Determinants of small vulnerable newborn births in two rural community-based cohorts in India: a prospective study

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Background: The Small Vulnerable Newborn (SVN) Consortium introduced the concept of SVN, combining preterm, low birth weight (LBW), and small for gestational age (SGA) into a single category. Limited data on the actual SVN burden and its determinants formed the basis of this study, where we estimated its incidence and associated factors in two distinct pregnant women cohorts in India. Methods: The study followed pregnant women cohorts from Hodal, Haryana, and Lowairpoa, Assam, through their antenatal period until 12 months postpartum to identify adverse maternal and infant outcomes. Incidence of SVN was estimated, and its association with various factors was assessed using modified Poisson regression models. Findings: The overall incidence of SVN was 48.3%, with term-SGA, preterm non-SGA, and preterm-SGA accounting for 32.2%, 14.7%, and 2.9%, respectively. This pattern was consistent across both sites. SVN incidence was higher among multiple gestations than among singleton births. Significant risk factors included antepartum hemorrhage [Hodal (H): adjusted relative risk [aRR] 1.29; 95% confidence interval [CI]: 1.15-1.44; Lowairpoa (L): aRR 1.88; 95% CI: 1.58-2.24], maternal height <145 cm [H: 1.30 (1.21-1.39); L: 1.24 (1.12-1.37)], previous LBW history [H: 1.33; 1.25-1.42; L: 1.47; 1.23-1.76], nulliparity [H: 1.31; 1.23-1.38; L: 1.39; 1.24-1.55], and exclusive biomass-fuel use [H: 1.13; 1.06-1.20; L: 1.26; 1.09-1.46]. Interpretation: This study suggests the need for targeted region-specific antenatal interventions to address the burden of small vulnerable newborns. Funding: This study was funded by The Gates Foundation to GK (INV-002320).

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