Translational Health Science and Technology Institute, Faridabad, India; Pondicherry Institute of Medical Sciences, Puducherry, India.
Translational Health Science and Technology Institute, Faridabad, India.
Lancet Glob Health. 2024 Aug;12(8):e1261-e1277. 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/m) 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.
全球范围内，最近的估计显示，2022 年仍有 360 万死产和新生儿死亡，其中近 60%发生在低收入和中等收入国家。小脆弱新生儿联合会提出了一个框架，将早产（<37 孕周）、按 INTERGROWTH-21 标准界定的小于胎龄儿（SGA）和出生体重<2500 克的低体重儿合并为小脆弱新生儿（SVN）。来自撒哈拉以南非洲、中亚和南亚的 SVN 可靠数据很少。我们旨在评估印度北部妊娠队列中小脆弱新生儿的发生率及其类型，并量化总体和特定孕期的风险因素。
在 GARBH-Ini（跨学科出生结局高级研究组-DBT 印度倡议）妊娠队列中，2015 年 5 月 11 日至 2020 年 8 月 8 日，在印度北部的一家二级保健医院，不到 20 周妊娠的 8000 名参与者入组。该队列在整个产前期间进行了随访，以对早产进行详细研究。我们对队列数据进行了二次分析，以确定 SVN 的结局及其类型（早产-SGA、早产-非 SGA 和足月-SGA）。我们使用（校正泊松回归）和其类型（多变量回归）来估计 SVN（改良泊松回归）及其类型（多变量回归）的候选风险因素的相对风险和人群归因分数。
7990 名参与者中有 7183 名（89.9%）完成了研究。在纳入分析的 6206 名新生儿中，SVN 的发生率为 48.4%（35.1%的足月 SGA 新生儿[n=2179]、9.7%的早产-非 SGA 新生儿[n=605]和 3.6%的早产 SGA 新生儿[n=222]）。与足月非 SGA 新生儿相比，SVN 新生儿在出生后 72 小时内的死产和新生儿死亡比例分别高出三倍和 2.5 倍。早产 SGA 新生儿的死产发生率最高（222 例中 15 例[6.8%]），新生儿死亡发生率也最高（142 例中 6 例[4.2%]）。参与者妊娠开始时的低体重指数（BMI<18.5kg/m）与早产 SGA（调整后的相对风险[RR]1.61[95%CI 1.17-2.22]）、早产-非 SGA（1.35[1.09-1.68]）和足月 SGA（1.44[1.27-1.64]）的风险增加相关，人群归因分数为 8.7%至 13.8%。子痫前期（调整后的 RR 1.48[95%CI 1.30-1.71]）、短宫颈长度（1.15[1.04-1.26]）和细菌性阴道病（1.13[0.88-1.45]）是其他重要的产前风险因素。
在对印度北部的 SVN 及其类型进行全面分析时，我们确定了风险因素，以指导干预措施的优先顺序。通过与风险分层工具相结合，这种有针对性的方法将增强产前保健，并加速实现可持续发展目标，即到 2030 年结束可预防的新生儿和 5 岁以下儿童死亡（目标 3.2）。
印度生物技术部和印度生物技术产业研究援助理事会，印度政府。
