ObjectivesTo study the trend in the prevalence of anaemia and low BMI among pregnant women from Eastern Maharashtra and evaluate if low BMI and anaemia affect pregnancy outcomes.DesignProspective observational cohort study.SettingCatchment areas of 20 rural primary health centres in four eastern districts of Maharashtra State, India.Participants72 750 women from the Nagpur site of Maternal and Newborn Health Registry of NIH’s Global Network, enrolled from 2009 to 2016.Main outcome measuresMode of delivery, pregnancy related complications at delivery, stillbirths, neonatal deaths and low birth weight (LBW) in babies.ResultsOver 90% of the women included in the study were anaemic and over a third were underweight (BMI <18 kg/m2) and with both conditions. Mild anaemia at any time during delivery significantly increased the risk (Risk ratio; 95% confidence interval (RR;(95% CI)) of stillbirth (1.3 (1.1–1.6)), neonatal deaths (1.3 (1–1.6)) and LBW babies (1.1 (1–1.2)). The risks became even more significant and increased further with moderate/severe anaemia any time during pregnancy for stillbirth (1.4 (1.2–1.8)), neonatal deaths (1.7 (1.3–2.1)) and LBW babies (1.3 (1.2–1.4)).,. Underweight at anytime during pregnancy increased the risk of neonatal deaths (1.1 (1–1.3)) and LBW babies (1.2;(1.2–1.3)). The risk of having stillbirths (1.5;(1.2–1.8)), neonatal deaths (1.7;(1.3–2.3)) and LBW babies (1.5;(1.4–1.6)) was highest when - the anaemia and underweight co-existed in the included women. Obesity/overweight during pregnancy increased the risk of maternal complications at delivery (1.6;(1.5–1.7)) and of caesarean section (1.5;(1.4–1.6)) and reduced the risk of LBW babies 0.8 (0.8–0.9)).ConclusionMaternal anaemia is associated with enhanced risk of stillbirth, neonatal deaths and LBW. The risks increased if anaemia and underweight were present simultaneously.Trial registration numberNCT01073475.

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BackgroundIn 2008, the Indian government introduced financial assistance to encourage health facility deliveries. Facility births have increased, but maternal and neonatal morbidity and mortality have not decreased raising questions about the quality of care provided in facilities and access to a quality referral system. We evaluated the potential role of inter-institutional transfers of women admitted for labor and delivery on adverse maternal and neonatal outcomes in an ongoing prospective, population-based Maternal and Newborn Health Registry in Central India.MethodsPregnant women from 20 rural Primary Health Centers near Nagpur, Maharashtra were followed throughout pregnancy and to day 42 post-partum. Inter- institutional referral was defined as transfer of a woman from a first or second level facility where she was admitted for labor and delivery to facility providing higher level of care, after admission to the day of delivery. Maternal mortality, stillbirth, early and late neonatal mortality were compared in mothers who were and were not referred. Factors associated with inter-institutional referral were analyzed using multivariable models with generalized estimating equations, adjusted for clustering at the level of the Primary Health Center.ResultsBetween June 2009 and June 2013, 3236 (9.4%) of 34,319 women had inter-institutional referral. Factors associated with referrals were maternal age (adjusted Relative Risk or aRR 1.1; 1.0–1.2); moderate or severe anemia (aRR 1.2; 1.2–1.4), gestational age <37 weeks (aRR 1.16; 1.05–1.27), multiple gestation (aRR 1.6; 1.2–2.1), absent fetal heart rate (aRR 1.7; 1.3–2.2), primigravida (aRR 1.4; 1.3, 1.6), primigravida with any pregnancy related maternal condition such as obstructed or prolonged labor; major antepartum or post-partum hemorrhage, hypertension or preeclampsia and breech, transverse or oblique lie (aRR 4.7; 3.8, 5.8), multigravida with any pregnancy related conditions (aRR 4.2; 3.4–5.2). Stillbirths, early neonatal,late neonatal and early infant deaths occurred in 7.3% referred mothers vs. 3.7% of not referred.ConclusionsAlmost 10% of the women had an inter-institutional referral and still birth or neonatal deaths were doubled in referred women. Conditions associated with referral were often known before onset of labor and delivery. Improvements in maternal and neonatal outcomes will likely require pregnant women with conditions associated with referral to be directly admitted at facilities equipped to care for complicated pregnancies and at risk neonates, as well as prompt detection and transfer those who develop “at risk” conditions during labor and delivery.Trial registrationClinicalTrials.gov NCT01073475.

Scientific paper authorship is an important academic achievement for all research professionals. Being designated as an author of a paper has academic, research, social and financial implications. Signing of a manuscript as an author does confer credit but also transfers responsibility. While authors get credit for the published work, they must accept the public responsibility that goes with it. Over the past few years, there has been a rising trend in authorship abuses. The prevalent culture of "publish or perish" appears to be responsible for this. In an endeavor to ensure honest practice, the International Committee of Medical Journal Editors (ICMJE), the Vancouver Group, developed the criteria for authorship and said that "all persons designated as authors should qualify for authorship and all those who qualify should be listed." However, authorship irregularities continue to exist and are a cause of concern. Budding authors should be enlightened about concurrent problems in authorship, during their formative years and encouraged toward fair practices in publications.

BackgroundPossible serious bacterial infection (PBSI) is a major cause of neonatal mortality worldwide. We studied risk factors for PSBI in a large rural population in central India where facility deliveries have increased as a result of a government financial assistance program.MethodsWe studied 37,379 pregnant women and their singleton live born infants with birth weight ≥ 1.5 kg from 20 rural primary health centers around Nagpur, India, using data from the 2010–13 population-based Maternal and Newborn Health Registry supported by NICHD’s Global Network for Women’s and Children’s Health Research. Factors associated with PSBI were identified using multivariable Poisson regression.ResultsTwo thousand one hundred twenty-three infants (6 %) had PSBI. Risk factors for PSBI included nulliparity (RR 1.13, 95 % CI 1.03–1.23), parity > 2 (RR 1.30, 95 % CI 1.07–1.57) compared to parity 1–2, first antenatal care visit in the 2nd/3rd trimester (RR 1.46, 95 % CI 1.08–1.98) compared to 1st trimester, administration of antenatal corticosteroids (RR 2.04, 95 % CI 1.60–2.61), low birth weight (RR 3.10, 95 % CI 2.17–4.42), male sex (RR 1.20, 95 % CI 1.10–1.31) and lack of early initiation of breastfeeding (RR 3.87, 95 % CI 2.69–5.58).ConclusionInfants who are low birth weight, born to mothers who present late to antenatal care or receive antenatal corticosteroids, or born to nulliparous women or those with a parity > 2, could be targeted for interventions before and after delivery to improve early recognition of signs and symptoms of PSBI and prompt referral. There also appears to be a need for a renewed focus on promoting early initiation of breastfeeding following delivery in facilities.Trial registrationThis trial is registered at ClinicalTrials.gov (NCT01073475).Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3688-3) contains supplementary material, which is available to authorized users.