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.”