Epidemiological Patterns of Preterm and Very Low Birth Weight Deliveries: A Decade-Long Multi-Center Study Across Selected Tertiary Obstetric Centers in Pakistan
Keywords:
Preterm birth, Very low birth weight, Neonatal mortality, Pakistan, Maternal determinants, Epidemiology, Multi-center cohortAbstract
Background: Preterm birth and very low birth weight (VLBW) are leading causes of neonatal morbidity and mortality worldwide, with the highest burden in low- and middle-income countries (LMICs). Despite notable progress in maternal and neonatal health, Pakistan continues to record high rates of preterm delivery and neonatal death. This study aimed to analyze epidemiological trends, maternal determinants, and neonatal outcomes associated with preterm and VLBW deliveries across selected tertiary obstetric centers in Pakistan over a ten-year period.
Methods: A retrospective multi-center cohort study was conducted across selected tertiary obstetric hospitals in Pakistan from January 2013 to December 2023. Data from delivery registers and neonatal records were reviewed for all live births between 24 and 37 weeks of gestation. Maternal demographic, obstetric, and clinical characteristics were analyzed alongside neonatal outcomes. Statistical analyses were performed using SPSS v26. Trends were examined over time, and multivariate logistic regression identified predictors of preterm and VLBW births.
Results: Among 89,612 live births, 9,746 (10.8%) were preterm and 3,214 (3.6%) were VLBW. The prevalence of preterm birth rose from 9.1% in 2013 to 12.2% in 2023 (p < 0.001). Major determinants included maternal age < 20 years (aOR 1.72, 95% CI 1.43–2.06), grand multiparity (aOR 1.51, 95% CI 1.29–1.77), inadequate antenatal care (aOR 1.89, 95% CI 1.64–2.21), hypertensive disorders (aOR 2.32, 95% CI 1.98–2.72), multiple gestation (aOR 3.14, 95% CI 2.65–3.74), and maternal infections (aOR 1.67, 95% CI 1.34–2.08). Neonatal mortality among VLBW infants declined modestly from 36.4% to 28.2% but remained high overall. Respiratory distress, sepsis, and prematurity complications accounted for most deaths.
Conclusions: Preterm and VLBW deliveries remain a major public-health challenge in Pakistan. Rising incidence and persistently high neonatal mortality reflect systemic gaps in antenatal care, infection control, and neonatal intensive-care capacity. Strengthening preventive strategies, improving antenatal surveillance, and expanding NICU infrastructure are essential to achieve sustainable neonatal-survival goals in LMIC settings.
Downloads
References
Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth. Lancet. 2012;379(9832):2162-2172.
Liu L, et al. Global, regional, and national causes of child mortality in 2000–2019. Lancet. 2021;398(10310):870-905.
Goldenberg RL, Culhane JF. Low birth weight in the developing world. Am J Clin Nutr. 2008;88(2):500–506.
WHO. Born Too Soon: The Global Action Report on Preterm Birth. Geneva: World Health Organization; 2022.
UNICEF. State of the World’s Children Report 2023: Every Child Alive. New York: UNICEF; 2023.
Pakistan Demographic and Health Survey (PDHS) 2022–23. National Institute of Population Studies; Islamabad.
Krebs, N. F., Chomba, E., Carlo, W. A., Lokangaka, A., et al. (2020). Regional trends in birth weight in low- and middle-income countries 2013–2018 Reproductive Health, 17(Suppl 3):162. https://doi.org/10.1186/s12978-020-01026-2
Khan, A., Nasrullah, F. D., & Jaleel, R. (2016). Frequency and risk factors of low birth weight in term pregnancy Pakistan Journal of Medical Sciences, 32(1), 138–142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795855/
Mason, L., Badshah, S., McKelvie, K., Payne, R., et al. (2008). Risk factors for low birthweight in public hospitals at Peshawar, NWFP–Pakistan BMC Public Health, 8:197. https://doi.org/10.1186/1471-2458-8-197
Dutta, A., Rahman, S., Applegate, J., et al. (2022). Burden and risk factors for antenatal depression and its effect on preterm birth in South Asia PLoS ONE, 17(2): e0263091. https://doi.org/10.1371/journal.pone.0263091
Shah, R., Mullany, L. C., Darmstadt, G. L., Mannan, I., et al. (2014). Incidence and risk factors of preterm birth in a rural Bangladeshi cohort BMC Pediatrics, 14:112. https://doi.org/10.1186/1471-2431-14-112
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
