Phenotypic characteristics associated with preterm births in the Indian population.

@article{gadekar2026phenotypic,
  title = {{Phenotypic characteristics associated with preterm births in the Indian population.}},
  author = {Veerendra P Gadekar and Aditi Sadhu and Shambo Basu Thakur and Ayushi and Rahul Jain and Dharmendra Sharma and Umesh Mehta and Alka Singh and GARBH-Ini Study Group and Nitya Wadhwa and Shinjini Bhatnagar and Siddarth Ramji and Ramachandran Thiruvengadam and Himanshu Sinha},
  journal = {BMC pregnancy and childbirth},
  year = {2026},
  month = aug,
  doi = {10.1186/s12884-026-09836-1},
  url = {https://europepmc.org/article/MED/42972316},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Phenotypic characteristics associated with preterm births in the Indian population.
AU  - Veerendra P Gadekar
AU  - Aditi Sadhu
AU  - Shambo Basu Thakur
AU  - Ayushi
AU  - Rahul Jain
AU  - Dharmendra Sharma
AU  - Umesh Mehta
AU  - Alka Singh
AU  - GARBH-Ini Study Group
AU  - Nitya Wadhwa
AU  - Shinjini Bhatnagar
AU  - Siddarth Ramji
AU  - Ramachandran Thiruvengadam
AU  - Himanshu Sinha
PY  - 2026
DA  - 2026/08/18
JO  - BMC pregnancy and childbirth
DO  - 10.1186/s12884-026-09836-1
UR  - https://europepmc.org/article/MED/42972316
AB  - Background  Preterm birth (PTB), defined as the birth of an infant before 37 weeks of gestation, poses significant health risks, including increased mortality and long-term disabilities. India stands as a major contributor to global PTB-related mortality, primarily due to its substantial prevalence. The complex temporal relationship among multiple etiological factors makes predicting PTB occurrence challenging. This is further complicated by the diverse PTB phenotypic categories, namely maternal, fetal, placental, parturition, and pathway-to-delivery features, which affect birth outcomes.Methods  Our study focused on PTB in the Indian population using a comprehensive dataset from the GARBH-Ini cohort. We analyzed 21 variables across maternal, fetal, placental, parturition-related, and other phenotypic categories in the context of Phenotype I (PTB/Non-PTB) and Phenotype II, which classifies PTB based on the pathway to delivery as either Spontaneous Onset of Labor (SOL) or Caregiver-Initiated (CGI). We assessed the prevalence of these phenotypic variables and their co-occurrences using the complete dataset. We applied hierarchical clustering to identify key PTB-associated phenotypic patterns and their impact on neonatal outcomes, including NICU admissions and early neonatal mortality. The optimal number of clusters (K = 20) was selected based on silhouette scores. Clusters with intermediate PTB composition (40-80% PTB, "grey zone") were excluded to minimize misclassification and improve interpretability. Additionally, we used one-year follow-up data to examine infant-related phenotypic variables and their distribution across PTB and non-PTB cases.Results  We identified key phenotypic variables across maternal, fetal, placental, and parturition categories that significantly influenced PTB outcomes. In SOL cases, fetal (perinatal sepsis, polyhydramnios) and parturition-related (PROM, short cervix, peripartum bleeding) features were significantly associated. In contrast, CGI cases were predominantly associated with maternal complications like illness suggestive of birth asphyxia, hypertension, and hypothyroidism. Placental abnormalities, such as placenta previa, in combination with PROM and short cervix, were notably prevalent in PTB cases, impacting neonatal mortality, NICU admissions, and infant health.Conclusions  Compared with non-PTB births, PTB cases showed higher prevalence of several key phenotypic features, including short cervix (10.84% vs 3.42%), perinatal sepsis (16.58% vs 3.63%), previous PTB among multiparous women (19.21% vs 7.1%), amniotic fluid abnormalities, PROM (21.67% vs 13.3%), and hypertensive disorders including eclampsia (9.52% vs 5.17%) (all Padj < 0.05). Stratified analyses demonstrated that SOL-associated PTB was enriched for short cervix, perinatal sepsis, PROM, and amniotic fluid abnormalities, whereas CGI-associated PTB was primarily linked to pre-eclampsia. PTB was also associated with higher NICU admissions and early neonatal mortality. This detailed PTB phenotyping enables healthcare providers to better monitor and manage high-risk pregnancies, leading to improved maternal and neonatal outcomes.
SN  - 1471-2393
ER  -