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Hemoglobin Concentrations And Adverse Birth Outcomes In South Asian Pregnant Women: Findings From A Prospective Maternal And Neonatal Health Registry, Sumera Aziz Ali, Shiyam Sunder Tikmani, Sarah Saleem, Archana B Patel, Patricia L Hibberd, Shivaprasad S Goudar, Sangappa Dhaded, Richard J Derman, Janet L Moore, Elizabeth M Mcclure, Robert L Goldenberg

Global Health Articles

BACKGROUND: While the relationship between hemoglobin (Hb) concentrations and pregnancy outcomes has been studied often, most reports have focused on a specific Hb cutoff used to define anemia. Fewer studies have evaluated pregnancy outcomes across the entire range of Hb values. Moreover, to date, most studies of the relationship of Hb concentrations to pregnancy outcomes have been done in high-income countries. Thus, we have sought to determine the relationship between the range of maternal Hb concentrations and adverse birth outcomes among South Asian pregnant women.

METHODS: For this study, we used data collected from two South Asian countries (Pakistan - …

Neonatal Deaths In Rural Karnataka, India 2014-2018: A Prospective Population-Based Observational Study In A Low-Resource Setting., Sangappa M Dhaded, Manjunath S Somannavar, Janet L Moore, Elizabeth M Mcclure, Sunil S Vernekar, S Yogeshkumar, Avinash Kavi, Umesh Y Ramadurg, Tracy L Nolen, Robert L Goldenberg, Richard J Derman, Shivaprasad S Goudar

Global Health Articles

BACKGROUND: Neonatal mortality causes a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC).

METHODS: We undertook a prospective, population-based research study of pregnant women residing in defined geographic areas in the Karnataka State of India, a research site of the Global Network for Women's and Children's Health Research. Study staff collected demographic and health care characteristics on eligible women enrolled with neonatal outcomes obtained at delivery and day 28. Cause of neonatal mortality at day 28 was assigned by algorithm using prospectively defined variables.

RESULTS: From 2014 to 2018, the neonatal mortality rate was 24.5 per …

The Relationship Between Birth Intervals And Adverse Maternal And Neonatal Outcomes In Six Low And Lower-Middle Income Countries., Melissa Bauserman, Kayla Nowak, Tracy L Nolen, Jackie Patterson, Adrien Lokangaka, Antoinette Tshefu, Archana B Patel, Patricia L Hibberd, Ana L Garces, Lester Figueroa, Nancy F Krebs, Fabian Esamai, Edward A Liechty, Waldemar A Carlo, Elwyn Chomba, Musaku Mwenechanya, Shivaprasad S Goudar, Umesh Ramadurg, Richard J Derman, Sarah Saleem, Saleem Jessani, Marion Koso-Thomas, Elizabeth M Mcclure, Robert L Goldenberg, Carl Bose

Global Health Articles

BACKGROUND: Due to high fertility rates in some low and lower-middle income countries, the interval between pregnancies can be short, which may lead to adverse maternal and neonatal outcomes.

METHODS: We analyzed data from women enrolled in the NICHD Global Network Maternal Newborn Health Registry (MNHR) from 2013 through 2018. We report maternal characteristics and outcomes in relationship to the inter-delivery interval (IDI, time from previous delivery [live or stillborn] to the delivery of the index birth), by category of 6-17 months (short), 18-36 months (reference), 37-60 months, and 61-180 months (long). We used non-parametric tests for maternal characteristics, and …

Looking Beyond The Numbers: Quality Assurance Procedures In The Global Network For Women's And Children's Health Research Maternal Newborn Health Registry., Ana Garces, Emily Macguire, Holly L Franklin, Norma Alfaro, Gustavo Arroyo, Lester Figueroa, Shivaprasad S Goudar, Sarah Saleem, Fabian Esamai, Archana Patel, Elwyn Chomba, Antoinette Tshefu, Rashidul Haque, Jacquelyn K Patterson, Edward A Liechty, Richard J Derman, Waldemar A Carlo, William Petri, Marion Elizabeth M Koso-Thomasmcclure, Robert L Goldenberg, Patricia Hibberd, Nancy F Krebs

Global Health Articles

BACKGROUND: Quality assurance (QA) is a process that should be an integral part of research to protect the rights and safety of study participants and to reduce the likelihood that the results are affected by bias in data collection. Most QA plans include processes related to study preparation and regulatory compliance, data collection, data analysis and publication of study results. However, little detailed information is available on the specific procedures associated with QA processes to ensure high-quality data in multi-site studies.

