepartum morbidities, lifestyle (phy sical activ ities and
consumption pattern) were incorporated as independent variables. The reference
categories of the independent variables were as follows: [religion= Hindu;
educational levels of both participants and spouses= non literate; occupational
types of the participants= service; occupational types of spouses= others]. Later,
hierarchical linear regression analysis was applied to understand the association
of birth weight with socio-demographic characteristics, reproductive history,
antepartum care and reported antepartum morbidities and lifestyle (physical

Ind. J. Phys. Anthrop & Hum. Genet. Vol. 39, No. 2, (2020)92
activities and consumption pattern). In model I, socio-demographic and
reproductive variables were incorporated as independent variables. In model
II, variables, like antepartum care and reported antepartum morbidities, lifestyle
(physical activities and consumption pattern) were used as independent variables.
Here, birth weight was incorporated as the dependent variable. Some of the
categorical variables (educational levels and occupational types of participants
and spouses) were converted into dummy variables as these variables had more
than two categories. All the statistical procedure were performed using SPSS
(Statistical Package for Social Science) version 20.0 (IBM 2011).
RESULTS
The mean ages of the participants and their spouses at the time of interview
were 25.57±5.3 years and 30.75±5.6 years respectively. The mean age at
marriage of the participants was 19.80±4.1 years. About 9.2% of the participants
and 4.6% of their spouses had no formal education, while majority of them
attained education below the 10th standard. The study participants were mostly
homemakers. Spouses of the participants were mostly involved in either business
or service. The median monthly household expenditure was Rs. 5,000. More
than 70% of the participants belonged to the Hindu ethnic group.
The same table also shows that the mean ages at first and last conception of
the participants were 21.41±4.0 years and 24.72±5.2 years respectively. More
than half of the participants had single child. Most of the participants did not
use oral contraceptives. Incidence of caesarean section (70%) during delivery
was common among the participants. The mean gestational age of the participants
during the last pregnancy was 36.20±2.09 weeks. Mean birth interval was
30.20±4.1 months (Table-1).
Table-1: Socio-demographic characteristics and reproductive history of the
participants (n=130)
Socio-demographic characteristics n %
Age of the participants at time of interview (years) mean±sd 25.57± 5.31
Age of the spouse at time of interview (years) mean±sd 30.75±5.68
Age at marriage of the participants (years) mean±sd 19.80±4.10
Educational levels of the participants
Non literate 12 9.2
Primary 49 37.7
Secondary 31 23.8
Higher secondary 20 15.4
Graduate 18 13.8
Educational levels of the spouse
Non literate 6 4.6
Primary 51 39.2
Secondary 34 26.1
Higher secondary 20 15.4
Graduate 19 14.6
Occupational types of the participants
Home maker 125 96.1

93Birth weight and maternal investment
Service 3 2.3
Business 2 1.5
Occupational types of the spouse
Service 46 35.4
Business 47 36.1
Others* 37 28.5
Monthly household expenditure (Indian rupees) median 5,000
Religious affinity
Hindu 94 72.3
Muslim 36 27.7
Reproductive history
Age at first conception (years) mean±sd 21.41±4.09
Age at last conception (years) mean±sd 24.72±5.21
Gestational age of the last pregnancy (weeks) mean±sd 36.20±2.09
Birth interval (months) mean±sd 30.20±4.10
Parity
One 72 55.4
Two 50 38.5
Three 8 6.2
Ever use of oral contraceptives
Yes 8 6.2
No 121 93.9
Mode of delivery of the last child
Vaginal 39 30.0
Caesarean section 91 70.0
*others: pension holders, labours
Birth weight of the last full term singleton live birth increased with the
increase in gestational weeks. For example, children who were born with weight
less than 2.6 kg. had gestational age of 34 weeks and those of 2.8kg, 3.0kg and
4.0 kg had gestational ages of 36, 39 and 41 weeks respectively. An appreciable
section of the participants (39.4%) who had conceived between the ages 26 and
29 years delivered child with LBW. On the other hand, most of the children
with normal birth weight were delivered by the participants who had conceived
below the age of 25 years. Birth weight had significant association with age of
the participants at the time of conception (p=0.007). However, the association of
birth weight with age of the participants at first conception (p=0.689), gestational
age (p=0.084) and parity (p=0.482) were not significant (Table-2).

