The First 1000 Critical Days: Determinants of Adverse Birth Outcomes in the Sari Birth Cohort, Iran.

BACKGROUND

Adverse birth outcomes (ABOs) during the first 1000 days of life are key indicators for evaluating reproductive health and impose heavy burdens on the healthcare system. Given the limited data on ABOs in Mazandaran Province, this study aimed to investigate ABOs and their associated factors among pregnant women in the Sari Birth Cohort.

METHODS

This prospective cohort study was initiated in 2017 with 3000 pregnant women from northern Iran. Participants were followed until delivery or the occurrence of miscarriage, stillbirth, maternal or neonatal death. ABOs included miscarriage, stillbirth, low birth weight (LBW), preterm birth, small for gestational age (SGA), and admission to the neonatal intensive care unit (NICU). Log-binomial regression in Stata 14 used to identify factors associated with ABOs.

RESULTS

Data from 2962 mothers and 2386 children were analyzed. Nearly one fifth of mothers experienced at least one ABOs. The most common ABOs were preterm birth (10.09%), SGA (7.91%), and LBW (6.29%). During the follow-up, two maternal and nine neonatal deaths occurred. The multivariable Log-binomial regression analysis indicated a significantly higher risk of ABOs among women with lower education (aRR = 1.65; 95% CI: 1.09-2.51), chronic diseases (aRR = 1.18; 95% CI: 1.01-1.39), and adverse pregnancy history (aRR = 1.23; 95% CI: 1.03-1.46).

CONCLUSIONS

The results showed that ABOs associated with lower levels of maternal education, chronic diseases, and adverse pregnancy history. These factors are modifiable; therefore, planning and implementing targeted interventions such as reproductive health education, management of chronic diseases, and care for high-risk mothers can help reduce complications.