Association of Maternal History of Neonatal Death With Subsequent Neonatal Death in India

Abstract

IMPORTANCE Among the United Nations' Sustainable Development Goals is to reduce the neonatal mortality rate to 12 per 1000 live births by 2030. Identifying high-risk pregnancies can help achieve this target in low-resource countries, such as India, which accounts for one-fourth of global neonatal deaths. OBJECTIVE To analyze the association of maternal history of neonatal death with subsequent neonatal mortality. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included a nationally representative sample of singleton live births from multiparous women. Data were obtained from the 2016 National Family Health Survey in India. Data were analyzed from November 2018 to January 2020. EXPOSURES Maternal history of neonatal death and a comprehensive set of covariates, including socioeconomic environment, maternal anthropometry, and pregnancy care. MAIN OUTCOMES AND MEASURES Subsequent neonatal mortality. Population-attributable risk associated with history of neonatal death was calculated, and sensitivity analyses were performed. RESULTS The overall study population consisted of 127 336 singleton live births from multiparous women aged 15 to 49 (mean [SD] age, 28.8 [5.2] years) years when the survey was undertaken. In our analytic sample, 11 101 (8.7%) mothers had a history of neonatal death, and 506 of 2224 total neonatal deaths (22.8%) were attributed to women with history of neonatal death. The prevalence of history of neonatal death differed by selected covariates and across states or union territories. Maternal history of neonatal death was associated with significantly higher odds of neonatal mortality (adjusted odds ratio, 2.23; 95% CI, 1.96-2.55), and this remained consistent across different subgroups. The population-attributable risk associated with maternal history of neonatal death was 11.8%. Stronger associations were found for maternal history of multiple neonatal deaths (adjusted odds ratio, 3.50; 95% CI, 2.78-4.41) and in respect to the risk of mortality in early neonatal period (ie, 0-2 completed days) (adjusted odds ratio, 2.45; 95% CI, 2.09-2.86). CONCLUSIONS AND RELEVANCE These findings suggest that maternal history of neonatal death is a potentially useful risk factor to identify women and neonates who may need extended and enhanced pregnancy care.

Association of maternal history of neonatal death with subsequent neonatal death across 56 low- and middle-income countries

“…Place of residence was a dichotomous variable, which categorized the population into urban and rural. We classified maternal education to six categories (no schooling, < 5 years, 5–7 years, 8–9 years, 10–11 years, and 12 years or more) 10 . Water source was considered to be improved if the household had access to water piped into dwelling or yard/plot, public tap/standpipe, tube well or borehole, protected well or spring, rain water, and bottled water 20 .…”

“…The child factors included sex of the child, birth weight of the child by type of report, size at birth, and breastfeeding initiation. We generated five categories for child birth weight by type of report, which were (1) not weighted, (2) < 2500 g based on mother’s recall, (3) < 2500 g based on written card, (4) 2500 g based on mother’s recall, and (5) 2500 g based on written card 10 . DHS classified child size at birth into three categories: (1) within reference range or higher, (2) small, (3) very small 21 .…”

“…We generated a dichotomous variable to see whether breastfeeding was initiated < 1 h of birth 22 . The pregnancy-related covariates included number of antenatal cares, full tetanus protection, whether delivered with a skilled birth attendant (SBA), whether delivered in a health facility, maternal age at birth, and birth interval 10 . Global guidelines recommend frequent medical visits during the antenatal period to decrease the risk of birth complications, with recommendation ranging from at least four to optimally eight visits during the pregnancy 23 .…”

“…The identification of cross-country heterogeneity is essential for the design of global and national health agenda. If the association between history of neonatal deaths and subsequent neonatal mortality turns out to be consistent across countries, then history of neonatal death could be considered as one of the indicators to identify high risk pregnancies in LMICs 10 . On the other hand, if the association shows substantial heterogeneity across countries, then the implication would be to develop more localized guidelines to promote positive pregnancy.…”

Maternal History of Neonatal Death as an Emerging Risk Factor of Subsequent Neonatal Mortality in Low- and Middle-Income Countries

“…The study by Kapoor et al 2 examined the association of maternal history of neonatal death with subsequent neonatal mortality using a cross-section of nationally representative data from the 2016 National Family Health Survey in India. The results reported by Kapoor et al 2 are consistent with published evidence that suggest that past adverse obstetric history can be a risk factor of adverse perinatal outcomes and that maternal history of neonatal death is associated with subsequent neonatal mortality. 2 The authors report that approximately one-quarter of subsequent neonatal deaths in their sample occurred among mothers with history of neonatal death.…”