Ind. J. Phys. Anthrop & Hum. Genet. Vol. 39, No. 2, (2020)94
Table 2: Birth weight of the last full term singleton live birth (n=130)
Quartile distribution of the birth weight and gestational age of the last full term singleton live birth
Quartile Birth weight (kg) Gestational age (weeks)
1st 2.6 34
2nd 2.8 36
3rd 3.0 39
4th 4.0 41
Birth weight of the last full term singleton live birth with respect to the age at first conception
Age at first Normal birth weight Low birth weight Chi square p value
conception (years) value
n % n %
20 and below 40 83.3 9 16.7 1.472 0.689
21-25 21 72.4 8 27.6
26-29 19 82.6 4 17.4
Above 30 23 79.3 6 20.7
Birth weight of the last singleton full term live birth with respect to age at respective conception
Age at first Normal birth weight Low birth weight Chi square p value
conception (years) value
n % n %
20 and below 34 81.0 8 19.0 12.057 0.007
21-25 27 93.1 2 6.9
26-29 20 60.6 13 39.4
Above 30 23 88.5 3 11.5
Birth weight of the last full term singleton live birth with respect to gestational age
Gestational age Normal Low Chi p value
(weeks) birth birth square
weight weight value
n % n % 2.995 0.084
<36 75 76.5 23 23.5
>36 29 90.6 3 9.4
Birth weight of the last full term singleton live birth with respect to parity
Parity Normal Low Chi p value
birth birth square
weight weight value
n % n %
One 56 77.8 16 22.2 0.498 0.482
More than one 48 82.8 10 17.2
About 99% of the participants completed the course of tetanus toxoid injection
and iron and folic acid tablets during the last pregnancy. More than 80% of the
participants administered TT injection twice during the pregnancy period.
Furthermore, about 65% of the participants administered this injection during
the 3rd to 5th months of pregnancy. The participants obtained this tetanus toxoid
injection from the public health institutions (Table-3).
Table 3: Antepartum care of the participants during the last pregnancy (n=130)
Antepartum care n %
Administered tetanus immunization
Yes 129 99.2
No 1 0.8
Tetanus Toxoid (TT) immunization administered
Once 3 2.3
Twice 105 80.8

95Birth weight and maternal investment
Thrice 22 16.9
TT immunization administered during months of pregnancy
<3 11 8.5
3-5 85 65.4
>6 34 26.2
Centre of taking immunization
Government hospital 58 44.7
Private clinic 15 11.5
Voluntary health clinic 57 43.8
Administered iron and folic acid tablets
Yes 129 99.2
No 1 0.8
Centre of visiting doctor
Government hospital 85 65.4
Private clinic 43 33.1
Voluntary health clinic 2 1.5
Less than 15% of the participants reported swelling in hands and feet during
the last pregnancy. The problems of hypertension (6.2%), severe vomiting (7.7%)
and hypothyroidism (6.9%) were also reported by the participants. Apart from these,
a few of the participants reported several health problems, like asthma, shoulder
pain, heartache, urinary infection, anaemia and haemorrhage (Table-4).
Table-4: Reported Antepartum morbidities of the participants during the last
pregnancy (n=130)
Morbidities n %
Antepartum morbidities
Swelling hands and feet 19 14.6
Diabetes 3 2.3
Hypertension 8 6.2
Hypotension 2 1.5
Hyperglycaemia 4 3.1
Severe vomiting 10 7.7
Hypothyroidism 9 6.9
Asthma 6 4.6
Shoulder pain 4 3.1
Stomach upset 2 1.5
Heartache 5 3.8
PCOS 1 0.8
Knee pain 1 0.8
Bleeding/ haemorrhage 3 2.3
Urinary infection 4 3.1
Constipation 1 0.8
Anaemia 3 2.3
Most of the participants were rarely or not engaged in regular physical
exercise during the last pregnancy period, rather were engaged in sitting light
work or in sitting moderate work. Only 40% of the participants were engaged in
standing light work during the last pregnancy. Most of the participants (90.8%)
were not engaged in standing moderate work. None of the participants were
involved in standing heavy work during the pregnancy (not presented in table).
Almost all the participants (99.2%) consumed carbohydrates and vegetables
during the last pregnancy. More than 60% of the participants consumed animal

