Association of Antenatal Care Components with Low Birth Weight: A Systematic Review and Meta-Analysis

Rini Nur Hayati, Revi Gama Hatta Novika, Eti Poncorini Pamungkasari, Setyo Sri Rahardjo, Vitri Widyaningsih

Abstract


Background: Low birth weight (LBW) remains a major global health problem contributing to neonatal morbidity and mortality. Although antenatal care (ANC) is recognized as an effective strategy to improve pregnancy outcomes, evidence regarding the association between specific ANC components and LBW remains inconsistent. This study aimed to systematically review and quantitatively synthesize the evidence on the association between ANC visit frequency, timing of initiation, iron-folic acid supplementation, nutritional counseling, and LBW risk.

Methods: A systematic review and meta-analysis was conducted on 22 studies involving 227,957 mother-infant pairs identified through PubMed. ANC components, including number of visits, timing of first visit, iron-folic acid (IFA) supplementation, and nutritional counseling, were assessed as exposure variables. The outcome was LBW (<2.5 kg). Pooled adjusted odds ratios (AOR) with 95% confidence intervals (CI) were estimated using fixed-effects or random-effects models. Heterogeneity was assessed using the I² statistic, and publication bias using funnel plots.

Results: Lack of nutritional counseling showed the strongest association (AOR 1.88; 95% CI 1.21–2.92), followed by fewer than four ANC visits (AOR 1.55; 95% CI 1.24–1.95), lack of iron-folic acid supplementation (AOR 1.27; 95% CI 1.04–1.54), and late ANC initiation (AOR 1.10; 95% CI 1.01–1.20). Moderate heterogeneity was observed across several outcomes.

Conclusion: Adequate uptake of specific ANC components, namely nutritional counseling, sufficient visit frequency, iron-folic acid supplementation, and early ANC initiation, is associated with a reduced risk of LBW. Strengthening the implementation and coverage of these individual components is essential to improve neonatal outcomes.

Keywords


Antenatal care; Iron-folic acid supplementation; Low birth weight; Nutritional counseling

Full Text:

