Around the world, pre-term births represent the leading cause of death in children under the age of five, according to the World Health Organization. Every year, at least 15 million babies are born before 37 weeks. Being born at this stage means that a child may have underdeveloped essential organs leading to life-long health complications which can endanger their survival.
Researchers from the Aga Khan University (AKU) are now partnering with the University of Calgary to explore one of the less recognised issues related to pre-term births: how psychological distress triggers dangerous biological responses in pregnant mothers that can lead to an early delivery.
In developing countries, at least one in five women suffer significant mental health problems during pregnancy and after childbirth. However, programmes to prevent and treat pregnancy-related emotional distress are largely based on research from high-income countries. The study will see researchers assess the specific psychological challenges of giving birth in low and middle income countries (LMICs) such as Pakistan, which has the fourth highest number of pre-term births in the world.
“Pregnant women in LMICs face different stressors to women in high-income countries. Most women in Pakistan live in large, extended families in male-dominated households. They often face undue pressure to deliver a male child and go through pregnancy in an environment with many social and economic disadvantages,” said Kiran Shaikh, assistant professor at SONAM and the local lead principal investigator on the study.
The study will collect blood samples from 1,872 pregnant women at two different stages of their pregnancy with researchers also staying in touch with women to determine if their babies were born pre-term.
Participants will also complete questionnaires assessing their psychological status with researchers using data from the questionnaire to assess the intensity of the stressors being experienced. These results will then be analysed alongside data from blood tests to detect the presence of biological changes. Both sets of data will then be evaluated to detect pathways showing how emotional distress affects the onset of pre-term births.
The objectives of the study are in line with global efforts to achieve targets under goal 3 of the Sustainable Development Goals. Goal 3: ensure healthy lives and promote well-being for all at all ages, calls for special efforts to end preventable deaths of newborns and children under the age of five by 2030, and also highlights the need for initiatives to promote mental health and wellbeing .
The study’s findings will inform efforts to develop targeted psychosocial interventions to improve the emotional wellbeing of mothers during pregnancy and to reduce the burden of pre-term births in Pakistan and among the Pakistani diaspora based in Canada. The research will also generate knowledge that can be applied to save lives in other LMICs.
The study Psychosocial Distress During Pregnancy and Pathways to Preterm Birth: Building Evidence in LMIC to Guide Targeted Psychosocial Interventions is funded by the Preterm Birth Initiative of the Canadian Institutes of Health Research (CIHR), the Canadian government’s health research investment agency. Two-thirds of infant deaths in Canada are related to pre-term births with the healthcare system noticing a 20 per cent increase in pre-term deaths over the past twenty years, according to the CIHR.
Dr Shahirose Premji, associate professor at University of Calgary in Canada, is the nominated principal investigator for the study.
Dr Imtiaz Jehan, associate professor in AKU’s department of community health sciences is the local principal investigator for the study. Sharifa Lalani, assistant professor at SONAM, and Dr Ayesha Mian, chair of the department of psychiatry at AKU are serving as co-investigators on the study.