Background: Length is an important neonatal measurement at birth. Many studies in the past have analyzed the birth weight andfactors affecting it but studies that investigated the relationship between maternal factors and birth length are scarce and inconsistent.Purpose: This study was conducted with the aim to estimate the effect of maternal and fetal factors on birth length in singletonpregnancy. Methods: The present cross-sectional observational study was conducted in a tertiary care center in central India duringFebruary 2012. Of 450 deliveries, 191 newborns were included on the basis of inclusion criteria. The weight of the baby was takenby electronic weighing scale, and length was taken with infantometer. Babies were divided into two groups based on Fenton’s chart,and Group A had babies with birth length &lt;3rd centile and Group B had babies with birth length &gt;3rd centile. The effects of factorssuch as maternal age, weight during last trimester of pregnancy, education, maternal and paternal height, parity, socioeconomic status,occupation, and residence were assessed. Fetal factors such as birth weight, sex, and birth order were assessed. Results: On analysisof data, it was found that maternal weight (p&lt;0.001), maternal height (p&lt;0.001), and occupation (p=0.04) was significantly associatedwith the length of the babies. The incidence of low birth length was lesser (53.37%) among housewives as compared to working mothers(72.09%) with p&lt;0.05. Socioeconomic status, paternal height, and parity had no significant relationship with birth length. On analysisof fetal factors, birth weight (p&lt;0.001) and head circumference (&lt;0.001) were significantly associated with birth length. Conclusions: Itmay be concluded that length at birth may be influenced by factors such as maternal weight and occupation, which indirectly show thenutritional status of the mother

Dwivedi, Deepak

Verma, Amit

English

Atharva Scientific Publications (E-Jounals)

Dwivedi and Verma Factors affecting birth length 
Vol 2 | Issue 3 | Jul - Sep 2015 Indian J Child Health 109
Original Article
Maternal and fetal factors affecting birth length of healthy newborn babies: An 
observational study
Deepak Dwivedi, Amit Verma
From Department of Paediatrics, Gandhi Memorial Hospital, Shyam Shah Medical College, APS University, Rewa, Madhya Pradesh, 
India
Correspondence to: Dr. Deepak Dwivedi, Department of Paediatrics, Gandhi Memorial Hospital, Shyam Shah Medical College, APS 
University, Rewa, Madhya Pradesh, India. E-mail: deepakdwi72@gmail.com
Received – 18 April 2015 Initial Review – 25 May 2015 Published Online – 25 July 2015
Abstract
Background: Length is an important neonatal measurement at birth. Many studies in the past have analyzed the birth weight and 
factors affecting it but studies that investigated the relationship between maternal factors and birth length are scarce and inconsistent. 
Purpose: This study was conducted with the aim to estimate the effect of maternal and fetal factors on birth length in singleton 
pregnancy. Methods: The present cross-sectional observational study was conducted in a tertiary care center in central India during 
February 2012. Of 450 deliveries, 191 newborns were included on the basis of inclusion criteria. The weight of the baby was taken 
by electronic weighing scale, and length was taken with infantometer. Babies were divided into two groups based on Fenton’s chart, 
and Group A had babies with birth length <3rd centile and Group B had babies with birth length >3rd centile. The effects of factors 
such as maternal age, weight during last trimester of pregnancy, education, maternal and paternal height, parity, socioeconomic status, 
occupation, and residence were assessed. Fetal factors such as birth weight, sex, and birth order were assessed. Results: On analysis 
of data, it was found that maternal weight (p<0.001), maternal height (p<0.001), and occupation (p=0.04) was significantly associated 
with the length of the babies. The incidence of low birth length was lesser (53.37%) among housewives as compared to working mothers 
(72.09%) with p<0.05. Socioeconomic status, paternal height, and parity had no significant relationship with birth length. On analysis 
of fetal factors, birth weight (p<0.001) and head circumference (<0.001) were significantly associated with birth length. Conclusions: It 
may be concluded that length at birth may be influenced by factors such as maternal weight and occupation, which indirectly show the 
nutritional status of the mother.
Key words: Birth length, Maternal weight, Birth weight
Length is an important neonatal measurement at birth, but factors affecting the length of a baby at birth are less known. Many studies in the past have analyzed 
determinants of birth weight and factors affecting it [1-4]. 
Studies that investigated the relationship between maternal 
factors and birth length are scarce, and those available are 
inconsistent. The length of a fetus is an important factor for 
assessment of antenatal wellbeing, besides length at birth may 
also have an effect on the future height of a baby. Length can be 
an essential indicator for monitoring and evaluating maternal 
and child health programs [5].
This study was conducted with the aim to estimate the effect 
of parental and fetal factors on crown heel length at birth in 
singleton pregnancy in a tertiary care center of the central India.
