Prevalence and Correlates of High-risk Pregnancy in an Aspirational District of Assam, India

Background: High-risk pregnancies (HRPs) significantly contribute to maternal and neonatal morbidity and mortality, particularly in resource-limited settings. This community-based, cross-sectional study was conducted in Dhubri, an aspirational district of Assam, to assess the prevalence and correlates of HRPs and also to assess the knowledge and practices of health care workers regarding HRP. Materials and Methods: A total of 964 pregnant women in their third trimester using multistage sampling and 70 healthcare workers (HCWs) by simple random sampling were recruited across 10 subcenters in three health blocks. Data collection involved structured interviews and clinical verification of high-risk factors using Mother and Child Protection (MCP) cards, medical records, and reviews. Practices of HCWs were assessed by direct observation by using various standardized checklists. Results: The prevalence of HRP was found to be 28.11%. Teenage pregnancy, short stature, and anemia were the most common high-risk factors, while conditions like hypertension, diabetes, and inadequate spacing were also observed. Age, religion, education, inadequate supplementation of iron and folic acid (14.39%), and calcium tablets (65.68%) were found to be significantly associated. While 74.29% of HCWs demonstrated adequate knowledge regarding HRPs, only 10% practiced as per protocols. On multivariate logistic regression, significant predictors of HRPs were maternal age ≥30 years, multiparity ≥3, low educational status, and inadequate ANC practices by health workers. Conclusion: In spite of intensive efforts in an aspirational district, nearly one-third of pregnant women had high-risk pregnancies. The findings highlight various gaps related to present pregnancy, indicating the need for strengthening skill-based training and supervision.