Asia Pregnancy Outcomes Study

NCT03438110 | Completed

• 1 other identifier: CP COD
• Study Type: observational
• Target: 1,226
• Locations: 2 countries
• Sites: 3

Brief Summary

Preterm birth is a major cause of child mortality and morbidity, most of which occurs in south-east Asia and sub-Saharan Africa. To date few neonatal cause of death studies, especially in low- and middle-income countries have determined the specific causes of preterm death, instead attributing all neonatal deaths of infants born at less than 37 weeks to prematurity. Infections are responsible for a large proportion of these deaths but because of complexity and costs associated with testing, little is known about the prevalence of infection-related deaths in preterm infants or the specific pathogens associated with mortality. The primary objective of this study is to determine the cause of deaths among preterm births and stillbirths. Secondary outcomes include determining the specific pathogens responsible for infection-related deaths, potential preventability of these deaths and interventions which may reduce mortality. One site in India and one in Pakistan will include a total sample size of 700 (350 stillbirths and 350 preterm neonatal deaths) for 1,400 cases to be included in the cause of death analyses. All women who deliver a preterm birth or a stillbirth at the study hospitals will be eligible for inclusion. Among those who consent, an obstetric history, clinical obstetric and (if applicable) neonatal care will be collected as well as research investigations including ultrasound, x-ray, microbiology and minimally invasive tissue sampling and autopsy will be collected. This study will align with other efforts to determine cause of death among infants and children and ultimately the results will inform future interventions to reduce neonatal mortality and stillbirth. The researchers emphasize that this study, with its focus on preterm neonatal mortality and stillbirth, will provide information not available elsewhere.

Conditions

Neonatal Death; Stillbirth

Keywords

Preterm birth; Neonatal death; Stillbirth; Asia; Africa

Outcome Measures

Primary Outcomes (1)

• Cause of Death

  Cause of death among preterm deaths and stillbirths.

  At time of study enrollment of mother

Secondary Outcomes (3)

• Neonatal Death

  At time of study enrollment of mother

• Preterm Death and Stillbirth Placental Pathology

  At time of study enrollment of mother

• Stillbirth and Preterm Death Pathogens

  Following stillbirth or infant death

Eligibility Criteria

• Age: 14 Years - 45 Years
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

The study will be conducted at hospitals identified in Karachi, Pakistan and in Davangere, India. All women who deliver a stillbirth and/or who deliver preterm at a study hospital will be screened for study eligibility.

You may qualify if:

• Women in labor and delivery with imminent preterm delivery and/or stillbirth

You may not qualify if:

• Induced (medical) abortion
• Unable to determine the gestational age at delivery
• Gestational age \< 20 weeks at delivery

Sponsors & Collaborators

• RTI International: lead

Study Sites (3)

J.J.M. Medical College Hospitals

Davangere, India

Location

National Institute of Child Health

Karachi, Pakistan, Pakistan

Location

Jinnah Postgrad Medical Center

Karachi, Pakistan

Location

Related Publications (23)

• GBD 2015 Child Mortality Collaborators. 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 Oct 8;388(10053):1725-1774. doi: 10.1016/S0140-6736(16)31575-6.

  PMID: 27733285 BACKGROUND

• Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015 Jan 31;385(9966):430-40. doi: 10.1016/S0140-6736(14)61698-6. Epub 2014 Sep 30.

  PMID: 25280870 BACKGROUND

• Oza S, Lawn JE, Hogan DR, Mathers C, Cousens SN. Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries: 2000-2013. Bull World Health Organ. 2015 Jan 1;93(1):19-28. doi: 10.2471/BLT.14.139790. Epub 2014 Nov 17.

  PMID: 25558104 BACKGROUND

• Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, Kinney M, Lawn J; Born Too Soon Preterm Birth Action Group. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health. 2013;10 Suppl 1(Suppl 1):S2. doi: 10.1186/1742-4755-10-S1-S2. Epub 2013 Nov 15.

  PMID: 24625129 BACKGROUND

• Lackritz EM, Wilson CB, Guttmacher AE, Howse JL, Engmann CM, Rubens CE, Mason EM, Muglia LJ, Gravett MG, Goldenberg RL, Murray JC, Spong CY, Simpson JL; Preterm Birth Research Priority Setting Group. A solution pathway for preterm birth: accelerating a priority research agenda. Lancet Glob Health. 2013 Dec;1(6):e328-30. doi: 10.1016/S2214-109X(13)70120-7. Epub 2013 Nov 15. No abstract available.