METHODS
The present cross-sectional observational study was conducted 
in the Department of paediatrics of a tertiary care hospital 
during February 2012. The study protocol was approved by 
Ethics Committee of the Institute. Consecutive sampling was 
done for over a period of time, and all babies who fulfilled 
inclusion criteria during that period were included in the study.
In the month of February 2012, 450 deliveries were there 
in the labor room of the hospital. Of these deliveries, 191 
newborns were included on the basis of following inclusion 
criteria: Single pregnancy with gestational age more than 37 
completed weeks, normal vaginal delivery, and birth weight 
≥2.5 kg. Informed consent from all the parents participating in 
the study was taken. Babies born with assisted/lower segment 
caesarian section (LSCS) delivery, having no antenatal visits, 
with any congenital malformation and parents not willing to 
participate in the study were excluded. Babies born with LSCS 
were excluded from the study to simplify the identification 
of normal newborns because some babies may have some 
problem antenatally for which LSCS was performed. The 
healthy newborn was defined as a baby having no antenatal and 
postnatal morbidity in first 24 h.
Dwivedi and Verma Factors affecting birth length 
Vol 2 | Issue 3 | Jul - Sep 2015 Indian J Child Health 110
These newborns were analyzed in postnatal wards. The 
weight of baby as taken within first 24 h by electronic weighing 
scale with precision of 0.001 kg, length was taken with 
infantometer with precision of 1 mm, and head circumference 
was taken by non-stretchable tape, and babies were divided into 
two groups. Length was plotted in Fenton’s fetal-infant growth 
chart (WHO growth standard version) after 40 completed 
weeks. Separate growth charts were used for boys and girls, 
and babies were divided into two groups Group A and Group B. 
Those babies falling below 3rd centile in gender appropriate 
growth curves were defined as small length at birth [6] and 
were put in Group A while those with above third centile were 
considered to have normal length and were put in Group B.
Maternal factors such as maternal age, education, parity, 
socioeconomic status, occupation, and residence were taken 
from antenatal records of the mother. Maternal weight during the 
last trimester was taken from an electronic weighing scale with 
a precision of 0.01 kg, and height was taken from stadiometer 
with the precision of 1 mm. Paternal height, educational status, 
and occupation were also noted down. Maternal education was 
noted and categorized from illiterate to intermediate and above; 
while according to parity, they were categorized as primiparous 
and multiparous. Socioeconomic status was assessed using 
Kuppuswami index and divided into upper, middle, and lower 
class; and residence was categorized as rural and urban. Fetal 
factors such as weight, sex of the baby, birth order, and head 
circumference were assessed from above mentioned methods.
Statistical Analysis
Demographic factors and clinical characteristics were 
summarized as counts (percentages for categorical variables 
such as maternal occupation, education, and parity, etc., and 
as mean for normally distributed continuous variable such 
as maternal weight, and height, etc.,). Both groups were 
compared using the Chi-square test for categorical variables 
and Student’s t-test was done for continuous variables. The 
multivariate regression analysis stepwise method was done to 
assess the correlation between different variables affecting the 
birth length. Statistical analysis was done by SPSS software 
version 22.
RESULTS
Of the total 191 babies included in the study, 110 (57.5%) babies 
were in Group A and 81 (42.5%) babies were in Group B. Table 1 
summarizes the characteristics of both the groups. Mothers who 
had normal length babies had significantly higher mean weight 
in the last trimester than mothers who had stunted babies 
(p<0.001). Similarly, mean maternal height in Group A was 
153.5 cm (standard error - 0.54) was significantly higher than in 
Group B (151.1±0.54 cm) (p<0.001). There was no significant 
relation birth length with maternal age and paternal height. 
Mean birth weight was higher in Group B 3.1 kg (SE - 0.04) 
than in Group A with mean weight of 2.7 kg (SE - 0.02) and 
mean head circumference was also higher in Group B than 
Group A. Both these parameters were significantly associated 
with birth length.
