{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T07:40:42Z","timestamp":1789890042779,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,1,8]],"date-time":"2018-01-08T00:00:00Z","timestamp":1515369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"publisher","award":["252075"],"award-info":[{"award-number":["252075"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>More than 20 million babies are born with low birthweight annually. Small newborns have an increased risk for mortality, growth failure, and other adverse outcomes. Numerous antenatal risk factors for small newborn size have been identified, but individual interventions addressing them have not markedly improved the health outcomes of interest. We tested a hypothesis that in low\u2010income settings, newborn size is influenced jointly by multiple maternal exposures and characterized pathways associating these exposures with newborn size. This was a prospective cohort study of pregnant women and their offspring nested in an intervention trial in rural Malawi. We collected information on maternal and placental characteristics and used regression analyses, structural equation modelling, and random forest models to build pathway maps for direct and indirect associations between these characteristics and newborn weight\u2010for\u2010age Z\u2010score and length\u2010for\u2010age Z\u2010score. We used multiple imputation to infer values for any missing data. Among 1,179 pregnant women and their babies, newborn weight\u2010for\u2010age Z\u2010score was directly predicted by maternal primiparity, body mass index, and plasma alpha\u20101\u2010acid glycoprotein concentration before 20\u00a0weeks of gestation, gestational weight gain, duration of pregnancy, placental weight, and newborn length\u2010for\u2010age Z\u2010score (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.05). The latter 5 variables were interconnected and were predicted by several more distal determinants. In low\u2010income conditions like rural Malawi, maternal infections, inflammation, nutrition, and certain constitutional factors jointly influence newborn size. Because of this complex network, comprehensive interventions that concurrently address multiple adverse exposures are more likely to increase mean newborn size than focused interventions targeting only maternal nutrition or specific infections.<\/jats:p>","DOI":"10.1111\/mcn.12585","type":"journal-article","created":{"date-parts":[[2018,1,10]],"date-time":"2018-01-10T07:18:28Z","timestamp":1515568708000},"source":"Crossref","is-referenced-by-count":19,"title":["Co\u2010causation of reduced newborn size by maternal undernutrition, infections, and inflammation"],"prefix":"10.1111","volume":"14","author":[{"given":"Per","family":"Ashorn","sequence":"first","affiliation":[{"name":"Centre for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital Tampere Finland"},{"name":"Department of Paediatrics Tampere University Hospital Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lotta","family":"Hallamaa","sequence":"additional","affiliation":[{"name":"Centre for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay H.","family":"Allen","sequence":"additional","affiliation":[{"name":"USDA Agricultural Research Service Western Human Nutrition Research Center Davis California USA"},{"name":"Program in International and Community Nutrition, Department of Nutrition University of California, Davis Davis California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulla","family":"Ashorn","sequence":"additional","affiliation":[{"name":"Centre for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital Tampere 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Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minyanga","family":"Nkhoma","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Family Medicine, College of Medicine University of Malawi Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6056-0585","authenticated-orcid":false,"given":"Brietta M.","family":"Oaks","sequence":"additional","affiliation":[{"name":"Program in International and Community Nutrition, Department of Nutrition University of California, Davis Davis California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2177-3224","authenticated-orcid":false,"given":"Basho","family":"Poelman","sequence":"additional","affiliation":[{"name":"Centre for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Rogerson","sequence":"additional","affiliation":[{"name":"Department of Medicine at Peter Doherty Institute University of Melbourne Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine P.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Program in International and Community Nutrition, Department of Nutrition University of California, Davis Davis California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamane","family":"Zeilani","sequence":"additional","affiliation":[{"name":"External Research and Nutrition Nutriset S.A.S Malaunay France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn G.","family":"Dewey","sequence":"additional","affiliation":[{"name":"Program in International and Community Nutrition, Department of Nutrition University of California, Davis Davis California 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