Relative impact of pre-eclampsia on birth weight in a low resource setting: a prospective cohort study

Abstract Objectives Low birth-weight is a major risk factor for perinatal death in sub-Saharan Africa, but the relative contribution of determinants of birth-weight are difficult to disentangle in low resource settings. We sought to delineate the relationship between birth-weight and maternal pre-eclampsia across gestation in a low-resource obstetric setting. Study design Prospective cohort study in a tertiary referral centre in urban Uganda, including 971 pre-eclampsia cases and 1,461 control pregnancies between 28-42 weeks gestation. Main outcome measures Nonlinear modeling of birth-weight versus maternal pre-eclampsia status across gestation. Models were adjusted for maternal-fetal characteristics including maternal age, parity, HIV status, and socio-economic status. Propensity score matching was used to control for the severity of pre-eclampsia at different gestational ages. Results Mean birth-weight for pre-eclampsia cases was 2.48kg (±0.81SD) compared to 3.06kg (±0.46SD) for controls (p Conclusions Pre-eclampsia is the dominant predictor of birth-weight in low-resource settings and hence likely to heavily influence perinatal survival. The impact of pre-eclampsia on birth-weight is smaller with advancing gestational age, a difference that is not fully explained by controlling for pre-eclampsia severity.