Low Birth Weight Neonates in The Gambia & Burkina Faso: Prevalence, risk factors, and short-term adverse outcomes from a prospective observational study utilising trial data

Introduction: Approximately 20 million neonates are born with low birth weight (LBW) annually, with West Africa bearing the highest burden of LBW and associated poor outcomes. This study aims to estimate the prevalence of LBW, identify maternal and foetal risk factors, and describe associated adverse perinatal and neonatal outcomes in a West African cohort. Methods: These are secondary analyses of data from a randomised clinical trial (PregnAnZI-2). Pregnant women without known acute or chronic conditions were enrolled during labour at ten primary and secondary health facilities in The Gambia and Burkina Faso (2017-2021). Birth weight was measured within 24h of birth using standardised methods. Logistic regression was applied to identify associations between LBW and both selected risk factors and adverse outcomes, guided by a novel conceptual framework. Results: 11,980 women and their 12,027 offspring were included in this study. The overall prevalence of LBW was 9.6% (1159/12027): 8.2% (551/6681) in The Gambia and 11.4% (608/5346) in Burkina Faso. Maternal risk factors for LBW included maternal ethnicity (p<0.001), primiparity (aOR 1.63, 9% CI 1.33-1.99, p<0.001), and previous history of stillbirth (aOR 1.88, 95% CI 1.35-2.62, p<0.001), while foetal risk factors included female sex (aOR 1.58, 95% CI 1.38-1.80, p<0.001) and twin birth (aOR 22.96, 95% CI 18.51-28.48, p<0.001). LBW newborns had increased risk of neonatal mortality (cOR 4.35, 95% CI 3.25-5.81, p<0.001); intrapartum stillbirth (cOR 3.37, 95% CI 2.07-5.51, p<0.001); neonatal hospitalisation (cOR 2.17, 95% CI 1.70-2.77, p<0.001); and intrapartum-related asphyxia defined as 1-min Apgar score <7 (cOR 2.04, 95% CI 1.59-2.62, p<0.001). 30.7% (69/225) of neonatal deaths and 26.2% (22/84) of intrapartum stillbirths were attributable to LBW. Conclusion: This study underlines the substantial contribution of LBW towards adverse perinatal and neonatal outcomes in West Africa. Early identification of in-utero growth restriction and women at risk of preterm delivery could enable targeted antenatal interventions and timely referral for hospital delivery, improving perinatal and neonatal outcomes to reach Sustainable Development Goal 3.2.