Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA.
Aga Khan University, Karachi, Pakistan.
Reprod Health. 2020 Dec 17;17(Suppl 3):190. doi: 10.1186/s12978-020-01023-5.
Pakistan has among the poorest pregnancy outcomes worldwide, significantly worse than many other low-resource countries. The reasons for these differences are not clear. In this study, we compared pregnancy outcomes in Pakistan to other low-resource countries and explored factors that might help explain these differences.
The Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia). Study staff enroll women in early pregnancy and follow-up soon after delivery and at 42 days to ascertain delivery, neonatal, and maternal outcomes. We analyzed the maternal mortality ratios (MMR), neonatal mortality rates (NMR), stillbirth rates, and potential explanatory factors from 2010 to 2018 across the GN sites.
From 2010 to 2018, there were 91,076 births in Pakistan and 456,276 births in the other GN sites combined. The MMR in Pakistan was 319 per 100,000 live births compared to an average of 124 in the other sites, while the Pakistan NMR was 49.4 per 1,000 live births compared to 20.4 in the other sites. The stillbirth rate in Pakistan was 53.5 per 1000 births compared to 23.2 for the other sites. Preterm birth and low birthweight rates were also substantially higher than the other sites combined. Within weight ranges, the Pakistani site generally had significantly higher rates of stillbirth and neonatal mortality than the other sites combined, with differences increasing as birthweights increased. By nearly every measure, medical care for pregnant women and their newborns in the Pakistan sites was worse than at the other sites combined.
The Pakistani pregnancy outcomes are much worse than those in the other GN sites. Reasons for these poorer outcomes likely include that the Pakistani sites' reproductive-aged women are largely poorly educated, undernourished, anemic, and deliver a high percentage of preterm and low-birthweight babies in settings of often inadequate maternal and newborn care. By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan's pregnancy outcomes.
巴基斯坦的妊娠结局在全球范围内属于最差之列，明显差于许多其他资源匮乏的国家。造成这些差异的原因尚不清楚。在这项研究中，我们将巴基斯坦的妊娠结局与其他资源匮乏的国家进行了比较，并探讨了可能有助于解释这些差异的因素。
全球网络（GN）孕产妇新生儿健康登记处（MNHR）是一项前瞻性、基于人群的观察性研究，涵盖了六个中低收入国家（印度、巴基斯坦、刚果民主共和国、危地马拉、肯尼亚和赞比亚）中特定地理社区的所有孕妇及其妊娠结局。研究人员在早期妊娠时招募孕妇，并在分娩后不久以及 42 天时进行随访，以确定分娩、新生儿和产妇结局。我们分析了 2010 年至 2018 年期间 GN 各站点的孕产妇死亡率（MMR）、新生儿死亡率（NMR）、死产率以及潜在的解释因素。
2010 年至 2018 年期间，巴基斯坦有 91076 例分娩，其他 GN 站点共有 456276 例分娩。巴基斯坦的孕产妇死亡率为每 10 万活产 319 例，而其他站点的平均水平为 124 例，巴基斯坦的新生儿死亡率为每 1000 例活产 49.4 例，而其他站点的平均水平为 20.4 例。巴基斯坦的死产率为每 1000 例活产 53.5 例，而其他站点的平均水平为 23.2 例。早产和低出生体重率也明显高于其他站点的总和。在体重范围内，巴基斯坦站点的死产率和新生儿死亡率普遍明显高于其他站点的总和，随着出生体重的增加，差异也在增加。几乎从每个指标来看，巴基斯坦站点的孕妇及其新生儿的医疗保健都比其他站点的总和差。
巴基斯坦的妊娠结局明显差于 GN 其他站点。造成这些较差结局的原因可能包括巴基斯坦站点的育龄妇女受教育程度低、营养不良、贫血，且在孕产妇和新生儿护理往往不足的情况下，很大比例的婴儿早产和低出生体重。通过解决本文所强调的问题，巴基斯坦的妊娠结局似乎有很大的改善空间。
