Rapporto UNICEF-OMS, ancora alta nel mondo la percentuale di bambini sottopeso alla nascita

Nel mondo 1 bambino su 7 (20,5 milioni di neonati, dato 2015) nascono ogni anno sottopeso, ossia con un peso inferiore a 2,5 kg.  

A rivelarlo è il nuovo studio “Low Birthweight Estimates 2019”realizzato dai ricercatori della London School of Hygiene & Tropical Medicine, dell’UNICEF e dell’Organizzazione Mondiale della Sanità (OMS), che ha preso in esame i dati relativi a 148 Stati e a 281 milioni di nascite, ed è stato pubblicato sulla prestigiosa rivista medica internazionale The Lancet Global Health

Quasi 3/4 di questi bambini nascono in Asia meridionale e in Africa Subsahariana, i continenti per i quali disponiamo anche dei dati statistici più limitati.
Il fenomeno rimane tuttavia presente anche nei Paesi ad alto reddito come quelli di EuropaNord America e Oceania, nei quali non si è verificato praticamente alcun progresso nella riduzione dei tassi di nascita sottopeso dal 2000 a oggi. 

Un traguardo fuori portata

Nel 2012, tutti i 195 Stati membri dell’OMS si erano impegnati a ridurre del 30% la percentuale di nascite sottopeso entro il 2025.  Secondo le stime del rapporto (le prime di questo genere) questa percentuale è diminuita solo lievemente, a livello globale, passando dal 17,5% del 2000 (22,9 milioni di nati vivi sotto i 2,5 kg) al 14,6% del 2015 (20,5 milioni).
Secondo il rapporto, con i tassi di progresso registrati negli ultimi 15 anni – ossia, una diminuzione del fenomeno pari a -1,2% annuo – non si raggiungerà il traguardo prefissato a livello globale, che avrebbe richiesto invece un tasso di riduzione annua del –2,7% tra il 2012 e il 2025. 

Preoccupa inoltre il fatto che i progressi stiano decelerando: nel quinquennio 2010-2015 il tasso di riduzione annuo delle nascite sottopeso è stato dell’1%, rispetto all’1,4% del quinquennio precedente e all’1,33% del 2000-2004.
Oltre l’80% dei 2,5 milioni di neonati nel mondo che muoiono ogni anno sono anche sottopeso in quanto nati prematuri oppure poco sviluppati rispetto all’età gestazionale. I bambini con basso peso alla nascita che sopravvivono hanno un rischio maggiore di soffrire di ritardi nella crescita e di avere problemi di salute, incluse disfunzioni croniche come diabete malattie cardiovascolari.
Gli autori della ricerca sottolineano che in 47 Stati (fra cui 40 paesi a basso e medio reddito nei quali si verifica circa un quarto di tutte le nascite a livello globale) si hanno insufficienti dati a disposizione sul fenomeno.
Le regioni che compiono i progressi maggiori sono anche quelle con il numero più alto di neonati sottopeso: Asia meridionale e Africa Subsahariana fanno registrare un declino annuale nella percentuale di nascite sottopeso rispettivamente dell’1,4% e dell’1,1%..
Ciononostante, a causa dell’incremento demografico, il numero assoluto di neonati sottopeso è aumentato nell’Africa Subsahariana, passando da 4,4 milioni a 5 milioni l’anno. Per le medesime ragioni, a causa del suo peso demografico, l’Asia Meridionale conta tuttora circa metà delle nascite sottopeso globali, circa 9,8 milioni annue.


Sottopeso nei paesi ricchi 

Secondo la ricerca, i tassi minori di nascite sottopeso (dato 2015) è quello della Svezia (2,4%), decisamente inferiore rispetto a Stati Uniti (8%), Gran Bretagna (7%), Australia (6,5%) e Nuova Zelanda (5,7%). 

In Italia il dato è pari al 7%: nel 2015 sono nati sottopeso circa 34.500 dei 495.200 neonati dell’anno.

Sono proprio gli i paesi ad alto reddito a registrare i progressi più lenti, con un tasso di riduzione media dello 0,01% annuo, nonostante un’incidenza del fenomeno del 7%, non molto inferiore rispetto a quella dei Paesi in via di sviluppo.