  PMID: 25104592 BACKGROUND

• McClure EM, Bose CL, Garces A, Esamai F, Goudar SS, Patel A, Chomba E, Pasha O, Tshefu A, Kodkany BS, Saleem S, Carlo WA, Derman RJ, Hibberd PL, Liechty EA, Hambidge KM, Krebs NF, Bauserman M, Koso-Thomas M, Moore J, Wallace DD, Jobe AH, Goldenberg RL. Global network for women's and children's health research: a system for low-resource areas to determine probable causes of stillbirth, neonatal, and maternal death. Matern Health Neonatol Perinatol. 2015 May 4;1:11. doi: 10.1186/s40748-015-0012-7. eCollection 2015.

  PMID: 27057328 BACKGROUND

• Engmann C, Jehan I, Ditekemena J, Garces A, Phiri M, Mazariegos M, Chomba E, Pasha O, Tshefu A, Hemed Y, McClure EM, Thorsten V, Bann C, Goldenberg RL, Bose C, Setel P, Carlo WA, Wright LL. Using verbal autopsy to ascertain perinatal cause of death: are trained non-physicians adequate? Trop Med Int Health. 2009 Dec;14(12):1496-504. doi: 10.1111/j.1365-3156.2009.02395.x. Epub 2009 Oct 1.

  PMID: 19799757 BACKGROUND

• McClure EM, Garces A, Saleem S, Moore JL, Bose CL, Esamai F, Goudar SS, Chomba E, Mwenechanya M, Pasha O, Tshefu A, Patel A, Dhaded SM, Tenge C, Marete I, Bauserman M, Sunder S, Kodkany BS, Carlo WA, Derman RJ, Hibberd PL, Liechty EA, Hambidge KM, Krebs NF, Koso-Thomas M, Miodovnik M, Wallace DD, Goldenberg RL. Global Network for Women's and Children's Health Research: probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system. BJOG. 2018 Jan;125(2):131-138. doi: 10.1111/1471-0528.14493. Epub 2017 Jan 31.

  PMID: 28139875 BACKGROUND

• Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA. 2011 Dec 14;306(22):2459-68. doi: 10.1001/jama.2011.1823.

  PMID: 22166605 BACKGROUND

• Belizan JM, McClure EM, Goudar SS, Pasha O, Esamai F, Patel A, Chomba E, Garces A, Wright LL, Koso-Thomas M, Moore J, Althabe F, Kodkany BS, Sami N, Manasyan A, Derman RJ, Liechty EA, Hibberd P, Carlo WA, Hambidge KM, Buekens P, Jobe AH, Goldenberg RL. Neonatal death in low- to middle-income countries: a global network study. Am J Perinatol. 2012 Sep;29(8):649-56. doi: 10.1055/s-0032-1314885. Epub 2012 May 29.

  PMID: 22644832 BACKGROUND

• Goldenberg RL, McClure EM, Saleem S, Reddy UM. Infection-related stillbirths. Lancet. 2010 Apr 24;375(9724):1482-90. doi: 10.1016/S0140-6736(09)61712-8. Epub 2010 Mar 9.

  PMID: 20223514 BACKGROUND

• Castillo P, Ussene E, Ismail MR, Jordao D, Lovane L, Carrilho C, Lorenzoni C, Lacerda MV, Palhares A, Rodriguez-Carunchio L, Martinez MJ, Vila J, Bassat Q, Menendez C, Ordi J. Pathological Methods Applied to the Investigation of Causes of Death in Developing Countries: Minimally Invasive Autopsy Approach. PLoS One. 2015 Jun 30;10(6):e0132057. doi: 10.1371/journal.pone.0132057. eCollection 2015.

  PMID: 26126191 BACKGROUND

• Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O, McClure EM, Moore J, Wright LL, Goldenberg RL. Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bull World Health Organ. 2009 Feb;87(2):130-8. doi: 10.2471/blt.08.050963.

  PMID: 19274365 BACKGROUND

• McClure EM, Goldenberg RL, Jobe AH, Miodovnik M, Koso-Thomas M, Buekens P, Belizan J, Althabe F. Reducing neonatal mortality associated with preterm birth: gaps in knowledge of the impact of antenatal corticosteroids on preterm birth outcomes in low-middle income countries. Reprod Health. 2016 May 24;13(1):61. doi: 10.1186/s12978-016-0180-6.

  PMID: 27221397 BACKGROUND

• Saleem S, Reza T, McClure EM, Pasha O, Moss N, Rouse DJ, Bartz J, Goldenberg RL. Chlorhexidine vaginal and neonatal wipes in home births in Pakistan: a randomized controlled trial. Obstet Gynecol. 2007 Nov;110(5):977-85. doi: 10.1097/01.AOG.0000285653.17869.26.

  PMID: 17978107 BACKGROUND

• Saleem S, Rouse DJ, McClure EM, Zaidi A, Reza T, Yahya Y, Memon IA, Khan NH, Memon G, Soomro N, Pasha O, Wright LL, Moore J, Goldenberg RL. Chlorhexidine vaginal and infant wipes to reduce perinatal mortality and morbidity: a randomized controlled trial. Obstet Gynecol. 2010 Jun;115(6):1225-1232. doi: 10.1097/AOG.0b013e3181e00ff0.

