Top

Published in:

Open Access 01-12-2024 | Miscarriage | Research

Risk factors of adverse birth outcomes among a cohort of pregnant women in Coastal Kenya, 2017–2019

Authors: Harriet Mirieri, Ruth Nduati, Jeanette Dawa, Lydia Okutoyi, Eric Osoro, Cyrus Mugo, Dalton Wamalwa, Hafsa Jin, Dufton Mwaengo, Nancy Otieno, Doris Marwanga, Mufida Shabibi, Peninah Munyua, John Kinuthia, Erin Clancey, Marc-Alain Widdowson, M. Kariuki Njenga, Jennifer R. Verani, Irene Inwani

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

Abstract

Introduction

Adverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya.

Methods

From October 2017 to July 2019, pregnant women < 28 weeks gestation were enrolled and followed up until delivery in three hospitals in coastal Kenya. Newborns were examined at delivery. Among women with birth outcome data, we assessed the frequency of congenital anomalies defined as gastroschisis, umbilical hernia, limb abnormalities and Trisomy 21, and adverse birth outcomes, defined as either stillbirth, miscarriage, preterm birth, small for gestational age, or microcephaly. We used log-binomial regression to identify maternal characteristics associated with the presence of at least one adverse outcome.

Results

Among the 2312 women enrolled, 1916 (82.9%) had birth outcome data. Overall, 402/1916 (20.9%; 95% confidence interval (CI): 19.1–22.8) pregnancies had adverse birth outcomes. Specifically, 66/1916 (3.4%; 95% CI: 2.7–4.4) were stillbirths, 34/1916 (1.8%; 95% CI: 1.2–2.4) were miscarriages and 23/1816 (1.2%; 95% CI: 0.8–1.9) had congenital anomalies. Among the participants with anthropometric measurements data, 142/1200 (11.8%; 95% CI: 10.1 − 13.8) were small for gestational age and among the participants with ultrasound records, 143/1711 (8.4%; 95% CI: 7.1–9.8) were preterm. Febrile illnesses in current pregnancy (adjusted risk ratio (aRR): 1.7; 95% CI: 1.1–2.8), a history of poor birth outcomes in prior pregnancy (aRR: 1.8; 95% CI: 1.3–2.4) and high blood pressure in pregnancy (aRR: 3.9, 95% CI: (1.7–9.2) were independently associated with adverse birth outcomes in a model that included age, education, human immunodeficiency virus status and high blood pressure at enrolment.

Conclusion

We found similar rates of overall adverse birth outcomes, congenital anomalies, and small for gestational age but higher rates of stillbirths and lower rates of prematurity compared to the rates that have been reported in the sub-Saharan Africa region. However, the rates of adverse birth outcomes in this study were comparable to other studies conducted in Kenya. Febrile illnesses during the current pregnancy, previous history of poor birth outcomes and high blood pressure in pregnancy are predictive of an increased risk of adverse birth outcomes.

Available only for authorised users

Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010;88(1):31–8. https://doi.org/10.2471/BLT.08.062554.CrossRefPubMed

Wang H, Bhutta ZA, Coates MM, Coggeshall M, Dandona L, Diallo K, et al. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the global burden of Disease Study 2015. Lancet. 2016;388(10053):1725–74. https://doi.org/10.1016/S0140-6736(16)31575-6.CrossRef

World Health. Standards for improving quality of maternal and newborn care in health facilities. WHO. 2016;2021:84.

Ludvigsson JF, Lu D, Hammarström L, Cnattingius S, Fang F. Small for gestational age and risk of childhood mortality: a Swedish population study. PLoS Med. 2018;15(12):1–18. https://doi.org/10.1371/journal.pmed.1002717.CrossRef

Lee ACC, Katz J, Blencowe H, Cousens S, Kozuki N, Vogel JP, et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Heal. 2013;1(1). https://doi.org/10.1016/S2214-109X(13)70006-8.

Wang H, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the global burden of Disease Study 2016. Lancet. 2017;390(10100):1084–150. https://doi.org/10.1016/S0140-6736(17)31833-0.CrossRef

Cao G, Liu J, Liu M, Global. Regional, and National Incidence and Mortality of neonatal Preterm Birth, 1990–2019. JAMA Pediatr. 2022;176(8):787–96. https://doi.org/10.1001/jamapediatrics.2022.1622.CrossRefPubMedPubMedCentral

Sitkin NA, Ozgediz D, Donkor P, Farmer DL. Congenital anomalies in low- and middle-income countries:the unborn child of global surgery. World J Surg. 2015;39(1):36–40. https://doi.org/10.1007/s00268-014-2714-9.CrossRefPubMed

Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162–72. https://doi.org/10.1016/S0140-6736(12)60820-4.CrossRefPubMed

10.

Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D. Stillbirths: rates, risk factors and potential for progress towards 2030. Lancet. 2016;387:587–603.CrossRefPubMed

11.

Moges N, Anley DT, Zemene MA, Adella GA, Solomon Y, Bantie B, et al. Congenital anomalies and risk factors in Africa: a systematic review and meta-analysis. BMJ Paediatr Open. 2023;7(1). https://doi.org/10.1136/bmjpo-2023-002022.

12.

A Neglected Tragedy. : The global burden of stillbirths - UNICEF DATA.

13.

Nabea GM, Matenjwa Kamau T, Kaburu EW, Kamau TM. The incidence of congenital anomalies among newborns at Pumwani Hospital, Nairobi, Kenya. Int J Heal Sci Res. 2017;7(5):302.

14.

Kenya National Bureau of Statistics, ICF Macro. Kenya Demographic Health Surv. 2014;603. https://doi.org/10.3109/03014460.2013.775344.

15.

Kramer MS. The epidemiology of adverse pregnancy outcomes: An overview. J Nutr. 2003;133(5 SUPPL. 1):1592–6. https://doi.org/10.1093/jn/133.5.1592s.

16.

Strauss RS. Of those born small for gestational age. J Am Med Assoc. 2000;283(5):625–32.CrossRef

17.

Asiki G, Baisley K, Newton R, Marions L, Seeley J, Kamali A, et al. Adverse pregnancy outcomes in rural Uganda (1996–2013): trends and associated factors from serial cross sectional surveys. BMC Pregnancy Childbirth. 2015;15(1):1–12. https://doi.org/10.1186/s12884-015-0708-8.CrossRef

18.

Lin L, Wei Y, Zhu W, Wang C, Su R, Feng H, et al. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study. BMC Pregnancy Childbirth. 2018;18(1):1–8. https://doi.org/10.1186/s12884-018-1739-8.CrossRef

19.

Saleem S, Tikmani SS, McClure EM, Moore JL, Azam SI, Dhaded SM, et al. Trends and determinants of stillbirth in developing countries: results from the Global Network’s Population-based Birth Registry. Reprod Health. 2018;15(Suppl 1). https://doi.org/10.1186/s12978-018-0526-3.

20.

Ngandu CB, Momberg D, Magan A, Chola L, Norris SA, Said-Mohamed R. The association between household socio-economic status, maternal socio-demographic characteristics and adverse birth and infant growth outcomes in sub-saharan Africa: a systematic review. J Dev Orig Health Dis. 2020;11(4):317–34. https://doi.org/10.1017/S2040174419000680.CrossRefPubMed

21.

Kagia J. Improving maternal health in Kenya: challenges and strategies for low resource nations. Linacre Q. 2013;80(2):161–6. https://doi.org/10.1179/0024363913Z.00000000029.CrossRefPubMedPubMedCentral

22.

Odhiambo JN, Sartorius B. Joint spatio-temporal modelling of adverse pregnancy outcomes sharing common risk factors at sub-county level in Kenya, 2016–2019. BMC Public Health. 2021;1–13. https://doi.org/10.1186/s12889-021-12210-9.

23.

Wagura P, Wasunna A, Laving A, Wamalwa D. Ng’Ang’a P. Prevalence and factors associated with preterm birth at kenyatta national hospital. BMC Pregnancy Childbirth. 2018;18(1):2–9. https://doi.org/10.1186/s12884-018-1740-2.CrossRef

24.

Muchemi OM, Echoka E, Makokha A. Factors associated with low birth weight among neonates born at Olkalou district hospital, central region, Kenya. Pan Afr Med J. 2015;20:1–11. https://doi.org/10.11604/pamj.2015.20.108.4831.CrossRef

25.

Osoro E, Inwani I, Mugo C, Hunsperger E, Verani JR, Omballa V, et al. Prevalence of microcephaly and Zika virus infection in a pregnancy cohort in Kenya, 2017–2019. BMC Med. 2022;1–11. https://doi.org/10.1186/s12916-022-02498-8.

