Poix Sébastien, O'Donnell Patrick, Elmusharaf Khalifa
Faculty of Education & Health Sciences, School of Medicine, University of Limerick, Limerick, Ireland.
Public Health, Applied Health Research, University of Birmingham Dubai, Dubai, United Arab Emirates.
PLoS One. 2025 Jul 3;20(7):e0325086. doi: 10.1371/journal.pone.0325086. eCollection 2025.
Poor preconception health has been associated with several pregnancy and childbirth-related complications, including perinatal mortality. Yet, the health and economic burden that inaction on preconception health places on societies remains under-researched, hindering efforts to address these issues effectively. This study aimed to quantify the economic burden of perinatal mortality attributable to five preconception risk factors in fifteen low and middle-income countries (LMICs).
We used a population-attributable fraction analysis to estimate the proportion of perinatal deaths in 2020 attributable to adolescent pregnancy, short birth intervals, intimate partner violence before pregnancy, pre-pregnancy overweight and obesity, and female genital mutilation. We then performed an economic impact analysis to quantify the foregone productivity and the societal costs due to these perinatal deaths, using both the human capital and the value of a statistical life-year approach.
More than 230,000 (20.7%) perinatal deaths were attributable to the five selected risk factors in the fifteen LMICs in 2020. The productivity losses were estimated at $INT21.3 billion, representing 0.7% of the combined GDP of those countries in 2020. The societal costs of perinatal mortality, the total economic burden was $INT51.0 billion.
Our findings indicate that inaction on preconception care potentially contributes to a substantial proportion of the burden of perinatal mortality, which, in turn, generates profound and long-term economic and societal losses in LMICs. These results highlight the need for effective preconception strategies and relevant policies, and further research is needed to explore the economic value of preconception care in these settings.
孕前健康状况不佳与多种妊娠及分娩相关并发症有关，包括围产期死亡率。然而，对孕前健康问题不作为给社会带来的健康和经济负担仍未得到充分研究，这阻碍了有效解决这些问题的努力。本研究旨在量化15个低收入和中等收入国家（LMICs）中由5个孕前风险因素导致的围产期死亡的经济负担。
我们采用人群归因分数分析来估计2020年围产期死亡中可归因于青少年妊娠、短生育间隔、孕前亲密伴侣暴力、孕前超重和肥胖以及女性生殖器切割的比例。然后，我们使用人力资本法和统计生命年价值法进行经济影响分析，以量化这些围产期死亡导致的生产力损失和社会成本。
2020年，在15个低收入和中等收入国家中，超过23万例（20.7%）围产期死亡可归因于所选的5个风险因素。生产力损失估计为213亿美元，占这些国家2020年国内生产总值总和的0.7%。围产期死亡的社会成本，即总经济负担为510亿美元。
我们的研究结果表明，对孕前保健不作为可能导致很大一部分围产期死亡负担，进而在低收入和中等收入国家造成深远和长期的经济及社会损失。这些结果凸显了制定有效孕前策略和相关政策的必要性，还需要进一步研究来探索这些环境下孕前保健的经济价值。