We analyzed categorical variables with the Chi-square test 
(Table 2). Residence of mother, socioeconomic status, maternal 
education, maternal occupation, birth order, and gender of the baby 
were assessed. We could not find any significant relation among 
these factors and stunting at birth except maternal occupation 
(Table 2). Working mothers had smaller babies as compared to 
non-working mothers in our study with 72.1% stunting in working 
Table 1: Baseline characteristics of both the groups 
studied
Characteristics Mean±SE p-value
Group A 
(<3rd 
percentile)
Group B 
(>3rd 
percentile)
Maternal age (years) 23.4±0.34 23.7±0.35 0.395
Maternal weight (kg) 50.6±0.74 57.5±1.07 <0.001
Maternal height (cm) 151.1±0.49 153.5±0.54 0.001
Paternal height (cm) 166.5±0.67 166.3±0.75 0.857
Birth weight (kg) 2.7±0.02 3.1±0.04 <0.001
Head circumference (cm) 33.6±0.09 34.1±0.10 <0.001
Table 2: Categorical variables studied in relation to birth 
length of babies
Parameter Group A 
(<3rd 
percentile)
Group B 
(>3rd 
percentile)
Total p-value
Residence
Urban 24 (64.9) 13 (35.1) 37 0.41
Rural 86 (55.8) 68 (44.2) 154
Socioeconomic status 
(Kuppuswamy index)
Middle 23 (58.9) 16 (41.1) 39 1
Lower 87 (57.6) 64 (42.4) 151
Maternal education
Illiterate+Primary 31 (52.5) 28 (47.5) 59 0.20
High school+Matric 59 (64.1) 33 (35.9) 92
Inter and above 20 (50) 20 (50) 40
Maternal 
occupation (%)
Housewife 79 (53.3) 69 (46.7) 148 0.04
Working 31 (72.1) 12 (27.9) 43
Parity
Primi 66 (58.4) 47 (41.5) 113 0.887
Multi 44 (56.4) 34 (43.5) 78
Sex of baby
Male 56 (52.3) 51 (47.7) 107 0.13
Female 54 (64.2) 30 (35.8) 84
Dwivedi and Verma Factors affecting birth length 
Vol 2 | Issue 3 | Jul - Sep 2015 Indian J Child Health 111
mothers as compared to 53.3% in housewives, which was statistically 
significant (p=0.04). Most of the working mothers in our study were 
laborers with 27.2% in Group A while 13.5% in Group B (Fig. 1).
Table 3 shows the correlation coefficients of various factors 
studied. Of all factors, maternal weight, and height, birth weight, 
and head circumference were significantly correlated with birth 
length. Table 4 shows the results of stepwise regression analysis 
on birth length with associated factors as independent variables. 
The contribution of birth weight was the strongest with birth 
length. Maternal weight significantly affected the birth length 
and head circumference was also significantly associated. 
Maternal age, socioeconomic status, parity, maternal height, 
paternal height, and gender did not meet the 0.05 significance 
level for entry into the model.
DISCUSSION
Maternal weight and occupational status of the mother have 
an important effect on the birth length of their offspring as 
we have demonstrated in our study [7]. Birth weight and head 
circumference were significantly associated fetal factor. Other 
factors studied such as educational status, parity, socioeconomic 
status, residence, and sex of baby had no effect in birth length. 
Mean maternal age was found to be similar in both groups in 
our study. Elshibly and Schmalisch, in their study in Sudan 
showed that young adolescent women tend to deliver smaller 
babies [8]. Similar findings have been reported by other authors 
also [9,10].
Maternal weight during the last trimester was the most 
important maternal factor affecting the birth length in our 
study. A study in Vienna, Austria showed that obese mothers 
tend to have babies heavier and longer than normal weight 
mothers [11]. Elshibly and Schmalisch [8] and Kumar et al. [9] 
found that the maternal pregnancy weight was significantly 
associated with birth length of the babies. It may be attributed 
to better nutrition and antenatal care to these mothers which 
increase the birth length [12].
In our study, occupation was a variable which was found 
to be significantly associated with the birth length, which may 
show the importance of rest during pregnancy and also the lack 
of the proper nutrition in working mothers due to work pressure. 
However, period of the rest and nutrition during pregnancy were 
not assessed on this study, which is an important limitation of 
our study. Most of the working mothers were laborers in this 
study (Fig. 1), which showed that these mothers may have less 
time for rest during the pregnancy. Similar finding were shown 
in a study held in Europe which showed that the working 
mothers tend to have smaller babies [13].
The effect of maternal height on the crown heel length of 
the newborn has been found to be statistically insignificant 
which is in consonance with findings of another study [14]. 
The length of the babies is distributed almost equally in 
either primipara or multipara mother and rural or urban 
mothers. Birth weight was the major fetal factor affecting 
the birth length. Although, we could not found any relation 
with gender and birth length but in studies conducted in 
Japan and Turkey, gender was significantly correlated with 
birth length [15,16].
The major strength of this study was that all healthy neonates 
born in labor room were taken into account. The limitation of 
the present study may be that the sample size was small. Further 
research is required with sufficient sample size and adequately 
power study (>80%) to support these results.