26.

KNBS and ICF. Kenya Demographic and Health Survey 2022. Key indicators Report. Nairobi, Kenya, and Rockville. Maryland, USA: KNBS and ICF; 2023.

27.

WHO recommendations on. antenatal care for a positive pregnancy experience.

28.

Harris SR. Measuring head circumference: update on infant microcephaly. Can Fam Physician. 2015;61(8):680–4.PubMedPubMedCentral

29.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377–81. https://doi.org/10.1016/j.jbi.2008.08.010.CrossRef

30.

Villar J, Ismail LC, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the newborn cross-sectional study of the INTERGROWTH-21st Project. Lancet. 2014;384(9946):857–68. https://doi.org/10.1016/s0140-6736(14)60932-6.CrossRefPubMed

31.

Kaforau LSK, Tessema GA, Jancey J, Dhamrait G, Bugoro H, Pereira G. Prevalence and risk factors of adverse birth outcomes in the Pacific Island region: a scoping review. Lancet Reg Heal - West Pac. 2022;21:100402. https://doi.org/10.1016/j.lanwpc.2022.100402.CrossRef

32.

Price JT, Vwalika B, Rittenhouse KJ, Mwape H, Winston J, Freeman BL, et al. Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort. Gates Open Res. 2020;3. https://doi.org/10.12688/gatesopenres.13046.2.

33.

Dash K, Goodacre S, Sutton L. Composite outcomes in clinical prediction modeling: are we trying to predict apples and oranges? Ann Emerg Med. 2022;80(1):12–9. https://doi.org/10.1016/j.annemergmed.2022.01.046.CrossRefPubMed

34.

Feldkamp ML, Carey JC, Byrne JLB, Krikov S, Botto LD. Etiology and clinical presentation of birth defects: Population based study. BMJ. 2017;357:1–8. https://doi.org/10.1136/bmj.j2249.CrossRef

35.

Zabransky S. Maternal nutrition. Caring Child Born Small Gestation Age. 2013;25–33. https://doi.org/10.1007/978-1-908517-90-6_3.

36.

Zhang Z. Model building strategy for logistic regression: purposeful selection. Ann Transl Med. 2016;4(6):4–10. https://doi.org/10.21037/atm.2016.02.15.CrossRef

37.

Fagerland MW, Hosmer DW. A generalized Hosmer-Lemeshow goodness-of-fit test for multinomial logistic regression models. Stata J. 2012;12(3):447–53. https://doi.org/10.1177/1536867x1201200307.CrossRef

38.

Waiswa P, Higgins BV, Mubiri P, Kirumbi L, Butrick E, Merai R, et al. Pregnancy outcomes in facility deliveries in Kenya and Uganda: a large cross-sectional analysis of maternity registers illuminating opportunities for mortality prevention. PLoS ONE. 2020;15(6):1–17. https://doi.org/10.1371/journal.pone.0233845.CrossRef

39.

Simiyu DE. Morbidity and mortality of low Birth Weight infants in the New Born Unit of Kenyatta National Hospital, Nairobi. East Afr Med J. 2004;81(7):367–74.CrossRefPubMed

40.

Barsosio HC, Nyamwaya DK, Gitonga JN, Karanja HK, Omuoyo DO, Kamau E, et al. Congenital microcephaly unrelated to flavivirus exposure in coastal Kenya [version 1; peer review: 2 approved, 1 approved with reservations]. Wellcome Open Res. 2019;4:179.CrossRefPubMedPubMedCentral

41.

Tamirat KS, Sisay MM, Tesema GA, Tessema ZT. Determinants of adverse birth outcome in Sub-saharan Africa: analysis of recent demographic and health surveys. BMC Public Health. 2021;21(1):1–10. https://doi.org/10.1186/s12889-021-11113-z.CrossRef

42.

Adane F, Afework M, Seyoum G, Gebrie A. Prevalence and associated factors of birth defects among newborns in sub-saharan African countries: a systematic review and meta-analysis. Pan Afr Med J. 2020;36:1–22. https://doi.org/10.11604/pamj.2020.36.19.19411.CrossRef

43.

Mashuda F, Zuechner A, Chalya PL, Kidenya BR, Manyama M. Pattern and factors associated with congenital anomalies among young infants admitted at Bugando medical centre, Mwanza, Tanzania. BMC Res Notes. 2014;7(1):1–7. https://doi.org/10.1186/1756-0500-7-195.CrossRef

44.

