Trends, determinants, and anthropometric consequences of low birthweight in Indian children: A prospective analysis of national data

Background Low birthweight (LBW) is a major concern for child survival and growth, and India accounts for the highest number of such cases globally. Studies have examined determinants of birthweight and child growth but little evidence exists on how birthweight influences growth outcomes during early childhood. This paper examines associations between maternal, household, and health-related factors, LBW, and growth faltering, and explores childhood growth trajectories across birthweight groups.

Methods Data from three waves of India’s National Family Health Survey were used to examine heaping-adjusted trends and predictors of LBW. Regression-based decomposition was used to quantify the way in which changes in predictors could reduce future LBW prevalence. Trajectories of childhood anthropometry by LBW status and determinants were examined by using smoothing and regression methods.

Results The LBW prevalence between 2000 and 2020 was 20% (unadjusted) and 40% (heaping-adjusted). Improvements in maternal stature, weight, household wealth, and antenatal care coverage could yield the largest future reductions in LBW. Children born with LBW had 1.5 times higher odds of being underweight and 1.3 times higher odds of stunting. Maternal short stature, underweight, and poverty were associated with higher odds of subsequent anthropometric faltering regardless of LBW.

Conclusion
Findings show the dominant role of maternal nutrition in birthweight and childhood growth outcomes. Once a child is born with LBW, there is limited potential to prevent subsequent anthropometric failure. To break the intergenerational cycle of undernutrition, programs must prioritize improved nutrition for girls beginning early in life and sustained through adolescence and preconception.