Detection of fetal malnutrition and its associated maternal factors in a rural setting


  • Alok M. Janardhan Consultant Pediatrician, Shrinivasa Nursing Home, Sakleshpur, Karnataka
  • Sandhya Alok Consultant Pediatrician, Shrinivasa Nursing Home, Sakleshpur, Karnataka
  • Leelavathi Janardhan Consultant Obstetrician and Gynaecologist, Shrinivasa Nursing Home, Sakleshpur, Karnataka



CAN score, Fetal malnutrition, Kanawati index, Maternal factors, Ponderal index


Background: The objectives of study were to analyse and compare the methods for detection of fetal malnutrition and to study the maternal factors associated with fetal malnutrition in babies born in rural hospitals.

Methods: Periodic prospective cross-sectional case-control questionnaire-based study. Nursing home and Hospital based in rural population from January 2017-March 2018. There were 350 term newborns born in Shrinivasa Nursing Home, and Crawford General Hospital, Sakleshpur, were selected consecutively. Inclusion criteria: live, singleton term neonates. Exclusion criteria: Preterms, post-terms, those with congenital malformation, multiple gestations, cephalhematoma, subgaleal bleed. Anthropometry, fetal malnutrition assessed using clinical assessment of nutrition (CAN) score, Ponderal and Kanawati indices between 24–48 hours of birth. Newborns with fetal malnutrition (cases), and well-nourished babies (controls) assessed for maternal risk factors using standardised questionnaire from mothers.

Results: CAN score identified 185 (52.9%) as malnourished and 165 (47.1%) as normal; Ponderal index classified 170(48.6%) as malnourished and 180 (51.4%) normal. Kanawati index grouped 151 (43.1%) as malnourished. Maternal factors:  age (91.7% among <20 yr mothers-malnourished, 25% among >35 yrs), socioeconomic status (status 3, 4 had 57.2%, 66.7% malnourishment), improper antenatal care(80.7% irregulars; 38.5% among regulars), primiparity (60%;against  38.3% among multipara), pre-eclampsia (78.7%; 41.3% in normotensives), anemia (55.4%), weight gain (83.2% in <10 kg; 33.33% in >10 kg), stature (73.5% in <145 cm; 39.7% in >145 cm), medical illness (55.81%).

Conclusions: CAN score is simple, systematic, clinical method of identifying malnutrition; statistically superior as screening tool. Maternal factors: improper antenatal checkups, primiparity, pre-eclampsia, medical illness, inadequate weight gain, short stature had significant association with fetal malnutrition. Maternal age, socioeconomic status, anemia not statistically significant.

Author Biographies

Alok M. Janardhan, Consultant Pediatrician, Shrinivasa Nursing Home, Sakleshpur, Karnataka

Consultant Pediatrician

Sandhya Alok, Consultant Pediatrician, Shrinivasa Nursing Home, Sakleshpur, Karnataka

Consultant Pediatrician

Leelavathi Janardhan, Consultant Obstetrician and Gynaecologist, Shrinivasa Nursing Home, Sakleshpur, Karnataka

Consultant Obstetrician and Gynaecologist


Scott KK, Usher RH. Epiphyseal development in fetal malnutrition syndrome. N Engl J Med. 1964;270:822-24.

Henriksen T. Fetal nutrition, fetal growth restriction and health later in life. Acta Paediat. 1999,429:4–8.

Metcoff J. Clinical assessment of nutritional status at birth. Fetal malnutrition and SGA are not synonymous. Pediatr Clin North Am. 1994;41:875–91.

Jayant D, Rajkumar J. Study of the prevalence and high risk factors for fetal malnutrition in term newborns. Ann Trop Paediatr. 1999;19:273–77.

Scott KK, Usher RH. Fetal malnutrition: Its incidence causes and effects. Am J Obstet Gynaecol. 1966;94:951-63.

Fok TF, Hon KL, Ng PC, Wong E, So HK, Lau J, et al. Use of anthropometric indices to reveal nutritional status: normative data from 10,226 Chinese neonates. Neonatology. 2009;95(1):23-32.

Villar J, Alobelli L, Kestler E, Belizan J. Health priorities for developing countries. The prevention of chronic fetal malnutrition. Bull World Health Organ. 1986;64:847-55.

Meadow NJ, Till J, Leaf A. Screening for intrauterine growth retardation using ratio of mid arm circumference to occipito frontal circumference. Br Med J. 1986;292:1039-40.

Mohan M, Chellani HK, Prasad SR, Kapani V. Intrauterine growth predictors. Indian Pediatr. 1991;28:1299-304.

WHO. Meeting of Advisory Group on Maternal Nutrition and Low Birthweight Geneva. 2002:4-6.

Kushwaha KP, Rai AK, Rathi AK, Singh YD, Sirohi R. Pregnancies in adolescents: Fetal, neonatal and maternal outcome. Indian Pediatr. 1993;30:501-5.

Singhal PK, Paul VK, Deorari AK, Singh M, Sundaram KR. Changing trends in intra uterine growth curves. Indian Peditr. 1991;28:281-3.

Miller HC, Hassonein K. Diagnosis of impaired fetal growth in newborn infants. Paediatrics. 1971;48:511-22.

Soundarya M, Basavaprabhu A, Raghuveera K, Baliga BS, Shivanagaraja BS. Comparative assessment of fetal malnutrition by anthropometry and CAN score. Iranian J Pediatr. 2012;22(1):70.

Mehta S, Tandon A, Dua T, Kumari S, Singh SK. Clinical assessment of nutritional status at birth. Indian pediatrics. 1998;35:423-8.

Kashyap L, Dwivedi R. Detection of fetal malnutrition by clinical assessment of nutritional status score (CAN score) at birth and its comparison with other methods of determining intrauterine growth. Pediatric Oncall J. 2006;3(1).

Sachdev HP. Low birth weight in South Asia. Int J Diab Dev Countries. 2001;21(1):13-33.

Metcoff J, Costiloe JP, Crosby W, Bentle L, Seshachalam D, Sandstead HH, et al. Maternal nutrition and fetal outcome. American J Clinical Nutrition. 1981;34:708-21.

Malhotra M, Sharma JB, Batra S, Sharma S, Murthy NS, Arora R. Maternal and perinatal outcome in varying degrees of anemia. Int J Gynaecol Obstet. 2002;79(2):93–100.

Steer P, Alam MA, Wadsworth J, Welch A. Relation between maternal haemoglobin concentration and birth weight in different ethnic groups. BMJ. 1995;310(6978):489-91.

Garn SM, Keating MT, Falkner F. Hematologic status and pregnancy outcomes. Am J Clin Nutr. 1981;34(1):115-7.

Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bulletin World Health Orga. 1987;65(5):663.

International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), India, 2015-16: Karnataka. Mumbai: IIPS.

Srikrishna SR, Stephen C. Birth weights in a Bangalore hospital: is the city women in the phase of a nutrition transition. Heal Popu Perspect. 2003;26 (2):74-86.






Original Research Articles