Uba AF, Igun GO, Kidmas AT, Chirdan LB. Prevalence of umbilical hernia in a private school admission-seeking Nigerian children. Niger Postgrad Med J. 2004;11(4):255–7.CrossRefPubMed

45.

Lee ACC, Kozuki N, Cousens S, Stevens GA, Blencowe H, Silveira MF, et al. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21 St standard: analysis of CHERG datasets. BMJ. 2017;358. https://doi.org/10.1136/bmj.j3677.

46.

Sass L, Urhoj SK, Kjærgaard J, Dreier JW, Strandberg-Larsen K, Nybo Andersen AM. Fever in pregnancy and the risk of congenital malformations: a cohort study. BMC Pregnancy Childbirth. 2017;17(1):1–9. https://doi.org/10.1186/s12884-017-1585-0.CrossRef

47.

More VS. Fever in pregnancy and its maternal and fetal outcomes. Int J Reprod Contracept Obstet Gynecol. 2017;6(12):5523. https://doi.org/10.18203/2320-1770.ijrcog20175273.CrossRef

48.

Sultan S, Parihar R, Badkur P. Study on pyrexia in pregnancy and labour with special emphasis on fetomaternal outcome. Int J Reprod Contracept Obstet Gynecol. 2020;9(11):4414. https://doi.org/10.18203/2320-1770.ijrcog20204464.CrossRef

49.

Sappenfield E, Jamieson DJ, Kourtis AP. Pregnancy and susceptibility to infectious diseases. Infect Dis Obstet Gynecol. 2013. https://doi.org/10.1155/2013/752852. 2013(December 2015.CrossRefPubMedPubMedCentral

50.

Kerr SM, Parker SE, Mitchell AA, Tinker SC, Werler MM. Periconceptional maternal fever, folic acid intake, and the risk for neural tube defects. Ann Epidemiol. 2017;27(12):777–782e1. https://doi.org/10.1016/j.annepidem.2017.10.010.CrossRefPubMedPubMedCentral

51.

Saroj Chakraborty S, Galla X, Cheng J-Y, Yeo B, Mell V, Singh BS, Yeoh P, Saha AV, Mathew. Matam Vijay-Kumar and BJ. HHS Public Access. Physiol Behav. 2017;176(5):139–48. https://doi.org/10.1002/bdr2.1147.Maternal.CrossRef

52.

Su D, Samson K, Garg A, Hanson C, Anderson Berry AL, Lin G, et al. Birth history as a predictor of adverse birth outcomes: evidence from state vital statistics data. Prev Med Rep. 2018;11(January):63–8. https://doi.org/10.1016/j.pmedr.2018.05.011.CrossRefPubMedPubMedCentral

53.

Sclowitz IKT, Santos IS, Domingues MR, Matijasevich A, Barros AJD. Prognostic factors for low birthweight repetition in successive pregnancies: a cohort study. BMC Pregnancy Childbirth. 2013;13. https://doi.org/10.1186/1471-2393-13-20.

54.

Singh G, Sidhu K. Bad obstetric history: a prospective study. Med J Armed Forces India 66(2):117–20. https://doi.org/10.1016/S0377-1237(10)80121-2.

55.

Jin M, Liu X, Liu X, Wu Y, Zhang Y, Zhang L, et al. Association of pre-/early pregnancy high blood pressure and pregnancy outcomes: a systemic review and meta-analysis. J Matern Fetal Neonatal Med. 2024;37(1):2296366. https://doi.org/10.1080/14767058.2023.2296366.CrossRefPubMed

56.

Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014;348(April):1–20. https://doi.org/10.1136/bmj.g2301.CrossRef

57.

Macdonald-wallis C, Lawlor DA, Fraser A, May M, Scott M. Blood pressure change in normotensive, gestational hypertensive, preeclamptic and essential hypertensive pregnancies. Hypertension. 2012;59(6):1241–8. https://doi.org/10.1161/HYPERTENSIONAHA.111.187039.BLOOD.CrossRefPubMed

58.

Zhu J, Zhang J, Ng MJ, Chern B, Yeo GSH, Tan KH. Angiogenic factors during pregnancy in Asian women with elevated blood pressure in early pregnancy and the risk of preeclampsia: a longitudinal cohort study. BMJ Open. 2019;9(11):1–7. https://doi.org/10.1136/bmjopen-2019-032237.CrossRef

59.