Table 3: Correlation coefficient of various factors studied 
on birth length
Factor Coefficient p-value
Maternal age 0.11 0.06
Socioeconomic status −0.03 0.34
Gravida −0.02 0.41
Maternal weight 0.45 <0.001
Maternal height 0.19 0.004
Paternal height −0.02 0.40
Birth weight 0.64 <0.001
Gender 0.15 0.41
Head circumference 0.52 <0.001
Table 4: Results of multiple regression analysis of factors associated with birth length (stepwise method)
Dependent variable Independent variable Beta p-value Multiple R Adjusted R2
Birth length Birth weight 0.443 <0.001 0.698 0.479
Maternal weight 0.223 <0.001
Head circumference 0.199 <0.001
Figure 1: Distribution of occupation of mother in both 
groups
Dwivedi and Verma Factors affecting birth length 
Vol 2 | Issue 3 | Jul - Sep 2015 Indian J Child Health 112
CONCLUSION
From this study, it may be concluded that length at birth may be 
influenced by factors such as maternal weight and occupation, 
which indirectly show the nutritional status of the mother. 
Long-term implications of assessing the birth length may 
require further longitudinal follow-up studies. Although, the 
genetic factors have always been known to affect the length of 
a person, but environmental factors may also be an important 
determinant of length.
AUTHORS CONTRIBUTIONS
AV: Collected the data and conducted the study; DD: Helped 
AV in conducting a study and writing the first draft of the 
manuscript conceived and supervised the study. Finalized the 
manuscript and will be the guarantors.
REFERENCES
1. Hirve SS, Ganatra BR. Determinants of low birth weight: A 
community based prospective cohort study. Indian Pediatr. 
1994;31(10):1221-5.
2. Restrepo-Mesa SL, Estrada-Restrepo A, González-Zapata LI, 
Agudelo-Suarez AA, Ronda-Pérez E. Factors related to birth 
weight: a comparison of related factors between newborns 
of Spanish and Colombian immigrant women in Spain. Arch 
Latinoam Nutr. 2010;60(1):15-22.
3. Sachar RK, Soni RK, Singh H, Kaur N, Singh B, Kumar V, et al. 
Correlation of some maternal variables with birth weight. Indian 
J Matern Child Health. 1994;5(2):43-5.
4. Wilcox AJ. Birth weight, gestation, and the fetal growth curve. 
Am J Obstet Gynecol. 1981;139(8):863-7.
5. Shajari H, Marsoosy V, Aslani M, Mohammady MR, 
Heshmaty P. The effect of maternal age, gestational age and parity 
on the size of the newborn. Acta Med Iran. 2006;44(6):400-4.
6. Fenton TR, Kim JH. A systematic review and meta-analysis to 
revise the Fenton growth chart for preterm infants. BMC Pediatr. 
2013;13:59.
7. Sajjadian N, Shajari H, Rahimi F, Jahadi R, Barakat MG. 
Anthropometric measurements at birth as predictor of low birth 
weight. Health. 2011;3(12):752-6.
8. Elshibly EM, Schmalisch G. The effect of maternal 
anthropometric characteristics and social factors on gestational 
age and birth weight in Sudanese newborn infants. BMC Public 
Health. 2008;8:244.
9. Phaneendra Rao RS, Prakash KP, Sreekumaran Nair N. Influence 
of prepregnancy weight, maternal height and weight gain during 
pregnancy on birth weight. Bahrain Med Bull 2001;23(1):22-6.
10. Kumar A, Choudhary K, Prasad S. Maternal and obstetric 
outcome in the north Indian population: A hospital based study. 
J Postgrad Med. 2010;56:192-5.
11. Kirchengast S, Hartmann B. Maternal obesity affects newborn 
somatometrics and vital parameters in a gender typical manner 
– Evidence for the male disadvantage hypothesis. Coll Antropol. 
2013;37(4):1057-63.
12. Lanou H, Huybregts L, Roberfroid D, Nikièma L, 
Kouanda S, Van Camp J, et al. Prenatal nutrient supplementation 
and postnatal growth in a developing nation: An RCT. Pediatrics. 
2014;133:e1001-8.
13. Casas M, Cordier S, Martínez D Barros H, Bonde JP, Burdorf 
A, et al. Maternal occupation during pregnancy, birth weight, 
and length of gestation: Combined analysis of 13 European birth 
cohorts. Scand J Work Environ Health. 2010;36(3):222-30.
14. Mishra D. Clinical Study of Newborns. Thesis for MD 
(Pediatrics). APS University, Rewa; 1998.
15. Yokoyama Y, Sugimoto M, Ooki S. Analysis of factors affecting 
birthweight, birth length and head circumference: Study of 
Japanese triplets. Twin Res Hum Genet. 2005;8(6):657-63.
16.  Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu MM, Akın MA, Çoban D, 
Gökoğlu S, et al. Body weight,  length and head circumference 
at birth in a cohort of Turkish Newborns. J Clin Res Pediatr 
Endocrinol. 2012;4(3):132-9.
Funding: None; Conflict of Interest: None Stated.
How to cite this article: Dwivedi D, Verma A. Maternal and 
foetal factors affecting the birth length of healthy newborn babies: 
An observational study. Indian J Child Health. 2015;2(3):109-112.


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