  PMID: 20502294 BACKGROUND

• Goudar SS, Goco N, Somannavar MS, Vernekar SS, Mallapur AA, Moore JL, Wallace DD, Sloan NL, Patel A, Hibberd PL, Koso-Thomas M, McClure EM, Goldenberg RL. Institutional deliveries and perinatal and neonatal mortality in Southern and Central India. Reprod Health. 2015;12 Suppl 2(Suppl 2):S13. doi: 10.1186/1742-4755-12-S2-S13. Epub 2015 Jun 8.

  PMID: 26063586 BACKGROUND

• Pasha O, Saleem S, Ali S, Goudar SS, Garces A, Esamai F, Patel A, Chomba E, Althabe F, Moore JL, Harrison M, Berrueta MB, Hambidge K, Krebs NF, Hibberd PL, Carlo WA, Kodkany B, Derman RJ, Liechty EA, Koso-Thomas M, McClure EM, Goldenberg RL. Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network's Maternal Newborn Health Registry: an active, community-based, pregnancy surveillance mechanism. Reprod Health. 2015;12 Suppl 2(Suppl 2):S15. doi: 10.1186/1742-4755-12-S2-S15. Epub 2015 Jun 8.

  PMID: 26062610 BACKGROUND

• Goldenberg RL, Gravett MG, Iams J, Papageorghiou AT, Waller SA, Kramer M, Culhane J, Barros F, Conde-Agudelo A, Bhutta ZA, Knight HE, Villar J. The preterm birth syndrome: issues to consider in creating a classification system. Am J Obstet Gynecol. 2012 Feb;206(2):113-8. doi: 10.1016/j.ajog.2011.10.865. Epub 2011 Oct 25.

  PMID: 22177186 BACKGROUND

• Goldenberg RL, McClure EM, Jobe AH, Kamath-Rayne BD, Gravette MG, Rubens CE. Stillbirths and neonatal mortality as outcomes. Int J Gynaecol Obstet. 2013 Dec;123(3):252-3. doi: 10.1016/j.ijgo.2013.06.020. Epub 2013 Sep 4.

  PMID: 24050480 BACKGROUND

• Dudley DJ, Goldenberg R, Conway D, Silver RM, Saade GR, Varner MW, Pinar H, Coustan D, Bukowski R, Stoll B, Koch MA, Parker CB, Reddy UM; Stillbirth Research Collaborative Network. A new system for determining the causes of stillbirth. Obstet Gynecol. 2010 Aug;116(2 Pt 1):254-260. doi: 10.1097/AOG.0b013e3181e7d975.

  PMID: 20664383 BACKGROUND

• Garces AL, McClure EM, Perez W, Hambidge KM, Krebs NF, Figueroa L, Bose CL, Carlo WA, Tenge C, Esamai F, Goudar SS, Saleem S, Patel AB, Chiwila M, Chomba E, Tshefu A, Derman RJ, Hibberd PL, Bucher S, Liechty EA, Bauserman M, Moore JL, Koso-Thomas M, Miodovnik M, Goldenberg RL. The Global Network Neonatal Cause of Death algorithm for low-resource settings. Acta Paediatr. 2017 Jun;106(6):904-911. doi: 10.1111/apa.13805. Epub 2017 Apr 5.

  PMID: 28240381 BACKGROUND

• McClure EM, Saleem S, Goudar SS, Dhaded S, Guruprasad G, Kumar Y, Tikmani SS, Kadir M, Raza J, Yasmin H, Moore JL, Kim J, Bann C, Parlberg L, Aceituno A, Carlo WA, Silver RM, Lamberti L, Patterson J, Goldenberg RL. The project to understand and research preterm pregnancy outcomes and stillbirths in South Asia (PURPOSe): a protocol of a prospective, cohort study of causes of mortality among preterm births and stillbirths. Reprod Health. 2018 Jun 22;15(Suppl 1):89. doi: 10.1186/s12978-018-0528-1.

  PMID: 29945651 DERIVED

MeSH Terms

Conditions

Perinatal Death; Stillbirth; Premature Birth

Condition Hierarchy (Ancestors)

Pregnancy Complications; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Death; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Fetal Death; Obstetric Labor, Premature; Obstetric Labor Complications

Study Officials

• Elizabeth McClure, PhD

  RTI International

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Research Epidemiologist

Study Record Dates

• First Submitted: January 29, 2018
• First Posted: February 19, 2018
• Study Start: September 1, 2018
• Primary Completion: February 12, 2020
• Study Completion: February 12, 2020
• Last Updated: August 13, 2025

Record last verified: 2025-08

Locations

PA (2); IN (1)