Prioritization of modifiable risk factors for adverse pregnancy outcomes and neonatal mortality in rural Nepal

优先考虑尼泊尔农村地区不良妊娠结局和新生儿死亡率的可改变危险因素

• 批准号: 9974546
• 负责人: JOANNE KATZ
• 金额: $ 24.6万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-22 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9974546
• 关键词: Address; Age; Alcohol consumption; Area; Asia; Birth; Blood Pressure; Consent; Country; Data; Data Analyses; Data Collection; Discipline of obstetrics; Distal; Environment; Factor Analysis; Female of child bearing age; Fetal Death; First Pregnancy Trimester; Gestational Age; Goals; Height; Infant; Infant Care; Intervention; Intervention Studies; Intervention Trial; Interview; Life; Live Birth; Maternal Health; Mediating; Menstruation; Modeling; Modification; Morbidity - disease rate; Neonatal; Neonatal Mortality; Nepal; Newborn Infant; Outcome; Perinatal mortality demographics; Physiologic pulse; Population Attributable Risks; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnancy Tests; Premature Birth; Procedures; Randomized Controlled Trials; Reproductive History; Resources; Risk Factors; Role; Rural; Rural Population; Small for Gestational Age Infant; Structure; Sustainable Development; Temperature; Tobacco use; United Nations; Visit; Weight; Woman; adverse birth outcomes; adverse outcome; adverse pregnancy outcome; antenatal care; care seeking; design; fetal; health disparity; infant outcome; instrument; intrapartum; modifiable risk; mortality; mother nutrition; neonatal death; population based; reproductive; secondary analysis; sex; socioeconomics; stillbirth; therapy design

ABSTRACT Nearly 3 million infants die each year in the first 28 days of life. An additional 2.6 million still births occur annually, almost universally in low resource settings. Two specific global targets have been established to address these rates: Sustainable Development Goal (SDG) 3.2 calls for a reduction in global neonatal mortality to 12/1000 live births, and the United Nations-endorsed Every Newborn Action Plan calls for every country to achieve 12 or fewer stillbirths per 1000 total births by 2030. Identifying and prioritizing potentially modifiable risk factors for late fetal and neonatal deaths is essential to meet the Sustainable Development Goals in low resource countries. In particular, identifying potential interventions for poor, rural populations is a first step to reducing health disparities common in these environments. We propose to prioritize risk factors in a secondary analysis of 45,000 pregnancies among married women of reproductive age combining data from four population-based randomized controlled trials in the southern low-lying plains of rural Nepal collected between 2010 and 2016. Data during pregnancy and through 28 days postpartum were collected across all trials using similar data collection instruments and procedures. All women of childbearing age in the study area were visited every 5 weeks to record date of last menstrual period and if a period was missed, to offer a pregnancy test. Maternal height, socioeconomic, demographic and reproductive history data were obtained on all consenting pregnancies. Women provided data on morbidity, care seeking and antenatal care visits, alcohol and tobacco use, weight, blood pressure, pulse and temperature from early in pregnancy (around 8-12 weeks) and monthly thereafter through delivery. Following the pregnancy outcome, women were interviewed about labor and delivery, and care of newborns. Live born infants were weighed as soon possible after birth. Infants in all studies were followed through 28 days of life. This study will separately characterize risk factors for mortality during four life stages: late fetal, intrapartum fetal, early neonatal (1-7 days) and late neonatal (8-28 days). The specific aims are to prioritize modifiable risk factors in pregnancy within the context of more distal and structural risk factors for 1) fresh and macerated stillbirths, 2) small-for-gestational-age/preterm, and 3) all cause and cause-specific early and late neonatal mortality. We will also examine differences in small-for-gestational-age/preterm and neonatal mortality by sex of the infant and whether sex modifies associations between adverse birth outcomes and neonatal mortality. The study will provide the requisite evidence to support design choices for intervention studies to reduce perinatal deaths, and late neonatal mortality in this and comparable settings.

抽象的 在生命的前28天，每年有近300万婴儿死亡。又发生了260万个出生 每年在低资源设置中几乎普遍普遍。已经建立了两个特定的全球目标 解决以下价格：可持续发展目标（SDG）3.2呼吁降低全球新生儿死亡率 到12/1000的活产，联合国对每个新生儿行动计划都要求每个国家 到2030年，每1000个分娩总分别达到12个或更少的死产。确定并确定可能修改的优先级 晚期胎儿和新生儿死亡的危险因素对于达到低的可持续发展目标至关重要 资源国家。特别是，确定贫困，农村人口的潜在干预措施是 减少在这些环境中常见的健康差异。我们建议在次要中优先考虑风险因素 分析已婚年龄的已婚妇女中的45,000例怀孕，结合了四个的数据 在尼泊尔的南部低洼平原中，基于人群的随机对照试验收集了 2010年和2016年。在所有试验中收集了怀孕期间的数据和产后28天 类似的数据收集工具和程序。研究领域的所有育龄妇女均为 每5周访问一次，以记录最后一个月经期的日期，如果错过了一段时间，请怀孕 测试。所有人都获得了母亲的身高，社会经济，人口统计学和生殖历史数据 同意怀孕。妇女提供了有关发病率，寻求护理和产前护理的数据，酒精 从怀孕初期开始使用烟草，体重，血压，脉搏和温度（约8-12周） 并在交货中每月一次。怀孕结束后，对妇女进行了采访 劳动和分娩以及新生儿的照顾。出生后尽快将活出生的婴儿称重。婴儿 在所有研究中，遵循生命的28天。 这项研究将分别表征四个生命阶段死亡率的风险因素：晚期，胎儿内部 胎儿，新生儿早期（1-7天）和新生儿晚期（8-28天）。具体目的是优先考虑可修改风险 在更远端和结构性风险因素的背景下怀孕的因素1）新鲜和浸泡 死胎，2）小胎龄/早产，以及3）所有原因和特定原因的早期和晚期新生儿 死亡。 我们还将检查小胎龄/早产和新生儿死亡率的差异 婴儿以及性别是否改变了不良出生结果与新生儿死亡率之间的关联。这 研究将提供必要的证据，以支持干预研究的设计选择以减少围产期 在此和可比较的环境中，死亡和新生儿死亡率晚期。

项目成果

Prevalence and predictors of spontaneous preterm births in Nepal: findings from a prospective, population-based pregnancy cohort in rural Nepal-a secondary data analysis.

• DOI: 10.1136/bmjopen-2022-066934
• 发表时间: 2022-12-01
• 期刊: BMJ open
• 影响因子: 2.9

Demographic, socio-economic, obstetric, and behavioral factors associated with small-and large-for-gestational-age from a prospective, population-based pregnancy cohort in rural Nepal: a secondary data analysis.

• DOI: 10.1186/s12884-022-04974-8
• 发表时间: 2022-08-19
• 期刊: BMC pregnancy and childbirth
• 影响因子: 3.1

Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study.

尼泊尔农村地区怀孕期间的恶心、呕吐和食欲不振以及不良分娩结局：一项观察性队列研究。

• DOI: 10.1186/s12884-020-03141-1
• 发表时间: 2020
• 期刊: BMC pregnancy and childbirth
• 影响因子: 3.1
• 作者: RegodónWallin,Amanda;Tielsch,JamesM;Khatry,SubarnaK;Mullany,LukeC;Englund,JanetA;Chu,Helen;LeClerq,StevenC;Katz,Joanne
• 通讯作者: Katz,Joanne