Assessment of fetal malnutrition by body mass index and intra uterine growth curves: a comparative study


  • Madhava Kamath K. Department of Pediatrics, K. S. Hegde Medical College, Deralakatte, Mangalore
  • Swathi S. Rao Department of Pediatrics, K. S. Hegde Medical College, Deralakatte, Mangalore
  • Rathika D. Shenoy Department of Pediatrics, K. S. Hegde Medical College, Deralakatte, Mangalore



Body Mass Index, Fetal Malnutrition, Intra uterine growth curves, Perinatal complications


Background:Assessment of fetal malnutrition (FM) is incomplete by intra uterine growth (IUG) charts where only single anthropometric measure like weight is used. Body mass index (BMI) is a weight to length ratio which is a sensitive indicator of malnutrition. This study was aimed at comparing the accuracy of various birth weight based IUG charts with Body mass index of the new-born babies in detection of FM and correlating the neonatal complications with the BMI and the birth weight.  

Methods: A cohort study was done with a sample of 1192 newborn babies with gestational ages from 34 to 40 weeks. The newborns were classified based on BMI and birth weight after plotting on the BMI charts and various IUG charts. The accuracy of the various IUG charts in identifying FM when compared to BMI was analyzed and correlated with neonatal complications.  

Results:The prevalence of FM was 26.59% on classifying using BMI charts which was the highest when compared to the IUG charts. The IUG charts misclassified the undernourished babies as well nourished. The incidence of complications was 26.3% among the babies with low BMI when compared to normal BMI (14.8%). The classification of the newborns according to IUG charts did not correlate with incidence of complications.

Conclusions:BMI chart is most sensitive indicator of FM at birth and its use is highly recommended in a developing country like India. It helps us to target the under nourished babies, provide better nutritional care and also anticipate and prevent neonatal complications. 


Ezenwa BN, Ezeaka VC, Ihora E, Egri-Okwaji MT. Determination of Fetal Malnutrition in Preterm new borns. J Food Nutr Sci. 2013;1:50-6.

Olsen IE, Groveman SA, Lawson L, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatr. 2010;125:e214-23.

Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from live born birth-weight data at 24 to 42 weeks of gestation. Pediatr. 1963;32:793-800.

Singh M. Care of the newborn. 8th ed. Noida: CBS Publishers;2015:310.

Olsen IE, Lawson L, Ferguson AN, Cantrell R, Grabich SC, Zemel BS et al. BMI curves for Preterm Infants. Pediatr. 2015;135:572-81.

Georgieff MK, Sasanow SR, Mammel MC, Periera GR. Mid-arm circumference/head circumference ratios for identification of symptomatic LGA,AGA and SGA new born infants. J Pediatr. 1986;109:316-21.

Soundarya M, Basavaprabhu A, Raghuveera K, Baliga BS, Shivanagaraja BSV. Comparative Assessment of Fetal Malnutrition by Anthropometry and CAN Score. Iran J Pediatr. 2012;22:70-6.

Thammanna PS, Sandeep M, Sridhar PV. A comparative study to assess fetal malnutrition by Clinical Assessment of Nutritional Status Score (Can score) and anthropometric Indices. J Evid Based Med Health. 2015;2:5820-7.

Kamalammal R, Rao S, Parameshwari PJ. Body mass index values for term new borns and its correlation with other anthropometric surrogates. Intl J Contemp Pediatr. 2016;3:120-4.

Singhal V, Agal V, Kamath N. Detection of fetal malnutrition by CAN score at birth and its comparison with other methods of determining intrauterine growth. Indian J Clin Pract. 2012;22:576-81.

Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatr. 1966;37:403-8.

Miller HC, Hassanein K. Diagnosis of impaired fetal growth in new born infants. Pediatr. 1971;48:511-22.

Milovanovic I, Njuieyon F, Deghmoun S, Chevenne D, Levy-Marcha C, Beltrand J. Innate small babies are metabolically healthy children. J Clin Endocrinol Metab. 2012;97:4407-13.

Brock RS, Falcao MC, Leone C. Body mass index values for new borns according to gestational age. Nutr Hosp. 2008;23:487-92.

Olsen IE, Lawson L, Meinzen-Derr J, Sapsford AL, Schibler KR, Donovan EF et al. Use of body proportionality Index for Growth Assessment of Preterm Infants. J Pediatr. 2009;154:486-91.

De Cunto A, Paviotti G, Ronfani L, Travan L, Bua J, Cont et al. Can body mass index accurately predict adiposity in new borns? Arch Dis Child Fetal Neonatal Ed. 2014;99:F238-9.






Original Research Articles