Risk factors for neonatal disorders and the Global Burden of Disease

We read with interest the Global Burden of Disease study 2013 (Dec 5, 2015; pp 2287–323). The authors' conclusion that the 79 behavioural, environmental and occupational, and metabolic risks studied jointly explained none of the outcomes in neonatal disorders is, we believe, highly implausible. Many of the risk factors that were studied predispose women to severe adverse pregnancy outcomes via maternal exposure.2, 3, 4 and 5 For example, consistent evidence links household air pollution to low birthweight and stillbirth;4 maternal smoking to congenital anomalies, stillbirth, preterm birth, and low birthweight;5 and high maternal body-mass index to stillbirth and neonatal mortality.3 In high-income countries, smoking has been estimated to contribute to 4–7% of stillbirths, and being overweight during pregnancy has been estimated to contribute to 8–18% of stillbirths. All of these risks are potentially preventable. Recognition of their contribution to adverse neonatal outcomes as part of the overall global burden of disease is therefore of pivotal importance.

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