News Excerpt:

As per a study published recently in the Journal of Global Health by researchers from the ICMR’s National Institute for Research in Reproductive and Child Health (NIRRCH), nearly 50% of pregnancies in India are high-risk.

Key findings of the study:

• Researchers analysed the data of nearly 24,000 pregnant women in India and found the prevalence of high-risk pregnancies to be high at 49.4%. 
• About 33% of pregnant women had a single high-risk factor, while 16% had multiple high-risk factors. 
• The Northeastern States of Meghalaya (67.8%), Manipur (66.7%), Mizoram (62.5%) and the southern State of Telangana (60.3%) had the highest prevalence of high-risk factors in India. 
• In comparison, Sikkim (33.3%), Odisha (37.3%) and Chhattisgarh (38.1%) had the lowest prevalence of high-risk pregnancies. 
• With 33%, women in Meghalaya had the highest frequency of multiple high-risk factors, followed by Manipur, Andhra Pradesh, and Telangana.
• The study found that pregnant women from vulnerable populations, such as poor women and those who had no education, had the possibility of having one or more risk factors for pregnancy. 
• The leading high-risk factors were - 
• Short-birth spacing (the time interval between the last birth to the time of current conception being less than 18 months), 
• Adverse birth outcomes such as miscarriage, abortion, or stillbirth. 
• Finally, women whose most recent delivery was a caesarean section. 
• The risk factors that were considered for the study were maternal risks, lifestyle risks, medical risks, current health risks, and previous birth outcome risks. 
• Maternal risk factors included - 
• Mother's age — adolescent women aged 15 to 17 years and women older than 35 years.
• Short, pregnant women (height below 140 cm).
• Having a higher body mass index of over 30. 
• Additionally, gestational weight gains up to 7-11 kg for overweight women and 5-9 kg for obese women were considered high-risk pregnancies.
• Short birth spacing of less than 18 months between previous birth and current conception was observed in 31% of pregnant women, followed by 19.5% of women with a history of adverse birth outcomes — either miscarriage, abortion, or stillbirth. 
• Other high-risk factors were women having longer spacing (15.8%), history of preterm delivery (14.1%) and comorbidities (6.4%).
• In contrast, advanced maternal age of over 35 years risk factor was most seen in Ladakh (14.3%), short stature (height below 140 cm) was highest in Puducherry (4.8%), and BMI over 30 was seen in Goa (17.4%). 
• Women with more than five children (higher birth order) were seen in Meghalaya (10.7%). 
• In contrast, short birth spacing of less than 18 months was highest in Andhra Pradesh (48.1%), and caesarean delivery was highest in Ladakh and Puducherry (50% each). 
• Women in Chandigarh had the highest adverse birth outcomes (40%) as well as preterm births (37.5%).
• According to the study, high-risk factors were more commonly seen during the third trimester (51%) than in the first (48.8%) and second trimester (48.6%).

Risk factors:

• Lifestyle risk factors included tobacco use and alcohol consumption. 
• Previous birth outcome risks included -
• Pregnant women with more than five children.
• Women with short birth spacing.
• Long birth intervals of over 59 months.
• Women with a history of preterm deliveries. 
• Miscarriages.
• Abortions.
• Stillbirths.
• The short birth spacing was the primary factor contributing to the high prevalence of high-risk pregnancies across the country. 
• The major problem of short birth spacing was that half of the Indian women were not using contraception to delay their next pregnancy. 
• The under-five-mortality rate for shorter birth intervals was reported to be twice as high as the rate for birth intervals of three or more years.

Way forward:

• In India, the high prevalence of high-risk pregnancies (HRP) is a matter of concern, and it could be a probable factor for high maternal and neonatal morbidity and mortality in the country. 
• Further investigations are required, focusing on factors such as advanced maternal age, tobacco use, pre-existing diseases, and adverse birth outcome issues. 
• Short birth spacing contributes to the major share of HRP prevalence in India. 
• Appropriate measures on birth spacing issues through policy and programmes and creating public awareness and education of women, in the long run, will help further improve maternal and neonatal outcomes. 
• The government should focus on regional-specific health issues and regional policies on socio-behavioural interventions to improve lifestyle practices, particularly in the Northeast. 
• More clinical and laboratory investigations could be the best way to address the health issues and improve maternal health and outcomes.
• There is also a need for regular monitoring of high-risk pregnancies through health systems, data harmonisation and tracking to prevent adverse maternal and neonatal outcomes.