Authors:

Abstract

Purpose: The Rajarata Pregnancy Cohort (RaPCo) is designed to provide evidence for context-specific practices and to understand the broader socio-demographic, economic, and psychological factors underlying maternal morbidity and mortality in rural Sri Lanka.

Participants: RaPCo included 3374 pregnant women in their early pregnancy (median gestation period of eight weeks) registered with the national pregnancy care program from July to September 2019 in Anuradhapura district, Sri Lanka. The sample included almost 90% of the study population. Baseline data collection included socio-demographic, economic, anthropometric, blood and urine biochemistry, comprehensive mental health, and social capital assessment. Pregnancy outcome data were collected from 96.6% of the entire cohort. The follow-up infant cohort was established with 2400 infants of RaPCo cohort women who are still residing in the area. This cohort profile summarizes the major finding so far as well.

Key findings: The study found that adolescent pregnancies were high (22%) and associated with social factors, undernourishment, and anxiety. Anaemia was prevalent (14.4% in the first trimester), and minor hemoglobinopathies (23%) were found in anaemic pregnant women. The study also revealed high out-of-pocket expenditure for the first antenatal clinic visit ($8.12). Miscarriage was more prevalent than previously reported (24%). Gestational diabetes was prevalent even in the first trimester (15%), and fasting plasma glucose in the first trimester was a good predictor of large for gestational age neonates. Fatty liver grades were identified as significant risk factors for early pregnancy miscarriage (RR12.5), and a valid fatty liver index was developed as a screening tool. The prevalence of metabolic syndrome was 6%, but individual metabolic derangement was higher than expected.

Future plans: This unique dataset and bio samples with population-based early pregnancy enrolment and a low attrition rate and the linked neonatal cohort (70% of the original cohort) will be used to generate evidence on the impact of complex social and mental factors, and biological factors in pregnancy on child health. Further analysis of bio samples will also be carried out to understand the causes and correlates of maternal morbidity.

Keywords: Pregnant women, Cohort studies, RaPCo, Sri Lanka, Morbidity