Association between adverse pregnancy outcomes and preceding risk factors: a cross-sectional study from Nashik District, India

Prakash Prabhakarrao Doke,Khanindra Kumar Bhuyan,Jayashree Sachin Gothankar,Sonali Hemant Palkar,Madhusudan Vamanrao Karnataki,Aparna Nishikant Shrotri,Amruta Paresh Chutke,Prasad Dnyandeo Pore,Aniruddha Vinayakrao Deshpande,Archana Vasantrao Patil

doi:10.1186/s12884-021-04174-w

Abstract

BackgroundThe preconception phase of women’s life cycle is critical but comparatively ignored. The presence of health risks is judged as hazardous to the wellbeing of women and their offspring. This study aimed to estimate the prevalence of various pregnancy outcomes and assess the association between certain risk factors and adverse outcomes.MethodsAs a part of a preconception care intervention project, a baseline survey was conducted in four blocks of Nashik District, India. In this population-based cross-sectional analytical study, we compared cases in the study group (randomly selected one tribal and one non-tribal block) with those of the control group (one tribal and one non-tribal block). A comparison was also made between the tribal and non-tribal blocks in each group. All women who had a pregnancy outcome in the preceding 12 months (01 April 2017 to 31 March 2018) were interviewed. Trained Accredited Social Health Activists conducted the survey under the direct supervision of Auxiliary Nurse Midwives and Medical Officers. Multivariate analysis was carried out to find the adjusted prevalence ratio of having a particular adverse outcome because of the prespecified potential risk factors.ResultsA total of 9307 women participated in the study. The prevalence of adverse pregnancy outcomes was as follows: abortion in 4.1%, stillbirth in 1.7%, preterm birth in 4.1%, low birth weight in 13.2%, and congenital physical defect in 2.8%. Prevalence of parental consanguinity, pre-existing maternal illness at conception, heavy work during the last six months of pregnancy, tobacco consumption, alcohol consumption, direct exposure to pesticides and domestic violence during pregnancy was 18.5, 2.2, 18.7, 5.6, 0.5, 2.3, and 0.8% respectively. Risk factors associated with abortion included pre-existing illness and heavy work in the last six months of the pregnancy. Consanguinity, tobacco consumption during pregnancy and pre-existing illness were identified as risk factors for stillbirth. Significant risk factors of low birth weight were heavy work in the last six months of pregnancy, pre-existing illness and residence in a tribal area.ConclusionThere is a need to emphasize on maternal behaviour, including tobacco consumption, and heavy work during pregnancy, as well as on parental consanguinity and pre-existing maternal illnesses, in order to achieve the best possible pregnancy outcomes.

Highlights

The preconception phase of women’s life cycle is critical but comparatively ignored
The urbanrural gap is evident through higher child mortality indicators for the rural area, which may result from the lack of health care facilities, apart from the socio-cultural environment [1, 2]
Study setting With the support of United Nations Children Funds (UNICEF), the government of Maharashtra conducted a study in the rural and tribal areas of Nashik district to assess the effect of an intervention in the form of Preconception care (PCC) on pregnancy outcomes

Summary

Introduction

The preconception phase of women’s life cycle is critical but comparatively ignored. The presence of health risks is judged as hazardous to the wellbeing of women and their offspring. India is the second-largest country globally, and almost 70% of its population resides in the rural area. The urbanrural gap is evident through higher child mortality indicators for the rural area, which may result from the lack of health care facilities, apart from the socio-cultural environment [1, 2]. The challenges increase further for the tribal people, who constitute 8.6% of India’s total population [3]. This socio-culturally different, underprivileged community is dissociated from the health care system. The health indicators of the tribal population are lower compared to non-tribal [5]. Preconception care (PCC) prevents mortality and morbidity among mothers and children [6]. The WHO [7] and the Government of India through the India Newborn Action Plan (INAP) [8], as well as the Federation of Obstetric and Gynaecological Associations of India, recommended the roll-out of PCC in India [9], it has not yet been rolled out systematically in many countries, including India

Objectives

Methods

Results

Discussion

Conclusion