Ind. J. Phys. Anthrop & Hum. Genet. Vol. 39, No. 2, (2020)96
protein and milk/milk products and fruits. Around one third of the participants
remained on special diet and observed food taboos independently. A substantial
section of the participants (36.9%) was exposed to passive smoking (Table-5).
Table 5: Physical activities and consumption pattern of the participants during the
last pregnancy (n=130)
Physical activities n %
Regular physical exercise
Ye s 5 3.8
No 125 96.1
Sitting light work
Ye s 108 83.1
No 2 2 16.9
Sitting moderate work
Ye s 91 70.0
No 3 9 30.0
Walking a distance
Ye s 98 75.4
No 3 2 24.6
Standing light work
Ye s 54 41.5
No 7 6 58.5
Standing moderate work
Ye s 12 9.2
No 118 90.8
Standing heavy work
Ye s - -
No 130 100.0
Consumption pattern
Carbohydrate s
Ye s 129 99.2
No 1 0.8
Animal protein
Ye s 90 69.2
No 4 0 30.8
Milk/ milk products
Ye s 79 60.8
No 5 1 39.2
Veg etables
Ye s 129 99.2
No 1 0.8
Fruits
Ye s 108 83.1
No 2 2 16.9
Highly processed foods
Ye s 57 43.8
No 7 3 56.2
On special diet
Ye s 49 37.7
No 8 1 62.3
Passive smoking
Ye s 48 36.9
No 8 2 63.1
Followe d food taboo
Ye s 44 33.8
No 8 6 66.2

97Birth weight and maternal investment
Result of binary logistic regression analysis showed that the incidence of
LBW was likely to increase with increase in participants’ age at respective
conception (last live birth) (OR= 1.286), educational levels [(below graduate
level) OR= 1.72], occupational types [(homemakers) OR= 2.20], religious affinity
[Muslim (OR=1.05)], parity (OR= 1.10), use of oral contraceptives (OR= 1.14),
reported antepartum morbidities (OR=1.69), exposure of participants to passive
smoking (OR=1.80), practice of food taboo during pregnancy (OR=1.18). On the
other hand, the incidence of LBW remained lower with increase in participants’
educational levels [graduate (OR=0.21)], monthly household expenditure
(OR=0.99), age at first conception (OR=0.99), gestational age (OR=0.98), birth
interval (OR=0.30), antenatal care [use of TT immunization (OR=0.45), iron/
folic acid tablets (OR=0.09)], physical activities [regular physical exercise
(OR=0.09), sitting light work (OR=0.36), sitting moderate work (OR=0.99),
walking a distance (OR=0.78), standing moderate work (OR= 0.31), standing
light work (OR=0.92)], and food consumption [carbohydrate (OR=0.81), animal
protein (OR=0.06), milk products (OR=0.57), vegetables (OR=0.67), fruits
(OR=0.53), calorie dense foods (OR=0.84)] (Table-6).
Table 6: Results of binary logistic regression analysis (n=130)
Dependent variable Odds ratio(OR) p value
Independent variables
Birth weight of the last full term singleton live birth(occurrence of LBW)
Educational levels of the participants
School levels 1.721 0.802
Graduate 0.217 0.901
Educational levels of spouse 0.413 0.553
Below graduate 0.433 0.638
Graduate
Occupational types of the participants 2.203 0.999
Home makers
Occupational types of the spouse 0.718 0.737
Business 0.742 0.617
Service
Religion 1.056 0.966
Muslim
Monthly household expenditure (Indian rupees) 0.999 0.322
Age at marriage (years) 0.993 0.981
Age at first conception (years) 0.993 0.983
Age at conception of the last child (years) 1.286 0.967
Gestational age of the last child (weeks) 0.983 0.924
Parity 1.102 0.927
Birth interval 0.309 0.783
Ever use of oral contraceptive 1.140 0.808
Administered TT. immunization 0.450 0.998
Administered iron/ folic acid tablets 0.093 0.999
Reported antepartum morbidities 1.693 0.043
Regular physical exercise 0.090 0.144
Sitting light work 0.360 0.412
Sitting moderate work 0.997 0.998
Walking a distance 0.787 0.786

