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Pregnancy, High RiskPRiSMA-MNHNCT05904145

PRISMA Maternal and Newborn Health Study

An observational study of Pregnancy, High Risk, run by George Washington University at 5 sites in 5 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Access to quality antenatal care (ANC) and postnatal care (PNC), including maternal, newborn, and infant services, is integral to reducing adverse pregnancy-related health outcomes and promoting positive birth experiences. The World Health Organization (WHO) recommends a total of eight ANC visits for pregnant women. Read more about this study

Who is it for?
Ages 15 years and older, women onlyHealthy volunteers can take part
Conditions the study is for
Pregnancy, High Risk
How many people
267,897 participants
Where
5 sitesin 5 countries
Study dates
1 Aug 2022to 31 Dec 2028
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 15 years and older
  • Women only
  • Healthy volunteers accepted
  • Child, Adult, Older adult

Study population: The investigators will identify, screen, and enroll pregnant participants through pregnancy surveillance systems, with a goal of identifying pregnancies prior to 20 weeks of pregnancy. Pregnant women will be assessed at <20, 20, 28, 32, and 36 weeks gestation, at labor and delivery, and at 3 days and 1, 4, 6, 26, and 52 weeks postpartum. Infants will similarly be assessed at 3 days and 1, 4, 6, 26, and 52 weeks of age.

A woman who meets the following inclusion criteria during screening may be enrolled:

  • Lives within the study catchment area;
  • Meets minimum age requirement in study site country:
  • Ghana: 15 years of age;
  • Kenya: 18 years of age or those who meet the criteria of emancipated minors;
  • Pakistan: 15 years of age or those who meet the criteria of emancipated minors;
  • Zambia: 15 years of age;
  • India: 18 years of age
  • Intrauterine pregnancy <20 weeks gestation verified via ultrasound;
  • Provides informed consent.

A woman who meets the following exclusion criteria during screening may NOT be enrolled:

  • Nonviable (e.g. ectopic or molar) pregnancy;
  • Plans to relocate outside of the study catchment area during pregnancy and/or postpartum.

Trial locations and contacts

5 sites in 5 countries. Contact the study team or a site near you to ask about taking part.

Emily R Smith, ScD, MPH contact

12029943589

emilysmith@gwu.edu

Bethany Freeman, MPH contact

bethany.freeman@gwu.edu

5 sites in 5 countries

Ghana1 site
  • Kintampo Health Research Centre

    Kintampo

    Completed

Other trials in Ghana

India1 site, 1 recruiting
  • Christian Medical College (CMC) Vellore

    Vellore

    Santosh Benjamin, MD, sbenjamin@cmcvellore.ac.in

    Anne George Cherian, MD, annegc@cmcvellore.ac.in

    Recruiting

Other trials in India

Kenya1 site
  • Kenya Medical Research Institute-Center for Global Health Research

    Kisumu

    Active, not recruiting

Other trials in Kenya

Pakistan1 site, 1 recruiting
  • Aga Khan University

    Karachi

    Zahra Hoodbhoy, PhD, zahra.hoodbhoy@aku.edu

    Recruiting

Other trials in Pakistan

Zambia1 site
  • University of North Carolina-Global Projects Zambia

    Lusaka

    Completed

Other trials in Zambia

About this study

Official title: Pregnancy Risk, Infant Surveillance, and Measurement Alliance (PRiSMA) Maternal and Newborn Health (MNH) Study: A Multi-center, Prospective Cohort Study of Maternal, Newborn, and Infant Health

Access to quality antenatal care (ANC) and postnatal care (PNC), including maternal, newborn, and infant services, is integral to reducing adverse pregnancy-related health outcomes and promoting positive birth experiences. The World Health Organization (WHO) recommends a total of eight ANC visits for pregnant women. However, the ANC coverage rate remains considerably lower among more vulnerable populations, and the quality of care that women receive is inconsistent, often poor, and frequently fails to detect risks in a timely fashion or adequately prepare women for the birth process. While rates of facility-based delivery are on the rise worldwide, disparities persist and the quality of care across facilities remains uneven. Even less information is available on PNC, where services beyond routine immunizations may not be widely available, especially in resource-poor regions.

