Prevalence of High-Risk Pregnancies in an Urban Field Practice Area of Mumbai, India: A Community-Based Analytical Cross-Sectional Study.

Introduction A high-risk pregnancy (HRP) is defined as a condition in which the mother, foetus, or both are at increased risk of adverse outcomes compared to a normal pregnancy or the general population. However, there is limited data available from urban slum settings for effective health planning and resource allocation for the management of HRPs. The current study aims to estimate the prevalence of HRPs in an urban slum of Mumbai and to identify the sociodemographic and obstetric factors and delivery characteristics associated with HRPs. Methodology An analytical cross-sectional study was conducted from January to December 2023 in an urban slum field practice area of a tertiary care institute in Mumbai. A total of 292 recently delivered women (within two months of delivery) were selected using systematic sampling. Data were collected through a pre-validated case record form and verified using medical records. HRPs were identified using the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) criteria. Sociodemographic, obstetric, and delivery-related variables were analysed. Associations were assessed using Chi-square/Fisher's exact test and multivariable logistic regression. Results The prevalence of HRP was 56.5% (n = 165), with 39.5% (n = 115) having a single risk factor and 17.1% (n = 50) having multiple risk factors. Severe anaemia and previous caesarean section were the most common risk factors (n = 40, 24.2% each). On bivariate analysis, increasing maternal age (p < 0.001), no schooling (p = 0.03), nuclear family type (p = 0.01), multiparity (p < 0.001), and private sector registration (p < 0.001) were significantly associated with HRP. On multivariable analysis, multiparity was independently associated with HRP (AOR: 1.85; 95% CI: 1.07-3.20, p = 0.03). HRPs were significantly associated with higher preterm delivery (n = 20, 12.1% vs. n = 6, 4.7%; p = 0.04), caesarean section (n = 92, 55.8% vs. n = 30, 23.6%; p < 0.001), neonatal morbidity (n = 64, 38.8% vs. n = 27, 21.3%; p = 0.002), higher out-of-pocket expenditure (OOPE) (median INR 6000 vs. 4000; p = 0.009), and longer hospital stay (median 4 vs. 3 days; p < 0.001). Early initiation of breastfeeding was significantly lower among HRPs (n = 81, 49.1% vs. n = 102, 80.3%; p < 0.001). Conclusion HRPs are highly prevalent in urban slum settings and are associated with adverse maternal and neonatal outcomes, as well as an increased economic burden. Strengthening early identification, addressing modifiable risk factors such as anaemia, evaluating rising caesarean section rates, and improving access to affordable maternal healthcare are essential to reduce the burden of HRPs.