Ind. J. Phys. Anthrop & Hum. Genet. Vol. 39, No. 2, (2020)98
Standing moderate work 0.313 0.534
Standing light work 0.926 0.925
Intake of carbohydrates 0.810 0.998
Intake of animal proteins 0.061 0.055
Intake of milk products 0.573 0.555
Intake of vegetables 0.675 0.976
Intake of fruits 0.532 0.559
Intake of calorie dense foods 0.845 0.839
Passive smoking 1.803 0.614
Followed food taboo 1.188 0.832
Remained on special diet 0.126 0.016
Results of hierarchical linear regression analysis demonstrate the association
of birth weight with socio-demographic characteristics and reproductive history,
antepartum care and reported antepartum morbidities and lifestyle of mothers.
In both the models (model I and model II), all the independent variables did not
show significant association with birth weight. In both the models, variables
like educational levels (up to school level), occupational types (homemaker),
religious affinity (Muslim), age at conception of respective pregnancy (last live
birth), ever use of oral contraceptives and parity of the participants showed
inverse association with the birth weight. In model II, variables like, reported
antepartum morbidities, passive smoking and practice of food taboo showed
inverse association with the birth weight. However, antepartum care (like, TT.
immunization, use of iron and folic acid tablets) and lifestyle [physical activities
(regular physical exercise, sitting light work, sitting moderate work, walking
distance, standing light work, standing moderate work) and consumption pattern
(intake of carbohydrate, animal protein, milk/milk products, vegetables, fruits,
and highly processed food)] showed positive association with the birth weight.
A change in R2 value [model II (0.325) - model I (0.206)] indicates that model II
is more better than model I (Table-7).

99Birth weight and maternal investment
Table 7: Results of hierarchical linear regression analyses (n=130)

Ind. J. Phys. Anthrop & Hum. Genet. Vol. 39, No. 2, (2020)100
DISCUSSION
*B- unstandardized coefficients
DISCUSSION
We aimed to understand how maternal investment determines birth weight of
the last full term singleton live birth. The study findings documented one fifth
of the children were born with LBW, corroborating with the findings from other
states of the country [Karnataka (22.9%), Tripura (23.9%,), Guwahati (26%),
Bhopal (36%), Delhi (39%) and Haryana(17%)] (Chabbra et al., 2004; Metgud
et al., 2012; Bhattacharjya et al., 2015; Gogoi, 2018; Kumar et al., 2017).
When compared with the other districts of West Bengal [Burdwan (27%),
Hooghly (28%), and Malda (36%)], the incidence of LBW among our study
participants seem to be lower (Kumar et al., 2018; Dasgupta and Basu, 2011;
Chouhan, 2019). In our study, birth weight of children was likely to be lower
for mothers who were homemakers, attained education below graduate level
and hailed from Muslim group. Similarly, other studies in India and elsewhere
revealed that both maternal education and occupation significantly predicted
the birth weight of children (Bhaskar et al., 2015; Kumar et al., 2017; Gogoi,
2018; Agorinya et al., 2018). Another study in rural West Bengal showed that
the prevalence of LBW was higher among Muslims than the Hindus (Manna et
al., 2013). Higher educational attainment of mothers probably increases the
level of knowledge and concerns about antenatal care among them that
eventually reduce the odds of LBW. Moreover, employed mothers being
economically independent, could be able to take decision about their own health,
access better medical facilities and develop positive attitudes towards antenatal

