Maternal and Child Health (MCH) is critical because it is a key determinant of the health of a society and the focus of our program is on finding effective solutions that have major public health implications. Our strategy is to encourage discovery research that is inspired by societal need and innovation which is driven by new or existing knowledge in order to create applications that can go back to the society.

Globally, neonatal deaths are a major public health problem. India has the highest contribution to neonatal deaths with preterm birth (PTB) complications, intrapartum-related events, and neonatal infections as leading causes. Slow decline (52 per 1000 live births in 1990 to 22 per 1000 live births in 2019) in the neonatal mortality rate in the country has contributed to high infant and under-five child mortality rates. With the highest number of preterm births and preterm deaths worldwide, India contributes 25% of the overall global preterm related deaths. The effects of PTB extend beyond early infancy with substantial long-term consequences in late childhood and adult life. Effective solutions have not been possible to prevent and/or manage PTB because of large gaps in fundamental knowledge.

Driven by this critical gap, DBT initiated a multidisciplinary research program to optimize maternal, neonatal and child health through its flagship program, GARBH-INi -Interdisciplinary Group for Advanced Research on BirtH outcomes. The programme focuses on finding solutions for better birth outcomes utilizing a multi-pronged approach of integrating clinical epidemiology, multi-omics biomarkers and AI-driven tools for personalized predictions. Spearheaded by the THSTI in the Delhi National Capital Region, this collaborative program brings together multiple research institutions, including the National Institute of Biomedical Genomics (Kalyani), and the Regional Centre for Biotechnology (Delhi NCR), as well as district-level facilities like Gurugram Civil Hospital (GCH) in Haryana and tertiary care centres such as Safdarjung Hospital, All India Institute of Medical Sciences and Maulana Azad Medical College in New Delhi.

Our core objectives are to deliver on (i) detailed epidemiological understanding of preterm birth and fetal growth restriction from the longitudinal data across pregnancy to inform clinical practice and policy, (ii) development of AI- driven tools from the clinical and serial ultrasound images for personalized prediction of birth outcomes, (iii) discovery of multi-omics bio-makers to provide customized clinical decision-making tools, (iv) discovery of candidate signatures/leads that can augment understanding of disease mechanisms for development of diagnostics and therapeutics, and (v) integration of clinical, epidemiological, imaging and biological sciences to develop a dynamic prediction algorithm for decision making for PTB.

GARBH-INi pregnancy cohort is one of the largest pregnancy cohorts in South Asia established from 2015 onwards at Gurugram Civil Hospital and has completed enrolment of over 12,000 pregnant women early in pregnancy (< 20 weeks period of gestation) and are followed through pregnancy to delivery and once within 6 months postpartum with longitudinal assessments of multidimensional characteristics including clinical, imaging and biological parameters.

A birth cohort has been established of the babies born to mothers enrolled in the GARBH-Ini cohort in the second phase (2021-2026) to investigate growth and development during the first 1,000 days of life, focusing on intergenerational factors and birth phenotypes. The objective is to establish growth trajectories specific to birth phenotypes and develop multidimensional risk stratification tools to identify at-risk babies for poor growth and/or development for early intervention. Over 1,800 babies have been enrolled till now.

The cohort has established a national biorepository containing extensively phenotyped longitudinal biospecimens, archived across 14 lakh aliquots, along with a collection of more than 5 lakh ultrasound images.

Bhatnagar, S., Majumder, P. P., Salunke, D. M., & the Interdisciplinary Group for Advanced Research on Birth Outcomes—DBT India Initiative (GARBH-Ini). (2019). A pregnancy cohort to study multidimensional correlates of preterm birth in India: Study design, implementation, and baseline characteristics of the participants. American Journal of Epidemiology, 188(3), 621-631. https://doi.org/10.1093/aje/kwy284