Less-expensive Pregnancy Interventions Can Prevent Millions Of Stillbirths And Newborn Deaths

The new four-paper series, published in The Lancet, examined some of the most common causes of fetal growth restriction and preterm birth. Eight interventions scaled up in low-and middle-income countries could prevent an estimated 566,000 stillbirths and 5.2 million babies from being born premature or small for gestational age, each year.

The eight interventions include:

Multiple micronutrient supplements
Balanced protein energy supplements
Aspirin prophylaxis
Treatment of syphilis
Education for smoking cessation
Prevention of malaria in pregnancy
Treatment of asymptomatic bacteriuria (the presence of bacteria in urine)
The researchers also suggest a further two proven interventions that could reduce the complications of preterm births:

Antenatal corticosteroids (a group of steroid hormones used to accelerate lung maturation)
Delayed clamping of the umbilical cord
The series estimates that, of the 135 million babies born alive in 2020, one in four (35.5 million) were born preterm or small for gestational age – including some with a low birth weight (less than 2.5 kg). The series groups together these children under the new term of “small vulnerable newborns”.

Researchers found that small vulnerable newborns were born in every country, with the majority in sub-Saharan Africa and southern Asia.

However, progress for reducing preterm birth and low birthweight is currently far behind targets worldwide – with the estimated annual rate of reduction at 0.59% compared to the Global Nutrition Target of 30% reduction by 2030.

In a global call to action, the series argues for a higher quality of care, including the implementation of the WHO-recommended minimum eight antenatal contacts for women during pregnancy, and specifically for the scale-up of pregnancy interventions in 81 low- and middle-income countries, which the series estimates could prevent approximately 32% of stillbirths, 20% of newborn baby deaths and 18% of all small and vulnerable newborns in those countries.

Researchers believe that these interventions will cost $1.1 billion in 2030. However, this cost would be balanced by cost savings from better overall health of the population.

Professor Nigel Klein (UCL Great Ormond Street Institute of Child Health), the senior author on the third paper of the series, said: “It’s important to remember that we don’t fully understand pregnancy in health let alone complications, adverse exposures and how they lead to poor outcomes. Moving forward requires continuous research, discovery, dissemination and implementation.”

Lead author Dr Patricia Hunter (UCL Great Ormond Street Institute of Child Health) added: “Increased antenatal contacts provide a tremendous opportunity for widespread implementation of what we know to be effective at reducing the prevalence of stillbirth and infants born small and vulnerable.”

Co-author Professor Anna David (UCL EGA Institute for Women’s Health), said: “These evidence-based antenatal interventions are relatively simple but will require global commitment to achieve high effective coverage for our pregnant populations”.

In addition to helping ensure good quality care, the series says better data collection is essential to inform progress and drive accountability. Counting stillbirths is important to capture the full burden, since new analyses in the series highlights that 74% of stillbirths were born preterm for a subset of countries.

Professor Per Ashorn (Tampere University, Finland) who was a lead author on the series, said: “Despite several global commitments and targets aimed at reducing small vulnerable newborn outcomes since 1990, every fourth baby in the world is ‘born too small’ or ‘born too soon’.

“Our series suggests that we already have the knowledge to reverse the current trend and save the lives of 100,000s of babies a year at a cost of $1.1billion, a fraction of what other health programmes receive. We need national actors, with global partners, to urgently prioritise action, advocate and invest.”