Murray C, Portwood C, Sexton H, Kumarendran M, Brandon Z, Kirtley S, et al. Adverse perinatal outcomes attributable to HIV in sub-saharan Africa from 1990 to 2020: systematic review and meta-analyses. Commun Med. 2023;3(1):1–13. https://doi.org/10.1038/s43856-023-00331-8.CrossRef

60.

Woldesenbet S, Cheyip M, Lombard C, Manda S, Ayalew K, Kufa T, et al. Progress towards the UNAIDS 95-95-95 targets among pregnant women in South Africa: results from the 2017 and 2019 national antenatal HIV sentinel surveys. PLoS ONE. 2022;17(7 July):1–15. https://doi.org/10.1371/journal.pone.0271564.CrossRef

61.

Bond E. Innovations And Impact Toward The Elimination Of Mother-To-Child Transmission In Kenya. 2019.

62.

Macdonald EM, Ng R, Bayoumi AM, Raboud J, Brophy J, Masinde K, irene, et al. Living with HIV: a Population-based study. J Obstet Gynaecol Can. 2015;37(4):302–9. https://doi.org/10.1016/S1701-2163(15)30279-6.CrossRefPubMed

63.

Koss CA, Natureeba P, Plenty A, Luwedde F, Mwesigwa J, Ades V, et al. Risk factors for preterm birth among HIV-infected pregnant Ugandan women randomized to lopinavir/ritonavir-or efavirenz-based antiretroviral therapy. J Acquir Immune Defic Syndr. 2014;67(2):128–35. https://doi.org/10.1097/QAI.0000000000000281.CrossRefPubMedPubMedCentral

64.

Weldon K. An analysis of drug abuse along the coastal region of Kenya. Int NGO J. 2013;8(7):153–8. https://doi.org/10.5897/INGOJ2013.0277B.CrossRef

65.

Quesada O, Gotman N, Howell HB, Funai EF, Rounsaville BJ, Yonkers KA. Prenatal hazardous substance use and adverse birth outcomes. J Matern Neonatal Med. 2012;25(8):1222–7. https://doi.org/10.3109/14767058.2011.602143.CrossRef

66.

Dejong K, Olyaei A, Lo JO. Alcohol use in pregnancy. Clin Obstet Gynecol. 2019;62(1):142–55. https://doi.org/10.1097/GRF.0000000000000414.CrossRefPubMedPubMedCentral

67.

Aylin P, Bennett P, Bottle A, Brett S, Sodhi V, Rivers A, et al. Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study. Heal Serv Deliv Res. 2016;4(29):1–76. https://doi.org/10.3310/hsdr04290.CrossRef

Title: Risk factors of adverse birth outcomes among a cohort of pregnant women in Coastal Kenya, 2017–2019
Authors: Harriet Mirieri
Ruth Nduati
Jeanette Dawa
Lydia Okutoyi
Eric Osoro
Cyrus Mugo
Dalton Wamalwa
Hafsa Jin
Dufton Mwaengo
Nancy Otieno
Doris Marwanga
Mufida Shabibi
Peninah Munyua
John Kinuthia
Erin Clancey
Marc-Alain Widdowson
M. Kariuki Njenga
Jennifer R. Verani
Irene Inwani
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Miscarriage
Premature Birth
Human Immunodeficiency Virus
Published in: BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-024-06320-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors of adverse birth outcomes among a cohort of pregnant women in Coastal Kenya, 2017–2019

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Comparison of Janani Suraksha Yojana (JSY) and augmented Arogya Laxmi scheme (ALS) in improving maternal and child health outcomes in urban settlements of Hyderabad, South India

Impact of parental leave system on the childbirth plan among working married women: a three-year follow-up study of the Korean longitudinal survey of women and families

Effects of calcium supplementation on changes in the IL2, IL4, IL6, IL10 axes and oxidative stress in pregnant women at risk for pre-eclampsia

Interpregnancy interval and adverse birth outcomes: a population-based cohort study of twins

Intrauterine ultrasound phenotyping, molecular characteristics, and postnatal follow-up of fetuses with the 15q11.2 BP1-BP2 microdeletion syndrome: a single-center, retrospective clinical study

Exploring the implementation of an SMS-based digital health tool on maternal and infant health in informal settlements