A study that analysed the data of nearly 24,000 pregnant women in India has 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. Northeastern States of Meghalaya (67.8%), Manipur (66.7%) and Mizoram (62.5%) and the southern State of Telangana (60.3%) had the highest prevalence of high-risk factors in India, while 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, 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) in Mumbai.
The study used the nationally representative cross-sectional household survey data of the National Family Health Survey-5 (2019-2021). The researchers used the unit-level data from the Demographic Health Surveys (DHS) programme. Data from around 28,400 currently pregnant women aged 15-49 years were extracted. Of these, 23,853 women who were pregnant at the time of the survey were included in the analyses. While 12,183 (50.6%) of pregnant women had no high-risk factors, 11,670 (49.4%) of pregnant women had one or more high-risk factors and were categorised as high-risk pregnancies.
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, and 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 the age of the mother — adolescent women aged 15 to 17 years and women older than 35 years — pregnant women who are short (height below 140 cm), and have a higher body mass index of over 30. Additionally, the gestational weight gains up to 7-11 kg for overweight women and 5-9 kg for obese women were considered high-risk pregnancies.
‘Risk factors’
Lifestyle risk factors included tobacco use and alcohol consumption, while previous birth outcome risks included pregnant women with more than five children, women with short birth spacing and long birth intervals of over 59 months. Also, women with a history of preterm deliveries, miscarriages, abortions, or stillbirths were included under the category of previous birth outcome risk factor.
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. Women who had recently delivered through caesarean sections were found in 16.4%. Other high-risk factors were women having longer spacing (15.8%), history of preterm delivery (14.1%) and comorbidities (6.4%).
Risk factor arising from adolescent pregnancies was highest in Tripura (10.3%), while 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
Women with more than five children (higher birth order) were seen in Meghalaya (10.7%), whereas 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%).
“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 authors write. “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.”
The authors suggest that policies and programmes and creating public awareness and education of women are needed to address the short interval between two successive pregnancies.
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%).
The proportion of multiple high risks was higher among women with no educational category (22.5%) compared with educated women.