101Birth weight and maternal investment
care which possibly lowers the odds of adverse postnatal outcomes.
Literature revealed that despite socio-demographic factors, reproductive
history of mothers was indeed responsible to determine the birth weight of
children. Maternal age at conception was a significant factor to predict postnatal
outcomes (Kenny et al., 2013). Our study showed that the birth weight of children
was likely to decline with early age at first conception and also with advanced
age at respective conception. The odds of LBW increased if mothers conceived at
an early age (Aras, 2013; Mahumud et al., 2017). It is probable that women
belonging to economically deprived families usually get married and conceive
at an early age and remain casual in availing antepartum care (Boamah et al.,
2016; Awasthi et al., 2018). Pregnancy at advanced age also increases the odds
of LBW (Lampinen et al., 2009; Mahumud et al., 2017). However, a recent
study in India documented that mothers of advanced age could have better
knowledge about nutrition and access proper utilization of maternal health care
services, which may lower the odds of LBW (Khan et al., 2019). Two case-control
studies in Ghana and Ethiopia reported that the cases of LBW occurred mostly
in association with short gestational weeks (Adam et al., 2019; Girma et al.,
2019). Similarly, like other studies in India (Dasgupta and Basu, 2011; Jhadhao
et al., 2016), our findings documented an association of the incidence of LBW
with short gestational age. Perhaps, the growth and development of foetus
become impaired with reduced gestational weeks (Di Pietro, 2008). Thus, it is
evident that shorter length of gestation is usually related to the occurrence of
preterm birth, which subsequently increases the odds of LBW and develops the
risk for infant mortality (Bansall et al., 2019). An inverse association of birth
weight with parity has been observed in our study supporting the fact that
high parity could have some adverse effects on birth weight (Celik and Younis,
2007; Manna et al., 2013). Mothers having three or more children were at an
increased risk of delivering live birth with LBW (Nobile et al., 2007). On the
contrary, Boo et al. (2008) and Anitha et al. (2009) demonstrated that odds of
LBW remained low in case of birth of first child. Parallel to this, birth interval
becomes a major factor indicating the postnatal outcome. Studies showed that
birth weight of children had positive association with birth interval, which
corroborates with our study. It seems that short inter-pregnancy interval depletes
maternal nutrient stores which adversely affects on maternal weight gain and
haemoglobin level. These adversities in maternal health increase the odds of
LBW for subsequent live births (Zhu et al., 1999; Black et al., 2008; Misra, et
al., 2015). Our findings showed that the birth weight of children was likely to
be lower with ever use of oral contraceptives. Prolonged use of oral contraceptives
before conception imposes a greater risk on birth outcome (Hatch et al., 2015).
However, contraception is highly recommended to increase inter pregnancy
interval, thereby mothers are advised to adopt exclusive breastfeeding as a
dedicated method of contraception (Sridhar and Salcedo, 2017).
Studies showed that antepartum care and morbidities had significant effect
on birth weight of children (Abdal Qader et al., 2012; Palve, 2016). It is usually