Additionally, limited evidence exists on innovative service delivery approaches and how to effectively scale tested maternal and newborn health (MNH) interventions. This coupled with the fragmented datasets from smaller studies limit our ability to advocate for policy change.

The Pregnancy Risk Stratification Innovation and Measurement Alliance (PRiSMA) is implementing a harmonized open cohort study that seeks to evaluate pregnancy risk factors and their associations with adverse pregnancy outcomes, including stillbirth, neonatal mortality and morbidity, and maternal mortality and severe morbidity. The goals are to develop a harmonized data set to improve understanding of pregnancy risk factors, vulnerabilities, and morbidity and mortality and to estimate the burden of these risk factors and outcomes in LMICs. Ultimately, these data will inform development of innovative strategies to optimize pregnancy outcomes for mothers and their newborns.

Keywords
Antenatal Care (ANC), Postnatal Care (PNC), Maternal Newborn Health

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Maternal Mortality

    Death from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.

    Measured: Assessed from time of pregnancy identification (on average, 10-20 weeks gestational age), through delivery or termination of pregnancy, and then 42 days postpartum

  2. Composite Severe Maternal Outcomes

    Composite outcome of maternal deaths + near-miss cases + potentially life-threatening complications + critical intervention.

    Measured: Assessed through 12 months postpartum

  3. Maternal Anemia

    Low hemoglobin levels throughout pregnancy and labor and delivery, classified as mild (10-10.9 g/dL), moderate (7-9.9 g/dL), or severe (<7 g/dL). Low hemoglobin levels in the postpartum period, classified as mild (11-11.9 g/dL), moderate (8-10.9 g/dL), or severe (<8 g/dL).

    Measured: Assessed from time of pregnancy identification (on average, 10-20 weeks gestational age) through 6 months postpartum

  4. Stillbirth

    Delivery of a fetus showing no signs of life, as indicated by absence of breathing, heartbeat, pulsation of the umbilical cord, or definite movements of voluntary muscles. The primary definition for the study is death prior to delivery of a fetus at >=20 weeks of gestation (or >350 g weight, if gestational age is unavailable). Additionally, we will analyze time-specific definitions: Early stillbirth (20-27 weeks), Late stillbirth (28-36 weeks), Term stillbirth (>=37 weeks), and WHO stillbirth (>=28 weeks).

    Measured: Assessed at delivery

  5. Neonatal Mortality

    Death of a live-born baby during the first 28 days of life from any cause.

    Measured: Assessed delivery to 28 days of life

  6. Preterm Birth

    Delivery prior to 37 completed weeks of gestation of a birth (live or stillbirth). Further classified as extremely preterm (<28 weeks), very preterm (28-32 weeks), and moderate to late preterm (32-37 weeks). For these, gestational age at birth will be determined by the best obstetric estimate: last menstrual period, Ultrasound (method to be determined), and ACOG algorithm.

    Measured: Assessed at delivery

  7. Low Birth Weight

    Defined as birth weight <2500 g and very low birth weight <1500 g.

    Measured: Assessed at delivery or within 72 hours for home births

  8. Small-for-Gestational-Age (SGA)

    Combined gestational age information and birthweight will be used to further categorize into: preterm-SGA, preterm-AGA, term-SGA, term-AGA.

    Measured: Assessed at delivery

Secondary outcomes (20)
  1. Late Maternal Mortality

    Measured: Assessed from 42 days postpartum up to one year

  2. Preeclampsia

    Measured: Assessed from time of pregnancy identification (on average, 10-20 weeks gestational age) through 42 days postpartum

  3. Preterm Birth Indication

    Measured: Assessed at delivery

  4. Preterm Premature Rupture of Membranes (PPROM)

    Measured: Assessed at <37 weeks of gestation

  5. Gestational Hypertension

    Measured: : Assessed from 20 weeks gestational age through delivery

  6. Postpartum Hypertension

    Measured: Assessed at delivery or time of pregnancy to 1 year postpartum

  7. Gestational Diabetes

    Measured: Assessed between 24 and 28 weeks gestation

  8. Perinatal Depression, as measured using the Edinburgh Postnatal Depression Scale

    The minimum value is 0 and the maximum value is 30. Higher scores indicate that more severe depression may be present.

