Bhise Mahadev, Mhamane Sharyu, Prusty Ranjan Kumar, Begum Shahina
Department of Biostatistics, Indian Council of Medical Research, National Institute for Research in Reproductive and Child Health, Mumbai, India.
Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, Maharashtra, India.
J Res Health Sci. 2025 Apr 1;25(2):e00645. doi: 10.34172/jrhs.2025.180.
Around 810 women die daily due to adverse pregnancy outcomes (APOs), predominantly in low- and middle-income countries. In India, despite advancements in maternal health initiatives, pregnancy loss (PL) rates remain high. This study analyzed the determinants, prevalence, and spatial distribution of PL in India. This study employed a cross-sectional design.
Using data from the National Family Health Survey (NFHS-5, 2019-2021), the study analyzed 255,385 pregnancies to assess the prevalence of PL. The analysis includes socio-demographic variables and spatial factors affecting PL rates.
The national PL prevalence is 11.1%, comprising 7.3% miscarriages, 2.9% abortions, and 0.9% stillbirths. Higher PL rates correlated with older maternal age, urban residence, higher wealth index, and tobacco use. The spatial analysis identified 84 districts as hot spots for PL, primarily located in Northern and Eastern India, while 89 cold spots were identified in Central and North-Eastern regions. Multilevel logistic regression revealed that women aged 35-49 years (aOR=3.8, 95% CI: 1.26-1.63) and women who used tobacco (aOR: 1.28, 95% CI: 1.09-1.49) were at a significantly higher risk of PL compared to younger women (<20 years) and non-tobacco users, respectively.
The study highlights the need for further research to elucidate the underlying causes of PLs and recommends strengthening the health system in hot spot districts. This can be achieved through targeted interventions that address regional disparities and socio-economic determinants, ultimately improving maternal health outcomes.
每天约有810名妇女因不良妊娠结局（APO）死亡，主要发生在低收入和中等收入国家。在印度，尽管孕产妇健康举措取得了进展，但流产率仍然很高。本研究分析了印度流产的决定因素、患病率和空间分布。本研究采用横断面设计。
利用全国家庭健康调查（NFHS-5，2019-2021）的数据，该研究分析了255385例妊娠，以评估流产的患病率。分析包括影响流产率的社会人口变量和空间因素。
全国流产患病率为11.1%，其中7.3%为自然流产，2.9%为人工流产，0.9%为死产。较高的流产率与产妇年龄较大、城市居住、较高的财富指数和吸烟有关。空间分析确定了84个地区为流产热点地区，主要位于印度北部和东部，而在中部和东北部地区确定了89个冷点地区。多水平逻辑回归显示，与年轻女性（<20岁）和非吸烟者相比，35-49岁的女性（调整后比值比[aOR]=3.8，95%置信区间[CI]：1.26-1.63）和吸烟女性（aOR：1.28，95%CI：1.09-1.49）流产风险显著更高。
该研究强调需要进一步研究以阐明流产的潜在原因，并建议加强热点地区的卫生系统。这可以通过针对性干预来实现，这些干预措施解决区域差异和社会经济决定因素，最终改善孕产妇健康结局。