PDF
rticle

References


  1. B. Jiang, K. Lin, N. Buys, Y. Qi, and J. Sun, “Burden of low birth weight and short gestation from 1990–2021 and projection to 2050: assessment against 2030 malnutrition reduction targets,” Front. Pediatr., vol. 13, Jun. 2025, doi: 10.3389/fped.2025.1545857.
  2. C. L. Cutland et al., “Low birth weight: Case definition &amp; guidelines for data collection, analysis, and presentation of maternal immunization safety data,” Vaccine, vol. 35, no. 48, pp. 6492–6500, Dec. 2017, doi: 10.1016/j.vaccine.2017.01.049.
  3. H. Blencowe et al., “National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis,” Lancet Glob. Health, vol. 7, no. 7, pp. e849–e860, Jul. 2019, doi: 10.1016/S2214-109X(18)30565-5.
  4. Y. Nakano, “Adult-Onset Diseases in Low Birth Weight Infants: Association with Adipose Tissue Maldevelopment,” J. Atheroscler. Thromb., vol. 27, no. 5, pp. 397–405, May 2020, doi: 10.5551/jat.RV17039.
  5. N. R. Dhivar, R. Gandhi, Y. Murugan, and H. Vora, “Outcomes and Morbidities in Low-Birth-Weight Neonates: A Retrospective Study From Western India,” Cureus, Jun. 2024, doi: 10.7759/cureus.61981.
  6. H. Arabzadeh, A. Doosti-Irani, S. Kamkari, M. Farhadian, E. Elyasi, and Y. Mohammadi, “The maternal factors associated with infant low birth weight: an umbrella review,” BMC Pregnancy Childbirth, vol. 24, no. 1, p. 316, Apr. 2024, doi: 10.1186/s12884-024-06487-y.
  7. S. Mulatu et al., “Early antenatal care (ANC) booking and associated factors among pregnant women attending ANC services at public health facilities in Bahir Dar City Administration, Northwestern Ethiopia, 2023: a cross-sectional study,” BMC Pregnancy Childbirth, vol. 25, no. 1, p. 1255, Nov. 2025, doi: 10.1186/s12884-025-08450-x.
  8. Mst. N. Mina et al., “The Effectiveness of Adequate Antenatal Care in Reducing Adverse Perinatal Outcomes: Evidence From a Low- or Middle-Income Country,” Cureus, Dec. 2023, doi: 10.7759/cureus.51254.
  9. G. T. Engdaw et al., “Effect of antenatal care on low birth weight: a systematic review and meta-analysis in Africa, 2022,” Front. Public Health, vol. 11, Jun. 2023, doi: 10.3389/fpubh.2023.1158809.
  10. S. Bellizzi and S. Padrini, “Quality utilization of antenatal care and low birth weight: evidence from 18 demographic health surveys,” Eastern Mediterranean Health Journal, vol. 26, no. 11, pp. 1381–1387, Nov. 2020, doi: 10.26719/emhj.20.055.
  11. T. Tolossa, L. Gold, E. H. Lau, M. Dheresa, and J. Abimanyi-Ochom, “Association between quality of antenatal care service utilisation and adverse birth outcomes among adolescent women in 22 Sub-Saharan African countries. A mixed-effects multilevel analysis,” Sexual & Reproductive Healthcare, vol. 42, p. 101036, Dec. 2024, doi: 10.1016/j.srhc.2024.101036.
  12. H. Zhou et al., “Quality antenatal care protects against low birth weight in 42 poor counties of Western China,” PLoS One, vol. 14, no. 1, p. e0210393, Jan. 2019, doi: 10.1371/journal.pone.0210393.
  13. K. da Silva Lopes et al., “Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews,” BMJ Glob. Health, vol. 2, no. 3, p. e000389, Sep. 2017, doi: 10.1136/bmjgh-2017-000389.
  14. M. N. Albarqi, “The Impact of Prenatal Care on the Prevention of Neonatal Outcomes: A Systematic Review and Meta-Analysis of Global Health Interventions,” Healthcare, vol. 13, no. 9, p. 1076, May 2025, doi: 10.3390/healthcare13091076.
  15. D. P. Sari et al., “Antenatal care utilization on low birth weight children among women with high-risk births,” F1000Res., vol. 12, p. 399, Jan. 2024, doi: 10.12688/f1000research.126814.2.
  16. F. Wulandari, T. Mahmudiono, M. A. Rifqi, S. Helmyati, M. Dewi, and C. T. Yuniar, “Maternal Characteristics and Socio-Economic Factors as Determinants of Low Birth Weight in Indonesia: Analysis of 2017 Indonesian Demographic and Health Survey (IDHS),” Int. J. Environ. Res. Public Health, vol. 19, no. 21, p. 13892, Oct. 2022, doi: 10.3390/ijerph192113892.
  17. B. Caira-Chuquineyra, D. Fernandez-Guzman, H. Giraldez-Salazar, D. Urrunaga-Pastor, and G. Bendezu-Quispe, “Association between inadequate prenatal care and low birth weight of newborns in Peru: Evidence from a peruvian demographic and health survey,” Heliyon, vol. 9, no. 4, p. e14667, Apr. 2023, doi: 10.1016/j.heliyon.2023.e14667.
  18. E. G. Minuci and M. F. de Almeida, “Diferenciais intra-urbanos de peso ao nascer no município de São Paulo,” Rev. Saude Publica, vol. 43, no. 2, pp. 256–266, Apr. 2009, doi: 10.1590/S0034-89102009005000011.
  19. M. Z. Hossain, M. M. Rahman, N. Rahman, M. S. Uddin, and M. Siegel, “Do community-level predictors have more impact than individual/family-level predictors on receiving the desired number of ANC services in Bangladesh?,” Heliyon, vol. 10, no. 3, p. e25005, Feb. 2024, doi: 10.1016/j.heliyon.2024.e25005.
  20. O. Dewidar et al., “Effectiveness of nutrition counseling for pregnant women in low‐ and middle‐income countries to improve maternal and infant behavioral, nutritional, and health outcomes: A systematic review,” Campbell Systematic Reviews, vol. 19, no. 4, Dec. 2023, doi: 10.1002/cl2.1361.