    Measured: Assessed at 20 and 32 weeks gestation and 6 weeks postpartum

  9. Maternal Infection and Sepsis

    Measured: Assessed from time of pregnancy identification (on average, 10-20 weeks gestational age) through 42 days postpartum

  10. Fetal Death

    Measured: Assessed from time of pregnancy identification (on average, 10-20 weeks gestational age) up until delivery

  11. Cause of Neonatal Death

    Measured: Assessed at <28 days of life

  12. Cause of Stillbirth

    Measured: : Assessed from 20 weeks gestational age through time of delivery

  13. Timing of Stillbirth

    Measured: : Assessed from 20 weeks gestational age through time of delivery

  14. Timing of neonatal mortality

    Measured: Assessed from delivery to 28 days of life

  15. Infant Mortality

    Measured: Assessed from delivery to 1 year of life

  16. Hyperbilirubinemia

    Measured: Assessed at birth, 3 days, and 7 days of age

  17. Neonatal Sepsis

    Measured: Assessed at delivery through 28 days

  18. Possible Severe Bacterial Infection

    Measured: Assessed from delivery to 59 days

  19. Postnatal Weight Trajectory

    Measured: Assessed collected at birth, 3 days, 7 days, and 28 days

  20. Infant Growth

    Measured: Assessed at birth, 4 weeks, 6 weeks, 6 months, 26 months, and 52 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Jun 2023
  2. Study start1 Aug 2022
  3. Primary completion31 Dec 2028 (estimated)
  4. Study completion31 Dec 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
267,897 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05904145
Sponsor's protocol ID
PRiSMA-MNH 2022
Acronym
PRiSMA-MNH
Status last verified
Jun 2026
First submitted
14 Oct 2022
Last updated
11 Jun 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Pregnancy Risk, Infant Surveillance, and Measurement Alliance (PRISMA) Investigators. Pregnancy Risk, Infant Surveillance, and Measurement Alliance (PRISMA) Maternal and Newborn Health Study: protocol for a multisite, prospective, open cohort study of pregnancy and postpartum health outcomes in South Asia and sub-Saharan Africa. BMJ Open. 2026 Jan 20;16(1):e104512. doi: 10.1136/bmjopen-2025-104512.

    PubMed 41558748
  • Smith ER, Hoodbhoy Z, Hotwani A, Jehan F, Khan A, Nisar I, Yazdani N, Benjamin SJ, Cherian AG, Mohan VR, Varghese S, Vijayalekshmi B, Wylie BJ, Chatterjee L, Dang A, Venketeshwar R, Baumann SG, Mores C, Pan Q, Sudfeld CR, Akelo V, Mwebia WK, Otieno K, Ouma G, Owuor H, Were J, Adu-Gyasi D, Agyemang V, Newton S, Tawiah C, Jadaun AS, Mazumder S, Sharma N, Ugwu LG, Benneh-Akwasi Kuma A, Freeman B, Kasaro MP, Mbewe FM, Mwape H, Resop RS, Spelke MB, Asante KP; Redefining Maternal Anemia in Pregnancy and Postpartum (ReMAPP) Study Investigators. Protocol for the Redefining Maternal Anemia in Pregnancy and Postpartum (ReMAPP) study: A multisite, international, population-based cohort study to establish global hemoglobin thresholds for maternal anemia. PLoS One. 2025 Jul 28;20(7):e0321943. doi: 10.1371/journal.pone.0321943. eCollection 2025.

    PubMed 40720446
  • Naz S, Jaffar A, Yazdani N, Kashif M, Hussain Z, Khan U, Farooq F, Nisar MI, Jehan F, Smith E, Hoodbhoy Z. Cohort profile: the Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA) - Pakistan. BMJ Open. 2023 Dec 10;13(12):e078222. doi: 10.1136/bmjopen-2023-078222.

    PubMed 38072494

Questions about this trial

What is this clinical trial studying?

An observational study of Pregnancy, High Risk, run by George Washington University at 5 sites in 5 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 11 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in Ghana, India, Kenya, Pakistan, Zambia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Emily R Smith, ScD, MPH (12029943589, emilysmith@gwu.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Maternal Mortality (time frame: Assessed from time of pregnancy identification (on average, 10-20 weeks gestational age), through delivery or termination of pregnancy, and then 42 days postpartum). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05904145, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Jun 2026.

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