Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021

D J. Erchick, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
E A. Hazel, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Katz, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
A C. Lee, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
M Diaz, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
L S. Wu, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
S Yoshida, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
R Bahl, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
C Grandi, Argentine Society of Paediatrics, Ciudad Autónoma de Buenos Aires, Argentina.
A B. Labrique, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
M Rashid, IntraHealth International, Dhaka, Bangladesh.
S Ahmed, Projahnmo Research Foundation, Dhaka, Bangladesh.
A D. Roy, Projahnmo Research Foundation, Dhaka, Bangladesh.
R Haque, JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh.
S Shaikh, JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh.
A H. Baqui, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
S K. Saha, Child Health Research Foundation, Dhaka, Bangladesh.
R Khanam, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
S Rahman, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
R Shapiro, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
R Zash, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
M F. Silveira, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
R Buffarini, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
P Kolsteren, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
C Lachat, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
L Huybregts, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
D Roberfroid, Medicine Department, Faculty of Medicine, University of Namur, Namur, Belgium.
L Zeng, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Z Zhu, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
J He, Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China.
X Qiu, Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China.
S H. Gebreyesus, Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.

Document Type

Journal Article

Publication Date

5-8-2023

Journal

BJOG : an international journal of obstetrics and gynaecology

DOI

10.1111/1471-0528.17510

Keywords

low birthweight; newborn; preterm birth; small for gestational age

Abstract

OBJECTIVE: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. DESIGN: Descriptive multi-country secondary data analysis. SETTING: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. POPULATION: Liveborn infants. METHODS: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. RESULTS: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). CONCLUSIONS: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.

Department

Global Health

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