The burden of low birth weight and short gestation in 1990-2021 and projection to 2050: Assessment against 2030 malnutrition reduction targets

Bengui Jiang^1,2Kelly Lin^3,4Bei Zhang⁴Nicholas Jan Buys⁵Yanfei (Jacob) Qi⁶Distinguished Prof Jing Sun^4*

• ¹Ningbo Women and Children's hospital, Ningbo University, Ningbo, Zhejiang Province, China
• ²Ningbo Clinical Research Center for Gynaecological Diseases, Ningbo, China
• ³School of Medicine and Dentistry, Griffith Health, Griffith University, Southport, Queensland, Australia
• ⁴Rural Health Research Institute, Charles Sturt University, Bathurst, New South Wales, Australia
• ⁵School of Health Science and Social Work, Griffith University, Nathan, Queensland, Australia
• ⁶Centenary Institute of Cancer Medicine and Cell Biology, The University of Sydney, Darlington, New South Wales, Australia

BackgroundLow birth weight (LBW) and short gestation (LBWSG) is defined as birth at gestational age less than 38 weeks and at a lower birth weight than the lowest risk weight of 3500g. Prematurity and LBW are the leading causes of global under 5 mortalities. This study aims to provide a systematic analysis on the changes in morality and disease burden of LBW and short gestation in the past 30 years to help inform health policies formation and guide resource allocation.MethodsThis study utilized data from the 2021 GBD study. We measured LBWSG mortality, DALYs, and YLDs in children under 20 years of age. Data from children under 20 years of age were accessed. To assess the progress in achieving the 2030 SDG of a 30% reduction in LBWSG, Average Annual Percentage Change (AAPC) were calculated on a global, regional, and national level. Mixed effects model with SDI and time as the main covariates were further used to forecast LBWSG mortality and DALYs from 2022 to 2050. Countries were further classified based on their sociodemographic index (SDI) score to compare AAPC and forecasted LBWSG mortality and disease burden results. ResultsCountries with high-middle SDI scores showed the most significant reduction in LBWSG under 5 mortalities (AAPC= -0.84, 95% CI= -0.86 to -0.82), followed by countries with middle, high, then low-middle SDI countries. However, no significant improvements were identified in low SDI countries. Furthermore, LBWSG burden worsened amongst 73 countries of all SDI and income levels. Forecasting results indicated an increase in LBWSG DALYs rate in children 5-19 years of age across low, low-middle, and high SDI countries.ConclusionSignificant inequalities in accessibility and quality of maternal and child healthcare between countries of high and low SDI scores. Temporal trends and forecasting results indicated increased disease burden for LBW and short gestation suggesting that 73 countries will not be able to achieve the 2030 nutritional target of a 30% reduction in preterm birth. Comprehensive policies to address maternal risk factors are required to reduce preterm birth, while upscaling of cost-effective life-saving interventions are needed to reduce death of preterm infants.