Every 2 Seconds A Preterm Birth, Every 40 Seconds a Death: India Turns to AI to Fight Crisis

New Delhi: Union Minister of State for Science and Technology Dr Jitendra Singh on Monday, while speaking at the launch of India's largest pregnancy cohort study in Delhi, involving 12,000 women under the GARBH-INi initiative, announced a milestone project to develop indigenous, AI-driven solutions for preterm births.

Singh underscored the strategic importance of the GARBH-INi programme, linking it directly to India’s long-term vision of becoming a developed nation by 2047. He emphasised that building a healthy, empowered and resilient population remains central to the Viksit Bharat goal, with maternal and child health forming the bedrock of the country’s future human capital. “The children born today will define India’s strength and productivity in 2047,” he said, highlighting that investments in early-life health outcomes are critical for sustained economic and social growth.

He noted that the initiative has enrolled around 12,000 pregnant women, creating one of South Asia’s largest pregnancy cohorts. This effort has resulted in a vast scientific repository, including over 1.6 million well-characterised biospecimens and more than one million ultrasound images, providing a strong foundation for advanced, data-driven research. He highlighted key outcomes of the programme, including the development of AI-based pregnancy dating models tailored to Indian populations, identification of microbiome-based predictors of preterm birth, rapid diagnostic tools, and genetic markers for early risk assessment. According to him, such indigenous innovations are essential to improving maternal and child health outcomes across diverse healthcare settings in India.

Pointing to the rapid expansion of India’s bioeconomy, from nearly US$ 10 billion in 2014 to about US$ 195 billion, Singh said biotechnology has been a major driver of this growth, positioning India as a global leader in preventive and primary healthcare. He added that science-led initiatives like GARBH-INi are not only advancing research but also contributing to nation-building by ensuring a healthier and more productive future generation.

India's Preterm Birth Crisis

With a baby born before term every two seconds across the globe, and one dying every 40 seconds, the crisis of preterm births has emerged as one of the most pressing public health challenges of the decade, according to recent UNICEF estimates. Preterm births in India account for almost a fourth of the total global number of deaths due to preterm deliveries (also known as birth occurring before 37 weeks gestation), occurring across 27 million total births. That is an average of nearly 3.6 million preterm deaths in India a year.

Preterm births also have longer term implications than just during the neonatal period. Pre-term babies, when they survive after being born, usually will face life-long health problems, like physical growth problems, developmental delay, higher incidence of chronic illness like Parkinson’s, diabetes, and cardiovascular diseases. Many experts agree that the complexity of preterm birth, which is shaped by many factors such as genetics, nutrition, gastrointestinal infection, environmental and exposure, and socio-economic status, has limited the success of the development of effective strategies for preventing pre-term birthing.

Against this backdrop, India’s Department of Biotechnology (DBT) in 2015 had launched the ambitious GARBH-INi (Interdisciplinary Group for Advanced Research on Birth Outcomes, a DBT India Initiative) programme. Designed as a large-scale, longitudinal pregnancy cohort, the initiative has now emerged as one of South Asia’s most comprehensive platforms for maternal and child health research.

Decade-Long Scientific Effort

GARBH-Ini, a 10-year scientific study involving 12,000+ women during their entire pregnancy (early pregnancy until postpartum), was established at Gurugram Civil Hospital. Measurements of clinical history, ultrasound images, and biological samples have collected during all phases of the study, resulting in a large amount of data collected that can be used for future research.

Recognising the need to extend research beyond birth, Phase II of the programme was launched in February 2022. This birth cohort follows children born to GARBH-INi mothers, transforming the initiative into a life-course research platform. So far, over 2,200 children have been enrolled, enabling scientists to study early childhood growth and development alongside maternal health.

V K Paul, Member of NITI Aayog, stressed that the next phase of the programme should prioritise effective utilisation of the tools, predictive models and platforms developed so far. He underscored the need for sustained scientific efforts, stronger institutional collaborations, and deeper analysis of outcomes to further strengthen and scale the initiative.

