Maternal and obstetric determinants of prematurity and term low birth weight in Afghanistan: a hospital-based case–control study

Prematurity and term low birth weight (LBW) are important contributors to neonatal morbidity and mortality in Afghanistan. Evidence from hospital-based studies in Herat remains limited, particularly studies that distinguish prematurity from term LBW. This study aimed to identify maternal, socioeconomic, obstetric, and pregnancy-related factors associated with prematurity and term LBW among newborns delivered in Herat, western Afghanistan. An unmatched hospital-based case-control study was conducted at Herat Midwifery Hospital from June 15 to September 15, 2023. The study included 176 premature infants, 84 term LBW infants, and 290 full-term normal-birth-weight controls. Prematurity was defined as birth before 37 completed weeks of gestation, and term LBW was defined as birth at ≥ 37 completed weeks with birth weight < 2500 g. Data were collected from hospital records and maternal interviews. Separate adjusted binary logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for prematurity and term LBW compared with full-term normal-birth-weight controls. Statistical significance was set at p < 0.05. Prematurity was associated with medium perceived economic status (OR = 2.21, 95% CI: 1.04-4.73), bad perceived economic status (OR = 5.16, 95% CI: 2.06-12.91), preeclampsia (OR = 5.98, 95% CI: 1.72-20.76), pregnancy-related health problems (OR = 13.76, 95% CI: 5.32-35.61), substance use during pregnancy (OR = 2.88, 95% CI: 1.11-7.45), and cesarean section (OR = 3.37, 95% CI: 1.99-5.73). Term LBW was associated with medium perceived economic status (OR = 3.98, 95% CI: 1.29-12.30), bad perceived economic status (OR = 19.62, 95% CI: 5.09-75.63), pregnancy-related health problems (OR = 8.88, 95% CI: 2.46-32.02), and cesarean section (OR = 9.76, 95% CI: 4.85-19.65). Poor perceived economic status and pregnancy-related health problems were associated with both prematurity and term LBW. Preeclampsia and substance use were associated mainly with prematurity. Cesarean section should be interpreted as a marker of high-risk obstetric conditions rather than as a direct causal factor. These findings support strengthening antenatal risk detection, management of pregnancy complications, and targeted maternal health interventions in Herat.