In alcuni paesi industrializzati si registra persino una tendenza al peggioramento: le nascite sottopeso stanno infatti aumentando nella Repubblica Ceca (+2% annuo), Irlanda (+1,3%), Portogallo (+1,2%) e Spagna (+1,1%).

Il Regno Unito ha registrato dal 2000 a oggi una diminuzione annua dello 0,3%, mentre in Italia la diminuzione è stata di appena lo 0,1% in 15 anni (dal 7,1% del 2000 al 7% del 2015)-

Questi dati evidenziano la l’urgenza di maggiori investimenti e interventi per accelerare i progressi, attraverso la conoscenza del fenomeno e affrontandone i fattori chiave: l’età troppo avanzata della madre, le gravidanze multiple, le complicazioni ostetriche, le condizioni croniche durante la maternità (ad es. ipertensione), le infezioni (come la malaria), lo stato nutrizionale delle donne e l’esposizione a fattori ambientali quali l’inquinamento dell’ambiente domestico e uso di alcoltabacco e droghe. 

Nei paesi a basso reddito, la causa principale del basso peso alla nascita è lo scarso sviluppo dell’utero dovuto all’età troppo bassa della madre.

In Occidente, invece, il basso peso alla nascita è spesso associato alla prematurità del parto (prima della 37° settimana di gravidanza).


«Nonostante i chiari impegni assunti, le nostre stime indicano che i governi stanno facendo troppo poco per ridurre il basso peso alla nascita» afferma l’autrice principale della ricerca, Hannah Blencowe, medico della London School of Hygiene & Tropical Medicine.

«Abbiamo visto pochissimi cambiamenti negli ultimi 15 anni, anche in ambienti ad alto reddito, dove il basso peso alla nascita è spesso dovuto a nascita prematura come risultato dell’età alta delle madri, il consumo di sigarette, parti cesarei clinicamente non necessari, e trattamenti per la fertilità che aumentano il rischio di nascite multiple. Queste sono le motivazioni alla base che i governi nei paesi ad alto reddito dovrebbero affrontare. 

Per raggiungere il traguardo globale della riduzione del 30% delle nascite sottopeso entro il 2025 dovremo più che raddoppiare il ritmo dei progressi.»

Gli autori dello studio chiedono un’azione internazionale per assicurare che tutti i bambini siano pesati alla nascita, siano migliorate le cure mediche e si promuovanocampagne di salute pubblica sulle cause di basso peso alla nascita al fine di ridurre mortalità e disabilità.

«Ogni neonato dovrebbe essere pesato subito dopo il parto» spiega la coautrice dello studio Julia Krasevec, specialista per le statistiche e il monitoraggio dell’UNICEF. «Eppure, nel mondo, di circa un terzo dei neonati non viene registrato il peso alla nascita.»

Non possiamo aiutare questi bambini senza prima migliorare la copertura e l’accuratezza dei dati statistici che li riguardano. Con sistemi migliori per rilevare il peso dei neonati e una raccolta di dati più strutturata, possiamo registrare il vero peso alla nascita di ogni bambino, anche di quelli nati in  casa, e fornire assistenza di qualità migliore a questi bambini e alle loro mamme.»

«Il peso basso alla nascita è una situazione clinica complessa, causata da una crescita intrauterina limitata e da una nascita prematura» spiega Mercedes de Onis (OMS). 

«Per intervenire sul fenomeno è necessario capire le cause profonde di ogni dato paese. Per esempio, in Asia meridionale c’è un’ampia percentuale di bambini sottopeso che pur se nati a termine hanno avuto una crescita intrauterina limitata, dovuta a una denutrizione materna cronica.

La nascita pre-termine è invece la causa maggiore delle nascite sottopeso in contesti caratterizzati da gravidanze in età adolescenziale, alta incidenza di malattie infettive. Lo stesso avviene però anche in paesi in cui sono diffusi i trattamenti per la fertilità e i parti cesarei, come negli USA o in Brasile. Comprendere e affrontare queste cause nei paesi più colpiti dovrebbe essere una priorità.»

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