DBT Secretary Rajesh S Gokhale described GARBH-INi as a “landmark cohort study” that exemplifies how interdisciplinary collaboration and high-quality data can address national health priorities. “Preterm birth remains a significant public health challenge. GARBH-INi represents a pioneering effort to generate multidimensional data for early diagnosis and evidence-based interventions,” he said.

AI, Indigenous Tools Reshape Maternal Care

One of the most significant achievements of the programme has been the integration of artificial intelligence into pregnancy care. Researchers have created AI models, like Garbhini-GA2 and GAUGE, to better estimate a woman's position in pregnancy regarding data from the Indian population. The introduction of PRAGATI (Pregnancy Risk Assessment Guided by AI Technology and Imaging) has been accomplished as part of this research/initiative that will help address the problems associated with Western clinical tools that are used to determine gestation and the inaccuracies associated with those tools.

PRAGATI is a handheld ultrasound device that can be used by health workers on the frontline of care to assess a woman's risk of having an undesirable outcome with her pregnancy. The device uses a traffic light system (red, yellow, green) indicating the level of risk that exists for a pregnancy being either at a low, medium or high level so that appropriate care/resources can be provided in a timely manner (even in remote/rural communities).

Clinicians will also be able to create an ongoing dynamic predictive algorithm that will provide physicians with the tools necessary to evaluate (on going) a woman's risk for undesired outcomes throughout the course of her pregnancy. Integrated into electronic medical records, the model provides personalised, real-time risk estimates, helping prioritise care for vulnerable pregnancies.

“These innovations mark a shift from reactive to predictive and preventive healthcare,” said Anamika Gambhir, Scientist ‘G’ at DBT. She noted that GARBH-INi combines clinical phenotyping with advanced “omics” technologies, genomics, proteomics, metabolomics, and microbiome research, to identify early biomarkers of risk.

Breakthroughs In Biomarkers, Microbiome Research

The programme has identified 66 genetic variants linked to spontaneous preterm birth and is validating protein and metabolite panels that can predict risk months in advance. A new technique is being used by researchers to separate helpful types of bacteria from a woman's vagina, such as Lactobacillus crispatus and Lactobacillus paragasseri. These may one day be developed as an intervention to help prevent preterm births.

Research on placentas has also revealed the molecular characteristics that might enable scientists to predict the occurrence of complications such as preeclampsia and fetal growth restriction and lead to more effective methods of providing individualized care during pregnancy.

According to Professor Ganesan Karthikeyan, Executive Director at the Translational Health Science and Technology Institute (THSTI), the programme fills a critical gap in locally relevant evidence. “For too long, our clinical tools relied on Western data that did not reflect Indian realities. GARBH-INi is helping bridge that gap with indigenous solutions,” he said.

The study found alarming results and has ramifications for public health.

Of those studied in this cohort, nearly half of newborns qualified as “small vulnerable newborns” due to being either born preterm; having low birth weight or being born small-for-gestational-age. Low maternal body mass index (BMI) was identified as a primary modifiable risk factor, indicating the need for more emphasis on maternal nutrition.

An accredited biorepository located at THSTI contains more than 1.8 million biospecimens, along with over one million ultrasound images and over 30,000 videos. In addition, genetic data from 6,000 women has been contributed to national databases to assist in national research.

On February 1st, 2025, DBT launched the GARBHINI-DRISHTI National Data Sharing Portal, which provides researchers with access to anonymized clinical data sets, anonymized clinical imaging, and biospecimens via a structured data sharing process. This program will facilitate the acceleration of scientific discoveries and build collaboration among scientists across the nation.

Collaborative National Resource

GARBH-INi has also contributed to major public health programmes such as the National Stillbirth Consortium and Anaemia Mukt Bharat, while collaborating with global research networks to tackle issues like preeclampsia and optimal gestational weight gain.

Experts say the programme exemplifies how integrated, long-term research can inform policy and clinical practice. “The real impact will be measured not just in publications, but in healthier mothers and fewer babies born too soon,” Gambhir said.