METHODS: The Global Network for Women's and Children's Health Maternal Newborn Health Registy (MNHR) is a prospective population-based registry …

The Global Network Maternal Newborn Health Registry: A Multi-Country, Community-Based Registry Of Pregnancy Outcomes., Elizabeth M. Mcclure, Ana L. Garces, Patricia L. Hibberd, Janet L. Moore, Shivaprasad S. Goudar, Sarah Saleem, Fabian Esamai, Archana Patel, Elwyn Chomba, Adrien Lokangaka, Antoinette Tshefu, Rashidul Haque, Carl L. Bose, Edward A. Liechty, Nancy F. Krebs, Richard J. Derman, Waldemar A. Carlo, William Petri, Marion Koso-Thomas, Robert L Goldenberg

Global Health Articles

BACKGROUND: The Global Network for Women's and Children's Health Research (Global Network) conducts clinical trials in resource-limited countries through partnerships among U.S. investigators, international investigators based in in low and middle-income countries (LMICs) and a central data coordinating center. The Global Network's objectives include evaluating low-cost, sustainable interventions to improve women's and children's health in LMICs. Accurate reporting of births, stillbirths, neonatal deaths, maternal mortality, and measures of obstetric and neonatal care is critical to determine strategies for improving pregnancy outcomes. In response to this need, the Global Network developed the Maternal Newborn Health Registry (MNHR), a prospective, population-based registry …

Neonatal Deaths In Infants Born Weighing ≥ 2500 G In Low And Middle-Income Countries., Sarah Saleem, Farnaz Naqvi, Elizabeth M. Mcclure, Kayla J. Nowak, Shiyam Sunder Tikmani, Ana L. Garces, Patricia L. Hibberd, Janet L. Moore, Tracy L. Nolen, Shivaprasad S. Goudar, Yogesh Kumar, Fabian Esamai, Irene Marete, Archana B. Patel, Elwyn Chomba, Musaku Mwenechanya, Carl L. Bose, Edward A. Liechty, Nancy F. Krebs, Richard Derman, Waldemar A. Carlo, Antoinette Tshefu, Marion Koso-Thomas, Sameen Siddiqi, Robert L. Goldenberg

Global Health Articles

BACKGROUND: Babies born weighing ≥ 2500 g account for more than 80% of the births in most resource-limited locations and for nearly 50% of the 28-day neonatal deaths. In contrast, in high-resource settings, 28-day neonatal mortality among this group represents only a small fraction of the neonatal deaths. Yet mortality risks for birth weight of ≥ 2500 g is limited. Knowledge regarding the factors associated with mortality in these babies will help in identifying interventions that can reduce mortality.

METHODS: The Global Network's Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and …

Stillbirth 2010-2018: A Prospective, Population-Based, Multi-Country Study From The Global Network., Elizabeth M. Mcclure, Sarah Saleem, Shivaprasad S. Goudar, Ana Garces, Ryan Whitworth, Fabian Esamai, Archana B. Patel, Shiyam Sunder Tikmani, Musaku Mwenechanya, Elwyn Chomba, Adrien Lokangaka, Carl L. Bose, Sherri Bucher, Edward A. Liechty, Nancy F. Krebs, S Yogesh Kumar, Richard J. Derman, Patricia L. Hibberd, Waldemar A. Carlo, Janet L. Moore, Tracy L. Nolen, Marion Koso-Thomas, Robert L. Goldenberg

Global Health Articles

BACKGROUND: Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time.

METHODS: We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, Democratic Republic of Congo, India, Pakistan, and Guatemala). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Cause of stillbirth was assigned by algorithm.

RESULTS: From …

Evaluating The Effect Of Care Around Labor And Delivery Practices On Early Neonatal Mortality In The Global Network's Maternal And Newborn Health Registry., Archana B. Patel, Elizabeth M. Simmons, Sowmya R. Rao, Janet Moore, Tracy L. Nolen, Robert L Goldenberg, Shivaprasad S. Goudar, Manjunath S. Somannavar, Fabian Esamai, Paul Nyongesa, Ana L. Garces, Elwyn Chomba, Musaku Mwenechanya, Sarah Saleem, Farnaz Naqvi, Melissa Bauserman, Sherri Bucher, Nancy F. Krebs, Richard J. Derman, Waldemar A. Carlo, Marion Koso-Thomas, Elizabeth M. Mcclure, Patricia L. Hibberd

Global Health Articles

BACKGROUND: Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation's (UN's) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization's Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness.