  21. M. M. Rahman et al., “Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis,” Am. J. Clin. Nutr., vol. 103, no. 2, pp. 495–504, Feb. 2016, doi: 10.3945/ajcn.115.107896.
  22. P. R. Kamudoni et al., “Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi,” Curr. Dev. Nutr., vol. 8, no. 12, p. 104506, Dec. 2024, doi: 10.1016/j.cdnut.2024.104506.
  23. S. Velardo, “The Nuances of Health Literacy, Nutrition Literacy, and Food Literacy,” J. Nutr. Educ. Behav., vol. 47, no. 4, pp. 385-389.e1, Jul. 2015, doi: 10.1016/j.jneb.2015.04.328.
  24. R. I. Lowensohn, D. D. Stadler, and C. Naze, “Current Concepts of Maternal Nutrition,” Obstet. Gynecol. Surv., vol. 71, no. 7, pp. 413–426, Jul. 2016, doi: 10.1097/OGX.0000000000000329.
  25. P. M. Farias et al., “Minerals in Pregnancy and Their Impact on Child Growth and Development,” Molecules, vol. 25, no. 23, p. 5630, Nov. 2020, doi: 10.3390/molecules25235630.
  26. F. Seyoum Tola, “The concept of folic acid supplementation and its role in prevention of neural tube defect among pregnant women: PRISMA,” Medicine, vol. 103, no. 19, p. e38154, May 2024, doi: 10.1097/MD.0000000000038154.
  27. B. Rahat, A. Hamid, R. Bagga, and J. Kaur, “Folic Acid Levels During Pregnancy Regulate Trophoblast Invasive Behavior and the Possible Development of Preeclampsia,” Front. Nutr., vol. 9, Apr. 2022, doi: 10.3389/fnut.2022.847136.
  28. M. M. van Vliet, S. Schoenmakers, S. P. Willemsen, K. D. Sinclair, and R. P. M. Steegers-Theunissen, “First-trimester maternal folate and vitamin B12 concentrations and their associations with first-trimester placental growth: the Rotterdam Periconception Cohort,” Human Reproduction, vol. 40, no. 8, pp. 1485–1494, Aug. 2025, doi: 10.1093/humrep/deaf095.
  29. G. U. Obeagu and E. I. Obeagu, “Complications of anemia in pregnancy: An updated overview for healthcare professionals,” Medicine, vol. 104, no. 35, p. e44246, Aug. 2025, doi: 10.1097/MD.0000000000044246.
  30. G. Agegnehu, A. Atenafu, H. Dagne, and B. Dagnew, “Adherence to Iron and Folic Acid Supplement and Its Associated Factors among Antenatal Care Attendant Mothers in Lay Armachiho Health Centers, Northwest, Ethiopia, 2017,” Int. J. Reprod. Med., vol. 2019, pp. 1–9, Jun. 2019, doi: 10.1155/2019/5863737.
  31. A. M. Ahmed, M. A. Ahmed, H. A. Ali, and A. D. Abdisalam, “Timing of first antenatal care initiation and associated factors among pregnant women attending antenatal clinics in Hargeisa, Somaliland,” BMC Pregnancy Childbirth, vol. 26, no. 1, p. 182, Jan. 2026, doi: 10.1186/s12884-026-08690-5.
  32. I. Mussa, O. Makhubela-Nkondo, M. B. Maruta, and A. Debella, “Missed Opportunity of Antenatal Care Services Utilization and Associated Factors among Reproductive Age Women in Eastern Hararghe Zone, Eastern Ethiopia: Mixed Methods Study,” J. Pregnancy, vol. 2023, pp. 1–13, Sep. 2023, doi: 10.1155/2023/8465463.
  33. Ş. Tunç, S. C. Oğlak, Z. Gedik Özköse, and F. Ölmez, “The evaluation of the antepartum and intrapartum risk factors in predicting the risk of birth asphyxia,” Journal of Obstetrics and Gynaecology Research, vol. 48, no. 6, pp. 1370–1378, Jun. 2022, doi: 10.1111/jog.15214.
  34. M. E. Palamuleni, “Factors Associated with Late Antenatal Initiation among Women in Malawi,” Int. J. Environ. Res. Public Health, vol. 21, no. 2, p. 143, Jan. 2024, doi: 10.3390/ijerph21020143.
  35. G. Uwimana, M. Elhoumed, M. A. Gebremedhin, M. M. Azalati, L. Nan, and L. Zeng, “Association between quality antenatal care and low birth weight in Rwanda: a cross-sectional study design using the Rwanda demographic and health surveys data,” BMC Health Serv. Res., vol. 23, no. 1, p. 558, May 2023, doi: 10.1186/s12913-023-09482-9.
  36. P. H. Nguyen et al., “Strengthening Nutrition Interventions in Antenatal Care Services Affects Dietary Intake, Micronutrient Intake, Gestational Weight Gain, and Breastfeeding in Uttar Pradesh, India: Results of a Cluster-Randomized Program Evaluation,” J. Nutr., vol. 151, no. 8, pp. 2282–2295, Aug. 2021, doi: 10.1093/jn/nxab131.
  37. F. Tadele, N. Getachew, K. Fentie, and D. Amdisa, “Late initiation of antenatal care and associated factors among pregnant women in Jimma Zone Public Hospitals, Southwest Ethiopia, 2020,” BMC Health Serv. Res., vol. 22, no. 1, p. 632, Dec. 2022, doi: 10.1186/s12913-022-08055-6.
  38. E. M. C. Tchibozo et al., “Late initiation of antenatal care and its associated factors among pregnant women in Benin: a facility based cross-sectional study,” BMC Pregnancy Childbirth, vol. 25, no. 1, p. 1008, Oct. 2025, doi: 10.1186/s12884-025-08170-2




DOI: https://doi.org/10.20961/placentum.v14i2.121426

Refbacks

  • There are currently no refbacks.


Copyright (c) 2026 Placentum: Jurnal Ilmiah Kesehatan dan Aplikasinya

View My Stats

Lisensi Creative Commons
This work is licensed under a Creative Commons Attribution-ShareAlike International 4.0 (CC BY-SA 4.0).