Ind. J. Phys. Anthrop & Hum. Genet. Vol. 39, No. 2, (2020)102
found that those mothers who received antenatal care were more likely have
live births with normal birth weight compared to those who never received such
care (Malik et al., 1997; Ahmed et al., 2012). Regular intake of iron and folic
acid tablets and administration of complete course of TT immunization by the
mothers in our study might indicate higher level of awareness about antepartum
care. Thus, the positive association of birth weight with antepartum care (like
use of iron-folic acid tablets and TT immunization) as found in our study supports
the existing literature (Sinha, 2006). Simultaneously, antepartum morbidities
as reported by the mothers in our study possibly leads to growth retardation in
foetus (Sharma et al., 2016; Battarbee et al., 2019). Therefore, the chances of
LBW increase if mothers develop co-morbidities during pregnancy (Bhaskar et
al., 2015; Girma et al., 2019). Hence, late visits to doctors during pregnancy
could bring the complicacy in health and subsequently may increase the odds of
LBW (Manna et al., 2013).
Lifestyle (consumption pattern and physical activities) of mothers during
pregnancy also affects birth weight of children. The consumption of balanced foods
provides nutrition among pregnant mothers and subsequently helps in development
of foetus. Thus, healthy dietary habits of mothers during pregnancy promote
healthy live birth with normal body weight and simultaneously reduce the odds of
LBW. One study showed that LBW is primarily caused by low gestational weight
gain due to low energy intake (Kramer, 2003). Our study revealed that birth weight
was likely to increase if mothers consumed animal proteins, carbohydrates, milk/
milk products, vegetables and fruits during antepartum period. This finding
corroborates with others studies (Poon et al., 2013; Abubakari and Jahn, 2016).
However, two studies in Ethiopia reported that taboos related to intake of certain
food items might cause adverse effects on nutritional status of pregnant mothers,
thereby resulting into adverse pregnancy outcomes (Zerfu et al., 2016; Vasilevski
and Carolan-Olah, 2016). A study in rural West Bengal reported that pregnant
women followed food taboos in order to prevent miscarriage and foetal malformation,
and promote delivery with ease. In addition to unhealthy dietary practices, substance
use is also responsible for developing the odds of LBW. For example, the habit of
smoking and alcohol consumption at the time of pregnancy may diminish foetal
growth by altering the function of the placenta (Wang et al., 2014). In our study, it
appears that reduction in birth weight is likely to be reduced for women who were
passive smokers. Likewise, a recent study in Malaysia found that mothers who
remained passive smokers during pregnancy had delivered the child with LBW
(Norsa’adah and Salinah, 2014). Physicians generally advice pregnant mothers to
get involved in either light household chores or light physical exercise on the regular
basis that would maintain the regulation of hormonal levels in body and
subsequently alleviate the problems at intrapartum. Some studies reported that
intrapartum issues often caused to affect postnatal outcomes (Muchemi et al., 2015).
Thus, regular involvement in physical activities (like physical exercise and light
household chores) was positively associated with birth weight of children as observed
in our study.

103Birth weight and maternal investment
Recently, Government of India has implemented a scheme through Pradhan
Mantri Matru Vandana Yojona to ensure the utilization of antenatal services
among pregnant mothers in exchange of conditional cash transfer and thereby
encourages them to register at the health centre within four months of conception,
attend at least one prenatal care session and regular use of iron-folic acid tablets
and TT immunization. However, various factors (like, lower maternal education,
lower economic status, spouse negligence during antenatal visits, higher parity,
pregnancy at adolescence and unintended pregnancy) were found to be
associated with lower odds of full ANC utilisation (Kumar et al., 2019). Our
findings implied how socio-demographic, r eproductive characteristics,
antepartum care, reported antepartum morbidities and lifestyle of mothers during
pregnancy determined the birth weight of children.
LBW is indicative of lower maternal investment that can be traced back
throughout the lives of mothers. Here, life history of mothers provides important
insights into the potential role on birth weight of children in human reproductive
strategies. Understanding the effects of life history and subsequent maternal
investment on birth weight of child indicates the trade-off between current and
future reproduction. Furthermore, maternal nutritional investment throughout
the life and also at antepartum stage promotes the growth and development of
foetus that eventually have an influence on the birth weight of children (Coall
and Chisholm, 2003; Merklinger-Gruchala, 2019). Repetition of this type of
study focusing on relation between maternal investment and birth weight would
perhaps be useful in further reducing the LBW across the country.
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