METHODS: Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD's Global Network's (GN) Maternal Newborn …

Predictive Modeling For Perinatal Mortality In Resource-Limited Settings., Vivek V. Shukla, Barry Eggleston, Namasivayam Ambalavanan, Elizabeth M. Mcclure, Musaku Mwenechanya, Elwyn Chomba, Carl Bose, Melissa Bauserman, Antoinette Tshefu, Shivaprasad S. Goudar, Richard J. Derman, Ana Garcés, Nancy F. Krebs, Sarah Saleem, Robert L. Goldenberg, Archana Patel, Patricia L. Hibberd, Fabian Esamai, Sherri Bucher, Edward A. Liechty, Marion Koso-Thomas, Waldemar A. Carlo

Global Health Articles

Importance: The overwhelming majority of fetal and neonatal deaths occur in low- and middle-income countries. Fetal and neonatal risk assessment tools may be useful to predict the risk of death.

Objective: To develop risk prediction models for intrapartum stillbirth and neonatal death.

Design, Setting, and Participants: This cohort study used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research population-based vital registry, including clinical sites in South Asia (India and Pakistan), Africa (Democratic Republic of Congo, Zambia, and Kenya), and Latin America (Guatemala). A total of 502 …

Preconception Nutrition Intervention Improved Birth Length And Reduced Stunting And Wasting In Newborns In South Asia: The Women First Randomized Controlled Trial., Sangappa M Dhaded, K. Michael Hambidge, Sumera Aziz Ali, Manjunath Somannavar, Sarah Saleem, Omrana Pasha, Umber Khan, Veena Herekar, Sunil Vernekar, S. Yogesh Kumar, Jamie E. Westcott, Vanessa R. Thorsten, Amaanti Sridhar, Abhik Das, Elizabeth Mcclure, Richard J. Derman, Robert L. Goldenberg, Marion Koso-Thomas, Shivaprasad S. Goudar, Nancy F. Krebs

Global Health Articles

South Asia has >50% of the global burden of low birth weight (LBW). The objective was to determine the extent to which maternal nutrition interventions commenced before conception or in the 1st trimester improved fetal growth in this region. This was a secondary analysis of combined newborn anthropometric data for the South Asian sites (India and Pakistan) in the Women First Preconception Maternal Nutrition Trial. Participants were 972 newborn of mothers who were poor, rural, unselected on basis of nutritional status, and had been randomized to receive a daily lipid-based micronutrient supplement commencing ≥3 months prior to conception (Arm 1), …

Low-Dose Aspirin For The Prevention Of Preterm Delivery In Nulliparous Women With A Singleton Pregnancy (Aspirin): A Randomised, Double-Blind, Placebo-Controlled Trial., Matthew K. Hoffman, Shivaprasad S. Goudar, Bhalachandra S. Kodkany, Mrityunjay Metgud, Manjunath Somannavar, Jean Okitawutshu, Adrien Lokangaka, Antoinette Tshefu, Carl L. Bose, Abigail Mwapule, Musaku Mwenechanya, Elwyn Chomba, Waldemar A. Carlo, Javier Chicuy, Lester Figueroa, Ana Garces, Nancy F. Krebs, Saleem Jessani, Farnaz Zehra, Sarah Saleem, Robert L. Goldenberg, Kunal Kurhe, Prabir Das, Archana Patel, Patricia L. Hibberd, Emmah Achieng, Paul Nyongesa, Fabian Esamai, Edward A. Liechty, Norman Goco, Jennifer Hemingway-Foday, Janet Moore, Tracy L. Nolen, Elizabeth M. Mcclure, Marion Koso-Thomas, Menachem Miodovnik, R. Silver, Richard J. Derman, Aspirin Study Group

Global Health Articles

BACKGROUND: Preterm birth remains a common cause of neonatal mortality, with a disproportionately high burden in low-income and middle-income countries. Meta-analyses of low-dose aspirin to prevent pre-eclampsia suggest that the incidence of preterm birth might also be decreased, particularly if initiated before 16 weeks of gestation.

METHODS: ASPIRIN was a randomised, multicountry, double-masked, placebo-controlled trial of low-dose aspirin (81 mg daily) initiated between 6 weeks and 0 days of pregnancy, and 13 weeks and 6 days of pregnancy, in nulliparous women with an ultrasound confirming gestational age and a singleton viable pregnancy. Participants were enrolled at seven community sites in …