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Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low middle-income countries


Addressing the global burden of preterm birth (before 37 weeks of pregnancy) is critical to reducing neonatal and childhood mortality and to achieving Sustainable Development Goal #3—to ensure healthy lives and to promote well-being for all at all ages. The World Health Organization (WHO) estimates that there are 15 million preterm births every year. Gestational age is more predictive of risk of neonatal and childhood mortality than low birth weight (LBW—below 2500 g), but prematurity is more difficult to ascertain accurately than birthweight. Ninety-seven percent of LBW babies are born in low and lower-middle income countries (LMIC) where estimates of gestational age are the most difficult to ascertain. Therefore, the WHO also estimates the number of babies born with LBW, currently 25 million babies annually. Although prematurity is a major reason for a baby being born LBW, LBW is an imperfect surrogate for preterm birth. Term babies may also be LBW because they are growth restricted and small for gestational age (SGA) that weigh less than 10th percentile of weight for gestational age and sex, resulting in an estimated 67% overlap between preterm birth and LBW. Mechanisms and risk factors for preterm and for LBW babies may differ despite a substantial proportion of LBW being contributed by preterm births as LBW infants are also a result of intrauterine growth restriction. LBW and/or preterm birth are important causes of neonatal mortality. In 2015, there were an estimated 1 million deaths in children under age 5 years globally attributed to prematurity. Infants who are SGA have an increased risk of neonatal mortality regardless of their association with preterm birth. Thirty five percent of neonatal deaths were attributed to prematurity and more than 80% of neonatal deaths were in LBW babies.

There have been calls for improved estimates of the burden of preterm birth and LBW, particularly in countries where the data are sparse, incomplete or not population-based. There is limited information on maternal factors associated with these neonatal conditions and whether and how they may occur in rural settings in LMICs. More accurate data may enable government policies and programs to more effectively target interventions to reduce preterm birth and LBW. Neonatal mortality in LBW preterm babies is higher, with more severe lifelong consequences, than for LBW and preterm babies alone and therefore accurate estimates of and risk factors for the combination are needed to improve survival of these newborns.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development’s (NICHD’s) Global Network (GN), is a multi-site research network representing partnerships of U.S. and international investigators at rural and semi-urban study sites in Guatemala, India (2 sites: Nagpur and Belgaum), Pakistan, Kenya, Zambia and the Democratic Republic of the Congo. The GN Maternal and Newborn Health Registry (MNHR) has been collecting data on a population-based sample of pregnant women and their babies starting in 2008. The GN has consistently focused on improving the quality of its data, by focusing on obtaining accurate and standardized methods of assessing birth weight and gestational age data across all participating sites. Gestational age data has been improved over time by increased access to ultrasound dating, mostly from January 2014. Standardized training of sonographers has also been possible across the GN as ultrasounds were required for three GN studies that drew their study participants from subjects participating in the MNHR. Here we describe and compare the rates of preterm births, LBW and a combination of preterm birth and LBW at the GN sites. We also explored and compared the maternal, delivery and infant characteristics as risk factors associated with preterm birth, LBW and both preterm birth and LBW for the GN sites.

By: Pusdekar YV, Patel AB, Kurhe KG, Bhargav SR, Thorsten V, Garces A et al.

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