Incidence of and risk factors for small vulnerable newborns in north India: a secondary analysis of a prospective pregnancy cohort

• Published in: The Lancet global health Vol. 12; no. 8; pp. e1261 - e1277
• Main Authors: Thiruvengadam, Ramachandran, Ayushi, Murugesan, Deepika Rathna, Desiraju, Bapu Koundinya, Misra, Sumit, Sharma, Dharmendra, Subbaian, Suresh Somi, Mehta, Umesh, Singh, Alka, Sharma, Sunita, Khurana, Ashok, Mittal, Pratima, Chellani, Harish, Bharti, Rekha, Tripathi, Reva, Sopory, Shailaja, Kshetrapal, Pallavi, Salunke, Dinakar M, Natchu, Uma Chandra Mouli, Ramji, Siddarth, Bhatnagar, Shinjini, Wadhwa, Nitya, Das, Bhabatosh, Kshetrapal, Pallavi S, Sachdeva, Kanika, Singh, Amanpreet, Nair, Balakrish G, Rath, Satyajit, Bal, Vineeta, Sharma, Alka, Sindhu, Brahmdeep, Gera, Rani, Suri, Jyotsna, Debata, Pradeep, Arya, Sugandha, Maitra, Arindam, Maiti, Tushar K, Tandon, Nikhil, Gupta, Yashdeep, Goyal, Alpesh, Hari, Smriti, Sharma, Aparna K, Rana, Anubhuti, Garg, Anju, Gupta, Rakesh, Sinha, Himanshu, Rengasamy, Raghunathan, Majumder, Partha P
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2024
• Subjects: Adult; Female; Humans; Incidence; India - epidemiology; Infant, Newborn; Infant, Small for Gestational Age; Male; Pregnancy; Premature Birth - epidemiology; Prospective Studies; Risk Factors; Young Adult; India
• ISSN: 2214-109X; 2214-109X
• DOI: 10.1016/S2214-109X(24)00212-2

Globally, recent estimates have shown there have been 3·6 million stillbirths and neonatal deaths in 2022, with nearly 60% occurring in low-income and middle-income countries. The Small Vulnerable Newborn Consortium has proposed a framework combining preterm birth (<37 weeks of gestation), small for gestational age (SGA) by INTERGROWTH-21st standard, and low birthweight (<2500 g) under the category small vulnerable newborns (SVN). Reliable data on SVN from sub-Saharan Africa, central Asia, and south Asia are sparse. We aimed to estimate the incidence of SVN and its types, and quantify risk factors, both overall and trimester-specific, from a pregnancy cohort in north India. In the GARBH-Ini (Interdisciplinary Group for Advanced Research on Birth Outcomes—DBT India Initiative) pregnancy cohort, 8000 participants were enrolled with less than 20 weeks’ gestation between May 11, 2015, and Aug 8, 2020, at a secondary-care hospital in north India. The cohort was followed up across the antenatal period for a detailed study on preterm birth. We conducted a secondary analysis of cohort data for the outcome of SVN, classified into its types: preterm-SGA, preterm-nonSGA, and term-SGA. We estimated the relative risk and population attributable fraction of candidate risk factors for SVN (modified Poisson regression) and its types (multinomial regression). 7183 (89·9%) of 7990 participants completed the study. Among 6206 newborns included for analysis, the incidence of SVN was 48·4% (35·1% term-SGA newborns [n=2179], 9·7% preterm-nonSGA newborns [n=605], and 3·6% preterm-SGA newborns [n=222]). Compared with term-nonSGA newborns, proportions of stillbirths and neonatal deaths within 72 h of birth among SVN were three times and 2·5 times higher, respectively. Preterm-SGA newborns had the highest incidence of stillbirth (15 [6·8%] of 222) and neonatal deaths (six [4·2%] of 142). Low body-mass index (BMI <18·5 kg/m2) of participants at the start of pregnancy was associated with higher risk for preterm-SGA (adjusted relative risk [RR] 1·61 [95% CI 1·17–2·22]), preterm-nonSGA (1·35 [1·09–1·68]), and term-SGA (1·44 [1·27– 1·64]), with population attributable fraction ranging from 8·7% to 13·8%. Pre-eclampsia (adjusted RR 1·48 [95% CI 1·30–1·71]), short cervical length (1·15 [1·04–1·26]), and bacterial vaginosis (1·13 [0·88–1·45]) were other important antenatal risk factors. In a comprehensive analysis of SVN and its types from north India, we identified risk factors to guide prioritisation of interventions. Complemented with risk-stratification tools, this focused approach will enhance antenatal care, and accelerate achievement of Sustainable Development Goals—namely, to end preventable deaths of newborns and children younger than 5 years by 2030 (target 3·2). Department of Biotechnology, Government of India and Grand Challenges India–Biotechnology Industry Research Assistance Council, Government of India. For the Hindi translation of the abstract see Supplementary Materials section.