Maternal Risk Factors of Neonatal Mortality in Iran: A Case-Control Study

Background: Neonatal death is defined as death at any point in time during the first four weeks of life. It is one of the most important criteria used to evaluate the effectiveness of interventions in public areas. We aimed to investigate pre-pregnancy risk factors associated with neonatal death. Materials and Methods: This population-based case-control study was conducted in eight provinces and two cities of Iran in 2,788 mothers referred to health care centers during 2015 to 2018. Participants were divided into two cases (1162), and control (1626) groups. Expert staff to interview the participants for case and control groups used a structural interview checklist based on the same protocol. We evaluate the association factor between neonatal mortality, the dependent variable, and the maternal demographic and health status characteristics. Data collection was a multi-stage cluster sampling method. Expert staff interviewed parents to collect data based on the same protocol for case and control groups. Results: This study was conducted on 2,788 participants, 90% of cases (n=1162), and 94% of controls (n=1626) were under 35 years of age. The chance of neonatal death was higher in Kurdish mothers [OR: 2.02; 95% CI (1.1 – 4.16)], mothers with low level illiteracy [OR: 1.82; 95% CI (1.01 – 3.27)], mothers with previous stillbirth [OR: 8.84; 95% CI (5.88 – 13.29)], using contraceptives [OR: 1.66; 95% CI (1.33- 2.06)], and passive smokers [OR: 1.49; 95% CI (1.20 – 1.86)]. Conclusion: Based on the results, maternal educational level, maternal body mass index, ethnicity, using contraceptives, pregnancy intervals, and history of stillbirth, abortion, and passive smoking were associated with neonatal mortality.